What Is (UP-TSU) Project
The Uttar Pradesh (UP-TSU) project
Recently, the Technical Support Unit in Uttar Pradesh supported the Government of UP to design their Project Implementation Plans (PIPs) and District Health Action Plans (DHAPs) using a situation analysis to better understand the current status of health, identify key issues and gaps and then plan for actual need.
Gaps identified through the situation analysis was the availability of delivery points with emergency services available, shortage of trained staff, shortage of drugs and equipment, poor infection prevention and absence of coordination between various degrees of care.
The Uttar Pradesh TSU Nurse Mentoring Approach
Various strategies for improving health outcomes were discussed prior to start of the project. Ultimately, the quality strategy chosen was based on the nurse mentoring programme initiated by the Sukshema Project in Karnataka but expanded to include the full RMNCH+A spectrum and to include both the activation and services widening and strengthening aspects necessary in the UP strategy.
One to two nurse mentors per block will be responsible for oversight of three crucial aspects of RMNCH+A care in the block, that aim to strengthen accessibility. availability and quality of RMNCH+A services.
The UP nurse mentoring strategy includes two key roles for the mentors:
1. Activation of facilities as delivery points and widening and strengthening the availability of essential RMNCH+A services at facilities - improved availability of different services
2. Strengthening the quality of RMNCH+A services - improved quality of services
Activation of facilities as delivery points and widening the availability of essential RMNCH+A services at facilities - improving availability
Many blocks lack even an adequate number of service delivery points so women and families lack even basic access to institutional delivery facilities.
Furthermore, most delivery points lack the whole range of RMNCH A services as outlined required by the Gov.UP, and no availability of services is compromised.
Nurse mentors will be actively involved in facilitating the process of activation of critical RMNCH+A services and delivery points within their designated blocks and in widening the spectrum of, and strengthening RMNCH+A services at existing DPs, based on the District PIPs. This will be supported by the Block Community Specialists (BCS) and by the Block Medical Officer in charge.
Strengthening the quality of RMNCH+A services - improving quality
Staff nurses and ANMS conducting deliveries at health facilities in UP require knowledge and skills in all aspects of RMNCH+A services, but importantly for reducing maternal and child mortality they need knowledge and skills in the assessment, identification and management of complications in maternal, neonatal and child health.
The main facilities that the strategy will focus on, at least initially until new facilities are activated, will be the BPHCS/CHCs, as this is where the majority of the institutional deliveries are currently occurring. It is also strategically located as a place from which manage all three mentor roles. Therefore, the NMs will be based at the main BPHCs/CHCs within their designated block, spending approximately half the time there and in activated DPs.
The quality improvement component will also include key SCS / APHCs that provide delivery services and will expand to include activated delivery points as they come on line.
Although the intrapartum and early postpartum period will be prioritized, the UP nurse mentoring strategy will provide a framework for the capacity building of the various staff at health facilities across the continuum of RMNCH A care.
The Nurse Mentoring programme will place 6 nurse mentors / district working in the 4 TSU focus blocks, as well as 2 additional blocks chosen by the TSU and the GoUP based on identified gaps within the district.
Quality improvement can take many different forms and therefore, the process for nurse mentoring in the UPTSU will be further described in this manual.
One advantage of nurse mentorship as a strategy is that the mentors will provide directive and participatory hands-on support to the staff nurses and ANMs to strengthen provider knowledge, skills and practice by addressing specific clinical/ technical aspects of care chosen for their evidence-based high impact and life- saving capabilities (ie. AMTSL).
The NMs will be equipped with tools (such as patient case sheets) to build capacity among staff nurses and ANMs in the documentation and in the identification and management of common maternal and neonatal complications that arise during the intrapartum and initial postpartum period.
The mentors will provide hand-holding support in new tools so that questions and problems in their utilization are addressed directly at the facility level.
Team self-assessments will be utilized by the NMs to assist the facility's staff (Ayahs, pharmacists, MOIC, SNs) in the identification of client concerns, in identifying clinical issues of concern and in local bottlenecks in medication and equipment supply, infection control practices, documentation, monitoring and evaluation, and referral practices, Teams will then be supported by the mentor to brainstorm possible solutions and create their own management plans to address these bottlenecks.
Nurse Mentor support to SNs is peer based and on-site to enable changes in behaviour and attitudes and to facilitate local problem-solving.
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