Joint Monitoring Visit by Ministry of Social Development and Golden community in Surkhet Provincial Hospital on SUSTAIN

Joint Monitoring Visit

by Ministry of Social Development, Karnali Province
Golden Community
in Provincial Hospital, Surkhet on
Scaling up Safer Birth Bundle Through Quality Improvement in Nepal

A joint monitoring visit led by Health Service Division of Ministry of Social Development (MoSD), Karnali Province was conducted on 26-29th December, 2020 in Province Hospital, Surkhet with the objective to monitor the status of SUSTAIN (Scaling Up Safer Birth Bundle Through Quality Improvement in Nepal) project and to identify potential gaps in implementation of safer birth bundle. Chairperson of Golden Community along with a technical staff were present during the monitoring field visit and discussion. A semi-structured tool developed by Golden Community was used to facilitate the discussion. The discussion session was led by Chief of Health Service Division. After the discussion, information on the availability, relevance, and effectiveness of safer birth bundles was gathered using a similar semi-structured tool with assistance from Hospital Nursing Inspector and Nursing Officer.

Photo 1: A group discussion on status of SUSTAIN led by Mr. Brish Bahadur Shahi, Chief of Health Service Division,
Ministry of Social Development, Karnali Province with hospital staffs (Dr. Keshar Dhakal, Dr. Amit Singh, Dr. Nawaraj
KC, Ms. Kalpana Thapa and Ms. Sakuntala Sapkota) at Province Hospital, Surkhet

The major highlights of the discussion were:

Dr. Keshar Dhakal shared- “the equipment provided have been appropriately used in the labor ward and it
helped in timely detection of complications such as abnormal heart beat and fetal distress. Thus, SUSTAIN
has facilitated in management.”
Accordingly, Dr. Amit Singh mentioned that- “the equipment we make use of, the HBS training and its refresher course provided to us on a regular basis have definitely augmented our knowledge and skills.” And also said ” the data presented to us has provided insights into what we are doing and where we are standing within comparison to other referral level government hospitals in Nepal… other than equipment, the best part of this project is the level of data collection being done by the project staffs because at the end it is thedata that drives us for further improvement.”, “definitely the quality of intrapartum care has improved since launch of new technologies (Safer Birth Bundle) which meets the standard of CTG machine.” He mentioned that “This improvement had come about as a result of the constant vigilance of the staff and although I hope it will continue, I am scared it will decline back after they’re gone…” Besides this, he added that data have revealed it all.
Ms. Kalpana Thapa shared – “the staffs properly record the work we perform and even push us to follow steps
as per the guidelines… they even record our handwashing practice before delivery, early initiation of breastfeeding, skin-to-skin contact and status for achieving golden one-minute… they facilitate in finding our gaps during PDSA meetings conducted fortnightly.” In regards to the PDSA meeting, she suggested- “top management could be provided with information on both gaps and on progress, so they remained updated
about happenings at the healthcare facility through PDSA meetings.”
Dr. Nawaraj shared that- “good efforts for quality improvement were made since before implementation of
SUSTAIN; however, SUSTAIN provided a good push and motivation to achieve such goals” as well as “Skill
drills and PDSA meeting help manage both managerial issues and clinical issues. He also added that- “it would
be better if one of the staffs provided support to the pediatric department… they could also monitor us in the
pediatric ward because sometimes we forget handwashing and other minor details.”
Ms. Sakuntala mentioned that- “data have helped us to track our progress and it can be seen… it has helped
us to focus on our objectives…” and she said “all components of Safer Birth Bundle are equally crucial and
collective use of these components would result to improvement.” And “we health workers also had to work
under a situation full of panic, so quality of service provided might have slightly declined at that time, in my
view… even the data showed declination in some indicators.”
Mr. Brish discussed regarding suggestion for quality improvement of SUSTAIN project. On that note, Dr. Nawaraj mentioned “stakeholders’ identification and stakeholder’s analysis are very crucial part of any project… and since composition and nature of every department at the hospital are different and as they need varying amount of motivation for successful implementation of the project, every stakeholder should be well included…” He also shared that- “improvement is also a continuous process, and things can always be
improved over time. For example, the SUSTAIN guidelines can be revised in light of the guidelines recently
introduced and in accordance with our own context.”

Photo 2: Mr. Brish Bahadur Shahi, Chief of Health Service Division, Ministry of Social Development, Karnali Province
with Mr. Dhan Bahadur Gurung, Chairperson, Golden Community on the left and Mr. Ankit Acharya, Assistant
Researcher on the right