Engaging providers in setting and using standards: Towards improving performance of postpartum intra-uterine contraceptive device (PPIUCD) services in India

Background: Given high unmet need for postpartum family planning and increasing institutional deliveries, government initiated strengthening PPIUCD services in selected hospitals (46) of 19 states, with Jhpiego's technical assistance. Method: Performance standards, verification criteria were set jointly by representative-providers from 19 states. With Jhpiego's post-training support, providers implemented services, assessed performance, analysed root cause of gaps and implemented action plans. Results of performance assessments of PPIUCD facilities conducted 4-6 months apart and service statistics are used here. Results: 46 facilities inserted over 81000 PPIUCD during 2010-12. Overall performance scores on standards improved from 39% during baseline to 82% during the end-line assessment. The performance scores for quality of counselling during ANC and early labour improved from 34 % and 44% respectively to 87% and 92%. Similarly, performance scores for quality of PPIUCD service delivery improved from 35% to 79% and record keeping from 50% to 73%. Percentage of facilities scoring >80% for overall quality standards increased from 3% to 73% during project period (2010-12). Follow-up of 30328 PPIUCD clients after 6 weeks of insertion revealed 2.36 % expulsions, 0.88% infections, 4.06% removal, 5.29% other complaints and 87% without any complaint, and thus justified performance improvement efforts. Recommendation: Involvement of providers in setting and using standards can result in substantial improvement in performance of PPIUCD services.