Monitoring and Evaluation of an MNCH Mentoring Intervention in Two Districts of Karnataka

By providing on-site mentoring for improved clinical care and service delivery, we hypothesize that the quality of services and care will improve and patients will have better clinical outcomes. Specifically we believe that routine on-site clinical and service delivery mentoring will strengthen clinical knowledge, skills and practices among staff nurses and ANMs (in year 2), will strengthen appropriate referrals and follow up care, will improve other aspects of service quality, and provider and client satisfaction. The evaluation will assess change during the first year of the intervention that focuses on clinical mentoring of staff nurses and on quality improvement in the PHCs as a whole. The evaluation will focus on success indicators as shown in Appendix 1. Due to the short time frame for evaluation, success indicators will be principally at the levels of inputs, outputs, and outcomes focusing on adherence to the Sukshema Critical Care package, although we also hope to assess some key health outcomes, in terms of reduction of "near-miss" cases.

A. Pre and post MM intervention evaluation strategy The "pre-intervention" evaluation will have two phases. The first phase will take place in all 122 sites before any intervention activities begin (Figure 1). This evaluation will focus on site readiness to provide quality services, provider knowledge, attitudes and reported or observed (or simulated) practices, supervision and mentoring, record keeping, and provider and client satisfaction. The NRHM SBA guidelines, PHC 24/7 guidelines, MHFW NSSK guidelines, and the Sukshema critical care package will all be used to determine expectations of clinical quality of care at this level.

The focus of the first year of the MM intervention is enhanced clinical skills in the intra-partum and postpartum periods and thus assessments of actual clinical practices are important. However, data on actual practices in the intrapartum and postpartum periods will be difficult to collect by observation during this baseline (especially those with complications). Most of the PHCs conduct only a few deliveries each week, and it will be therefore almost impossible to obtain a representative sample of observations. Therefore we will assess intrapartum and postpartum clinical practices largely though the audit of case sheets and registers. However, these case sheets are currently either not available or not used. Thus our strategy necessitates delay of this part of the second phase of the baseline until after the update training where all staff will be given and instructed in the use of new and improved case sheets. All sites will be given the opportunity to practice using these patient case sheets for one month before they are collected by project staff and used as a basis for assessing both compliance with the new case sheets, adequacy of reporting, and actual case management. Actual case observations will be done during routine MM visits where possible. The post intervention phase of the assessment will take place in all sites once year after the first (planned 6) MM visits and will repeat the baseline survey.

Pre and post MM intervention evaluation survey tools

The survey will use four types of survey tools pre and post MM intervention and one additional tool after one year in the intervention sites only: