Quality Care Is Important For Improving Maternal Health Outcomes

“Universal health coverage means much more than just health care or insurance. It is ensuring people get quality health services, where and when they need them.” 

– Dr. Tedros Adhanom Ghebreyesus, Director-General, World Health Organization

On Universal Health Coverage (UHC) day, the Government has a onetime opportunity to give the mother-of-all schemes - Ayushman Bharat – a whole new meaning. A strong political will can ensure this national healthcare protection scheme accelerate our progress towards an important milestone of halving maternal mortality rates in India.

UHC pillars

The Governments’ efforts toward achieving UHC, and in particular maternal health, is currently resting on two pillars – that of access and affordability. Quality care and demand for quality care are the missing links. Supply reliability, for instance, is critical in shaping demand for quality health care services. However, the Government is largely piggybacking on the public health infrastructure. 

Private care could greatly complement public health system in improving access, especially in areas of greatest need, while smarter strategic purchase from private providers can improve health outcomes. Using digital innovations can enable women to choose affordable, quality maternal health care services and provide feedback on these services via mobile platforms. 

Quality gap

Expanding service coverage and ensuring affordability are insufficient without quality care. In fact, UHC will fail to achieve its primary objective of creating better health unless patients have access to services that at least meet the World Health Organization recommended standards. Every year about 45,000 women in India die giving birth. Surprisingly, many of these deaths are preventable – as women fail to get quality maternal care. Currently, about 130 women in India die from complications for every one lakh live births. As we stare at the Sustainable Development Goal-3 target to reduce this number to below 70 by 2030, the focus has to change from access towards improving quality to avert maternal deaths. 

Thinking beyond NABH

While National Accreditation Board for Hospitals & Healthcare Providers (NABH) accreditation of hospitals can improve outcomes, it’s not only limited in its coverage but it also does not ensure that basic clinical standards are met. NABH ensures hospital and patient care safety standards are met. Clinical standards ensure proper preparedness for any complication during childbirth. Clinical standards ensures both the mother and the baby are attended to and that the facility is adequately equipped and the doctors and health workers skilled appropriately. Only about 1% of Indian hospitals are accredited by NABH leaving behind most of the small private hospitals. And surprisingly, even today, private health facilities don’t adhere to any quality accreditation standards and remain unregulated, while working without standard operating procedures. Lack of technical resources, insufficient training of staff and weak incentives to invest in quality improvement – especially the private maternity facilities - pose a serious challenge in reducing maternal mortality.

India can accelerate progress towards UHC and reducing maternal mortality by engaging local private providers – doctors, nurses, midwives, drug shop owners and community health workers. Along with the Government’s various initiatives such as LAQSHYA to improve quality of labour rooms at public hospitals, the quality of care at private hospitals should be upgraded by incentivizing them to attain certification. 

Quality of Care Certification for Private Sector

Certification unlike the lofty NABH standards, could be at an intermediate level that essentially validates quality medical services. Minimal compliance cost, lesser infrastructure alteration and documentation requirements could do the trick. The Federation of Obstetric & Gynaecological Societies of India provides, Manyata-quality certification to private maternity providers based on WHO clinical standards for maternal care. This is already moving the needle in the states of Uttar Pradesh, Jharkhand and Maharashtra. It has also expanded to Rajasthan this year.

Over time, such intermediate level certifications could prepare private facilities for larger standard based quality management programs (NABH, NQAS). In this journey, it is important to co-opt the private sector for its innovations and expertise to achieve sustainable change.Defining Roles Clearly 

Moreover, accountability is critical for UHC. The role of the private sector should be defined clearly under a robust regulatory framework. In the end, it would be a missed opportunity if national health systems fail to integrate local private providers in policies and strategies to meet health care coverage needs in a country where 50% of the institutionalized deliveries happen in the private sector.