Objectives: The Dakshata program was launched by the Government of India (GOI) to improve the quality of care by competent health care providers in labor rooms situated in public health facilities. Dakshata in Rajasthan was funded by Child Investment Fund Foundation(CIFF), implemented by Jhpiego in collaboration with the Government of Rajasthan(GOR). The Dakshata package included rapid baseline assessment, three days of competency-based training, mentoring, and supportive visits (MSVs), and periodic assessment (PA). The study is aimed to share findings of competency and knowledge assessment of 10 evidence-based childbirth practices performed by providers posted in the labor room.
Methods: Jhpiego program officers assessed the competency of 409 providers posted in labor room and postnatal ward of 62 intervention facilities. They used OSCEs (Objective Structured Clinical evaluation) and case studies for assessment.
Results: 348 (85%) and 309 (76%) providers were competent in AMTSL (Active Management of Third State of Labor) and management of severe pre-eclampsia/ eclampsia respectively. Skills like plotting of partograph and per-abdomen examination showed lesser competency (60% each). Total 111(27%) of 409 providers demonstrated competency in all 10 practices.
Conclusions: Quality improvement initiatives like Dakshata focusing on competency-based program helped in improving the quality of care by competent providers. Childbirth practices with indirect impact or relatively complex procedures or rarely performed during childbirth showed lesser competency. Therefore, it is critical to institutionalize periodic assessment of competency and knowledge of healthcare providers to adhere evidence-based practices and sustain the quality of care during childbirth.