Quality Assessments Of Public Health Facilities In Madhya Pradesh

As an economist, I often find myself viewing the world through the lens of resources, efficiency, demand, and supply. But the recent quality assessment visits to the district and government hospitals in Anuppur, following the unsettling events in Kolkata, have prompted me to reflect on a different set of questions. Questions that go beyond the traditional economic framework.

I find myself deeply concerned about the safety of women working in these hospitals. Are they truly safe in their workplaces? What are the conditions they face on a daily basis? How gruelling are their shifts, and who bears the responsibility for ensuring their safety?

The Quality Assessment Framework

As the Laqshya coordinator for Jan Swasthya Sahyog in Anuppur, I administer the national labour room quality improvement assessment to multiple health facilities, each month.

The Laqshya quality assessment looks at the following eight areas of concern in both the Labour Rooms (LR) and the Maternal Operation Theatres (MOT)

Inputs: Changing rooms, triage, staff, etc.

Service provision: Lab tests, elective surgeries, newborn resuscitation, etc. 

Support services: Equipment insurance, calibration, security guards, indenting, etc.

Patient rights: Wheelchairs, signages, behaviour of staff

Clinical services: Medicines, assisted deliveries.

Quality measurement systems: Root cause analysis, PDCA, action plans, etc.  

Infection control: BMW, cleaning agents, etc.

Outcomes: Outcome indicators

Each of these sections accumulate to form the final assessment score received by the health facility. As the development partner organization of these facilities, Jan Swasthya Sahyog is responsible for administering assessment and providing actionable monthly feedback to both the health facility and the government officials. In order to ensure this, we form quality circles in the hospital where the action plans are reviewed and implemented on a monthly basis.

Do The Nursing Staff Feel Safe In Their Hospitals?

One particular question in the Laqshya assessment tool which I have been administering, resonates with this concern of safety: “do the nursing staff feel safe in their hospitals?”

During a recent assessment at the Community Health Center in Rajendragram, the importance of this question became even more apparent. For context, Rajendragram is a quaint yet bustling hilly town in Madhya Pradesh situated around 40kms off Anuppur district headquarter. The remoteness of Rajendragram exacerbates the challenges related to safety. Nestled between dense forests, the town is surrounded by a diverse array of wildlife. In fact, on my last visit, I encountered a leopard that quickly crossed my path in front of me as I drove past.

In Rajendragram, one security guard sits on the premises of the hospital. Due to the shortage of staff, this single security guard was busy registering patients as we started the assessment. Aside from the low score on their assessment for this parameter, the question of nurses feeling safe on the premises becomes more pronounced.

Remoteness And Sense Of Safety

When we asked the nursing staff, they explained that while no similar events such as what happened in Kolkata had happened on their health facility. But they frequently get harassed by patients and do not have the reinforcements needed. Additionally, they also explained that the poor lighting and bad planning of spaces makes moving from the labour rooms to the wards an uncomfortable experience of night. Corridors are dimly lit and no security is available. They also explained how frequent thefts take place in the labour rooms because nobody is around to monitor.

This same question was then posed to the staff at the District Hospital in Anuppur. Their responses were more optimistic. The labour rooms at Anuppur District Hospital have three women security guards who are available for most of the day. This is still only 50% of the realistic 6 security guards required to meet the national quality standard. In addition to the presence of security guards, Anuppur is also a bigger town and does not have the added dimension of wildlife roaming free in their vicinity and is better funded and therefore better staffed with more staff nurses working at night.

Did Recent National Level Issue Based Protext Change Anything?

I then asked if the events that unfolded in Kolkata had any impact at all on hospital policy. Incidentally, it did. In DH Anuppur, they created a panel to ensure the safety of their staff. While nobody joined the protests, the events deeply affected the working conditions and sentiments of the staff in this small town in Madhya Pradesh. This panel then implemented a group chat with relevant people who could address safety concerns round the clock. Staff could post messages on the group asking for reinforcement or message an authorized person privately to share an incident that would then be investigated. Nurses also shared personal experiences of when they had to share bad news with family members and were threatened or harassed by them. These were not isolated incidents, unfortunately.

Intersection

These observations highlight the urgent need to reevaluate the adequacy of existing safety measures in remote hospitals. The issues we often overlook, comes to the light in areas like Rajendragram due to their unique intersection of workplace safety, gender, and geography. It’s not merely a question of resources or operational efficiency. It is about prioritizing the protection and well-being of those who serve on the front lines, often under the most difficult circumstances. If the healthcare system is to thrive, those who sustain it—the nurses, doctors, and support staff—must not only be equipped with the tools. They need but also feel secure, valued, and protected as they provide care in environments that can, at times, be as dangerous as they are essential.