IEC / BCC


JSSK

Kutsil

NAS

QUALITY ASSURANCE

Quality Assurance Committee

The National Rural Health Mission(NRHM) was launched in the year 2005 with the goal “to improve the availability of and access to quality healthcare for people, especially  for those residing in rural areas, the poor, women and children.” The Mission has led to considerable expansion of health services through rapid expansion of infrastructure, increased availability of skilled human resources and greater local level flexibility inoperations,increased budgetary allocation and improved financial management. However, improvement in Quality of health  services at every location has not been perceived, generally.

Perceptions of poor quality of health care may, infact, dissuade patients from using the available services because health issues are among the most salient of human concerns. Ensuring quality of the services will result in improved patient/client level outcomes at the facility level.

Ministry of Health and Family Welfare, Government of India is committed to support and facilitate a Quality Assurance Programme, which meets needs of Public Health System in the country and is sustainable. Main focus of proposed Quality Assurance Programme would be enhancing satisfaction level among users of the GovernmentHealthFacilitiesandreposingtrustinthePublicHealthSystem.

State Quality Assurance Committee (SQAC):

The broad responsibility of this committee will be to oversee the quality assurance activities across the state in accordance with the national & state’s guidelines, and also ensure regular and accurate reporting of the various key indicators.

Members:

1. Secretary, Medical and Health (Chairperson).

2. Mission Director – NHM (Vice Chairperson).

3. Director Family Welfare/Director Health Services/Director Public Health Equivalent (Convener): to be nominated by the Chairperson.

4. Additional/Joint Director (FW)/Deputy Director (FW)/Equivalent, designated by the state.

5. Director, Medical Education.

6. Director/Principal of state training institution e.g. SIHFW/ CTI/ RHFWTC.

7. One Empanelled Gynaecologist (from public institutions).

8. One Empanelled Surgeon (from public institutions).

9. One Anaesthetist (from public institutions).

10. One Paediatrician (from public institutions).

11.One Medical Specialist (from public institutions).

12.One nominated Medical Superintendent (or equivalent of DH).

13.One each In-charge of PHC, CHC, and Sub-divisional Hospital.

14.State Nursing Adviser (Equivalent).

15.One member from an accredited private sector hospital/ NGO (health care sector).

16.One representative from the legal cell.

17.One representative from medical professional bodies e.g. FOGSI/ IMA/ IAP/IAPSM/ Association of Public Health.

18.Any other member or representatives of public health organisations of eminence as nominated by the state government.


The Quality Assurance Committee as laid down in the “Quality Assurance Manual for Sterilization Services’ shall stand subsumed within the QAC mentioned above.

SQAC would redress, dispose and disburse claims/complaints received through the DQAC, to the district health society as per procedure and time frame laid down in the manual on “Family Planning Indemnity Scheme 2013”

The subcommittee would comprise of the following:

1.Mission Director –NRHM (Chairperson).

2.Director Family Welfare/Director Health Services/Director Public Health Equivalent (Convener).

3.Additional/Joint Director (FW)/Deputy Director (FW)/Equivalent (Member Secretary).

4. Empanelled Gynaecologist (from public institutions).

5. Empanelled Surgeon (from public institutions)


Process of SQAC:

1.The state quality assurance committee will meet at least once in six months.

2.The convener will issue meeting notice at least seven working days before the scheduled date of meeting with the approval of the chairperson/ vice chairperson.

3.While every attempt should be made to ensure that the chairperson and/or the vice-chairperson are able to attend the meeting, however, in the absence of the chair, the Convenor shall have the right to convene the meeting and conduct it according to the set agenda. Under such circumstances, the minutes of the meeting should be sent to the chairperson and vice chairperson for information and ratification.

4.The member secretary will ensure the preparation of the agenda notes for meeting, minutes of d. the last meeting and Action Taken Report (ATR), which will also be circulated in advance to all committee members, at least seven days before the scheduled date for the meetings.

5.An attendance by at least one-third of the Committee members will constitute the quorum required for a valid meeting.

6.Member secretary will ensure follow-up actions with responsibilities and timelines for the same.

7.The “State Family Planning Indemnity Subcommittee” would meet as often as warranted at least three members would constitute the quorum of this subcommittee.


State Quality Assurance Unit (SQAU):

SQAU is the working arm under SQAC that will be responsible for undertaking various activities as per ToRs of the unit, and other tasks, as entrusted to them from time to time by the SQAC.

Members:

  • 1.Additional/Joint Director (FW)/Deputy Director (FW)/Equivalent, designated by the state Government as the Nodal Officer for the Quality Assurance (QA) Unit (Member Secretary - SQAC).
  • 2.State Nodal Officer of Programme Divisions.
  • 3.State Consultant (Quality Assurance).
  • 4.State Consultant (Public health).
  • 5.State Consultant (Quality Monitoring).
  • 6.Administrative-cum-Programme Assistant.

The SQAU is headed by the SQAC’s member Secretary, who along with the State Programme Officers provide support to the SQAC for implementation of QA activities in the state. All the positions of this unit should preferably be regular from the state cadre, however in case of non- availability from the state cadre, the post at Sl. No. 3 – 6 can be hired under NRHM till the posts are filled in from the State Cadre.

The number of full time technical persons (consultants) may be increased once the state decides to expand QA for the Disease Control and other programmes as part of the mandate of the State QAC

Process of SQAU:

The terms of reference for the SQAU remain the same as of SQAC, since it is the working arm of SQAC. However, some of the important activities of the SQAU are listed below:

  • 1.Adapt check-lists for RMNCH-A services (as well as for Disease Control Programme) to match the state needs.
  • 2.Develop a plan for the Quality Assurance at each level of health institution in a phased manner.
  • 3.Orient the state level assessors, district level QA units on the quality standards, tools for assessment and improvement plans, and the processes to be followed for QA activities. Assistance of QI Division of NHSRC may be taken for organising the orientation programme.
  • 4.Disseminating the quality assurance guidelines & tools and methodology to be followed at district and sub-district level.
  • 5.Develop a field travel plan for independent and joint (with District team) visits to the Districts by member of the State QAU and programme officers.
  • 6.Following these visits, prepare draft report and recommendations for review.
  • 7.Mentor the Programme Officers and facility in-charge at the Districts for improvement measures at the facilities.
  • 8.Compile and collate monthly data received from districts on KPI, especially those related to cases of adverse outcomes/complications in maternal, neonatal & child health; maternal, infant & child deaths (all cases), disease control programmes and share it with the SQAC members and discuss at the SQAC meeting.
  • 9.Send the regular reports on sterilisation related indicators (deaths, complications, failures) to the Centre after ratification of the same by the Chairperson of SQAC.
  • 10.Review the implementation of the National Family Planning Indemnity Scheme/ payment of compensation in the state, based on reports received from the districts as well as from the visits undertaken by the QAU members.

District Quality Assurance Committee (DQAC)

Members:

  • 1.District Collector/Dy. Commissioner, Chairperson.
  • 2.Chief Medical Officer/Deputy Director/CDMO/District Health Officer/Equivalent (Convener).
  • 3.District Family Welfare Officer/RCHO/ACMO/equivalent (Convener)
  • 4.Deputy Superintendent/Civil Surgeon/Chief Medical Superintendent of District Hospital or equivalent.
  • 5.In-charge of CHC & PHC (one each, by rotation).
  • 6.Nodal Officer of Programme Divisions at Districts.
  • 7.One empanelled gynaecologist (from public institutions).
  • 8.One empanelled surgeon(from public institutions).
  • 9.One Medical Specialist (from public institutions).
  • 10.One anaesthetist (from public institutions).10. One paediatrician (from public institutions).
  • 11.One representative from the nursing cadre.
  • 12.One representative from the legal cell.
  • 13.One member from an accredited private sector hospital/ NGO (health care sector).
  • 14.One representative from medical professional bodies e.g. FOGSI/IMA/IAP/IAPSM/ Association of Public Health

A 5 member “District Family Planning Indemnity Subcommittee” from within the DQAC would process claims received from the clients and complaints/claims lodged against the surgeons and accredited facilities, as per procedure and time frame laid down in the manual on “Family Planning Indemnity Scheme 2013”.

The sub-committee would comprise of the following:

  • 1.District Collector, (Chairperson).
  • 2.Chief Medical Officer/District Health Officer/CDMO/CMHO
  • 3.District Family Welfare Officer/RCHO/ACMO/equivalent (member secretary)
  • 4.Empanelled Gynaecologist (from public institutions).
  • 5.Empanelled Surgeon (from public institutions)

Process of DQAC:

  • 1.The district quality assurance committee will meet at least once in a quarter.
  • 2.The convener will issue meeting notice at least seven working days before the scheduled date of the meeting with the approval of the chairperson.
  • 3.While every attempt should be made to ensure that the chairperson is able to attend the meeting, however, in the absence of the chair, the Convenor shall have the right to convene the meeting. Under such circumstances, the minutes of the meeting should be sent to the Chairperson for information and ratification.
  • 4.Member secretary will ensure the preparation of agenda notes, and action taken reports, which will be circulated in advance to all committee members preceding the DQAC meetings.
  • 5.An attendance by at least one third of the Committee members will constitute the quorum required for a valid meeting.
  • 6.Member secretary will ensure follow-up actions with responsibilities and timelines for the same.
  • 7.The “District Family Planning Indemnity Subcommittee” would meet as often as warranted.
  • 8.At least three members would constitute the quorum of this subcommittee

District Quality Assurance Unit:

DQAU is the working arm under DQAC that will be responsible for undertaking various activities as per the ToRs of the committee and also entrusted to them from time to time by the DQA Committee.

Members:

  • 1.District Family Welfare Officer/RCHO/ACMO/equivalent (Head of DQAU)
  • 2.One Clinician (Surgical/ Medical/ any other speciality).
  • 3.District Consultant (Quality Assurance).
  • 4.District Consultant (Public Health).
  • 5.District Consultant (Quality Monitoring).
  • 6.Administrative cum Programme Assistant.

The DQAUs is headed by the Member Secretary DQAC, who along with the District Programme Officers provide the support to the DQAC for implementation of QA activities in the district. All the positions of this unit should preferably be regular staff from the government. However, in case of non- availability of the regular cadre staff, posts at sl. no 3 to 6 can be hired under NRHM till the regular cadre become available.

Process of SQAU:

  • 1.Ensure roll out of standard protocols for RMNCH-A services (as well as for Disease Control 1. Programme implementation).
  • 2.Develop a plan for the Quality Assurance at each level of health institution in a phased manner.
  • 3.Disseminating the quality assurance guidelines & tools and methodology to be followed at district and sub district level.
  • 4.Develop a field travel plan for independent and joint (witth State teams) visits to the health facilities in the districts by members of the DQAU.
  • 5.Following these visits, prepare the draft report and recommendations.
  • 6.Mentor the facility in-charges at the districts for implementing quality improvement measures at the facilities.
  • 7.Compile and collate monthly data received from facilities on outcome level indicators, especially those related to cases of adverse outcomes/complications in maternal, neonatal & child health; maternal, infant & child deaths (all cases), disease control programmes and share it with the DQAC members and discuss with DQAC meeting.
  • 8.Send the regular reports on sterilisation related indicators (deaths, complications, failures) to the State after ratification of the same by the Chairperson of the DQAC.
  • 9.Review the implementation of the National Family Planning Indemnity Scheme/ payment of compensation in the district, based on reports received from the facilities as well as from the visits undertaken by the DQAU members.