Does Quality Certification Work? An Assessment of Manyata, a Childbirth Quality Program in India’s Private Sector

Manyata, a quality improvement initiative for labor room staff at private facilities in India, yielded increased knowledge among staff, increased adherence to evidence-based practices, and a suggestive decrease in referrals but no change in facility-reported health outcomes. Key Findings After the Manyata quality improvement initiative in private facilities was implemented, nurses’ knowledge and practical skills in maternal and newborn practices increased. Private sector facilities’ adherence to quality standards and evidence-based practices improved during their participation in Manyata; however, no change in in-facility morbidity or mortality was reported. Certification strategies offered by professional societies, such as the Federation of Obstetric and Gynaecological Societies of India, can be effective in improving quality at private health facilities, as long as training and mentoring support are provided. Key Implications Manyata offers an effective model for improving the quality of care at private maternity facilities in India. More work is needed to pursue strategies to ensure that improvements in quality are sustained. ABSTRACT Background: In India, more than 60% of hospital beds are in private facilities, yet several studies have observed suboptimal quality of care in private facilities. We aimed to understand the role of Manyata, a quality improvement initiative in private facilities focused on mentorship and clinical standards, to improve the knowledge and skills of health care providers, their adherence to key childbirth-related clinical practices, and health outcomes for women and newborns. Methods: We conducted a secondary analysis of Manyata program data collected from 466 private facilities across 3 states (Jharkhand, Maharashtra, and Uttar Pradesh) in India from October 2016 to February 2019. We calculated means and 95% confidence intervals for knowledge and skills assessment, adherence to facility standards was analyzed by calculating the proportion of facilities passing a given quality standard at baseline and endline, and changes in pregnancy outcomes were assessed with autoregression modeling. Results: From assessments conducted before and after training among providers in Manyata, we observed a significant increase in average knowledge score (6.3 vs. 13.2 of 20) and skill score (8.0 vs. 34.3 of 40). Overall, a significant increase occurred in adherence to clinical standards between baseline and endline assessments (29% vs. 93%). The standards with the greatest improvements were identification and management of eclampsia/preeclampsia, postpartum hemorrhage, and neonatal resuscitation. There were no significant changes over time in absolute rate of reported complications; however, referral rates from private facilities for preeclampsia and newborn sepsis identification and management declined. Conclusion: Our analysis indicates private facilities’ adherence to quality standards and nurses’ childbirth knowledge and practical skills increased during Manyata. Additional efforts are needed to ensure high-quality care during cesarean deliveries at private facilities. Future studies with rigorous design are required to evaluate the impact of this quality improvement initiative in improving pregnancy outcomes.