GOAL SETTING FOR QUALITY IMPROVEMENT

IN HEALTH FACILITY

Dr Prabir Ranjan MoharanaMD(Community Medicine), PGDHHM

State Technical Specialist, Care-India, Bihar.

WHY QI TEAM & WHAT IT STANDS FOR???

Step-1:Formation of QI team at each facility.

STEP-1:FORMATION OF QI TEAM AT EACH LEVEL OF

FACILITY.

A Quality Improvement (QI)Team in each facility will be formed taking hospital staff from each hierarchy as its members.

This QI team will conduct focused QI meetings monthly.

QI team will set Goals towards provision of quality health services resulting in decrease in maternal and child mortality and morbidity .

QI team will prepare a Comprehensive Action Plan for facility towards Quality Improvement Processes.

STEP-1

QI team will prepare and review the action plan monthly and ensure services as per FFHI checklist.

QI team will ensure standard operating procedures and management protocols for maternal and new born care.

QI team will follow-up, monitor and supervise QI processes happening in the facility.

QI team will track MCH indicators and this tracking will be data driven type.

QI Team will comply to District Quality Assurance Cell(DQAC) & Regional Program Management Unit(RPMU) timely .

WHAT ARE QI GOAL, OBJECTIVE AND PROCESS???

Step-2: Defining QI goals, Objectives & Processes.

STEP-2: DEFINING QI GOALS, OBJECTIVES &

PROCESSES.

QI Goal is a goal to ensure quality maternal and new born health services in the facility to reduce maternal and new born morbidity and mortality.

QI Goal should be broad, smart, realistic and practically feasible & achievable.

Each QI Goal will include certain objectives to achieve.

Each objective will be very specific and it will include processes/ activities. Objective should be either Short-Term(ST) or Long-Term(LT).

Every process/activity will be either onetime or recurring/repeating in nature. A process may be of shorter(S) or longer(L). A process may be of qualitative or quantitative type.

STEP-2: SHORT TERM V/S LONG TERM OBJECTIVES

We need to differentiate between short term and long term objectives basing only on time required to achieve it. For example if an objective takes more than 1 month for achievement can be called a Long Term Objective.

Sometimes a process/an activity requiring less money may take a longer time to happen and vice versa.

Some activity and processes don’t require money/require minimum amount of money i.e. initiation of breast feeding within one hour of delivery, washing the labor room table/floor with detergent & plain water in the absence of bleaching powder, filling-up of case sheet etc. These require only change in behavior.

Goal-1: To provide BEmONC

(Basic Emergency Obstetric and New

Born Care) at each PHC .

Short Term Objectives:

Functional QI Team in

every PHC.

Long Term Objectives:

Functional labor room in

every PHC.

Onetime

Process/

Activity:

Formation

of QI Team

Recurring

Process/

Activity:

Conducting

monthly QI

meetings.

Recurring

Process/

Activity:

Maintenance

of a functional

labor room.

Onetime

Process/

Activity:

Construction

of a labor

room.

STEP-2

Listing out of short term and long term objectives in a

facility towards BEmONC should be done by QI team. FAT

and DoD findings could be helpful in identification &

listing of objectives.

Listing of activities and processes towards each objective

should be done.

Prioritizing of objectives and activities should be done

with respect to need, characteristic, HR issues, available

resources etc in each facility.

Each facility should have complete freedom of selecting

and prioritizing its objectives.

Resifting of objectives from long term to short term

type and vice versa could be done by QI team of

facility.

Goal and Objectives set by QI team should be a team

activity. Every staff of facility/hospital should be

accountable towards its achievement.

QI team will identify each member and assign them

tasks of completing QI processes.

STEP-3

Identification of Maternal & Child Health Goals for the

facility.

Menu of Goals:

Goal-1: To provide quality perinatal and intranatal care and services for safe delivery and healthy baby.

Goal-2: To perform all signal functions of BEmONC(Basic Emergency Obstetric and New Born Care) at PHC round the clock.

Goal-3: To perform all signal functions of CEmONC(Comprehensive Emergency Obstetric and New Born Care) at DH/Selected SDH/RH round the clock.

Goal-4:To ensure quality Essential New Born Care for every baby born at PHC.

Menu of Goals:

Goal-5: To manage Bio-medical Waste as per statutory

and policy norms.

Goal-6: To minimize and prevent hospital acquired

infections through meticulous and scientific infection

control measures.

Goal-7:To provide quality family planning services.

Goal-8: To provide quality Immunization Services at

PHC/CHC/SDH/RH/DH.

Goal-9: To provide safe abortion services.

Goal-1: To provide quality perinatal and intranatal care and

services for safe delivery and healthy baby.

Objective-1: To take adequate obstetric history and

examine every expectant mother clinically.

Objective-2: To identify any obstetric emergency as early

as possible and refer in time.

Objective-3: To provide skilled care and assist labour

services round the clock.

Objective-4: To give adequate post delivery and pre

discharge advice to 100% mothers and their family

members on post partum care of mother and baby.

Processes of Objective-1(Goal-1): To take adequate

obstetric history and examine every expectant mother

clinically.

i. Ensuring functional sphygmomanometer, stethoscope,

thermometer, fetoscope/fetal heart monitor etc in the

labour room.

ii. Ensuring availability of Case Sheet in labour room.

iii. Adequate obstetric history taking and doing clinical

examination of every expectant mother as early as

possible.

iv. Filling up a case sheet for each expectant mother

meticulously and completely.

Processes of Objective-1(Goal-1): To take adequate

obstetric history and examine every expectant mother

clinically.

v. Registering each case into labour room register.

vi. Recognizing of any risk which is associated with current

pregnancy like severe anemia, pre-eclampsia, twin

pregnancy etc.

vii. Meticulous maintaining of the records and reports of care

given to every mother and new born in register.

Processes of Objective-2(Goal-1): To identify any obstetric

emergency as early as possible and refer in time.

i. Ensuring availability of partograph in labour room.

ii. Displaying the contact number of higher facility in labour

room.

iii. Using partograph for observation and recording of

progress of labour.

iv. Recognizing any imminent complications like obstructed

labour, cord prolapse etc.

Processes of Objective-2(Goal-1): To identify any obstetric

emergency as early as possible and refer in time.

v. Giving pre-referral management and (Obstetric First-Aid)

and stabilizing the cases with obstetric emergency before

referral.

vi. Dialing the higher center and informing about the

complications being referred to them.

vii. Referring the complicated case with a properly filled-up

referral slip.

Processes of Objective-3(Goal-1): To provide skilled care

and assist labour round the clock.

i. Organizing the labour room with equipments, instruments,

consumables, essential and emergency drugs etc.

ii. Assisting the labour with compassion, competence and

skill.

iii. Managing each delivery and complication as per standard

management protocol.

Processes of Objective-4(Goal-1): To give adequate post

delivery and pre discharge advice to 100% mothers and

their family members on post partum care of mother and

baby.

i. Counseling mother and family for 48 hours’ hospital stay

post delivery.

ii. Ensuring all the postnatal services from Day 1 to Day 3 to

mother and baby.

iii. Advising mothers/family about post natal care of mother .

iv. Advising mothers/family about essential new born care and

Kangaroo Mother Care for weak new born.

Processes of Objective-4(Goal-1): To give adequate post

delivery and pre discharge advice to 100% mothers and

their family members on post partum care of mother and

baby.

v. Counseling of families about post partum maternal

complications and telling them how to identify

complications and when to seek help.

vi. Counseling of family to identify new born illness and tell

them when to seek help.

vii. Advocacy for spacing and family planning.

Goal-2: To perform all signal functions of BEmONC (Basic Emergency Obstetric and New Born Care) at PHC round the clock.

Objective-1: To ensure administration of parenteral antibiotics.

Objective-2: To use Uterotonic drugs appropriately for AMTSL in every delivery and management of PPH and shock if needed.

Objective-3: To manage pre-eclampsia and to administer parenteral anticonvulsants to pregnant woman in eclampsia.

Objective-4: To ensure manual removal of placenta and retained products.

Objective-5: To perform assisted vaginal delivery.

Objective-6: To perform basic neonatal resuscitation in a baby born with birth asphyxia.

Processes of Objective-1(Goal-2): To ensure administration of

parenteral antibiotics.

i. Keeping a cup board/almirah in labour room to keep

consumables, equipments and drugs.

ii. Daily updating of indent register.

iii. Timely placing of indent order for consumables and drugs.

iv. Ensuring availability of parenteral antibiotics for both mother and

child in labour room.

v. Ensuring consumables like cotton, gauge piece, surgical spirit,

syringes(2 ml, 5ml & 10 ml), IV set, scalp vein, IV cannula, RL,

NS, DNS etc in the labour room round the clock.

Processes of Objective-2(Goal-2): To use Uterotonicdrugs appropriately for AMTSL in every delivery and management of PPH and shock if needed.

i. Keeping a refrigerator in labour room for thermo sensitive uterotonics.

ii. Displaying management protocol of AMTSL and PPH on the wall of labour room.

iii. Ensuring round the clock availability of uterotonics like Oxytocin, Methyl Ergometrine and Misoprostol.

iv. Ensuring round the clock availability of volume expanders like NS and RL etc.

Processes of Objective-2(Goal-2): To use Uterotonic

drugs appropriately for AMTSL in every delivery and

management of PPH and shock if needed.

v. To ensure round the clock availability of cardiotonic drugs

like Adrenaline, Nor-Adrenaline, Dopamine in labour

room.

vi. To ensure blood grouping and Rh-typing of PPH cases

before referring out.

vii. To establish assured referral linkage with higher facility

(keeping phone number, making call and giving referral

slip).

Processes of Objective-3 (Goal-2): To manage pre-eclampsia and to administer parenteral anticonvulsants to pregnant woman in eclampsia.

i. Measuring BP of every woman at every ante natal and post natal visit.

ii. Testing urine of woman for proteinuria if she has Hypertension.

iii. Treating and following up each case of Pre-eclampsiarecognized in facility.

iv. Encouraging a woman with pre-eclampsia for institutional delivery.

Processes of Objective-3 (Goal-2): To manage pre-eclampsia

and to administer parenteral anticonvulsants to pregnant

woman in eclampsia.

v. Orienting and training Labour room Nurses and Medical

Officers for management of Pre-eclampsia and Eclampsia.

vi. Ensuring availability of nifedipine(Sublingual capsules and

tablets),methyl dopa, Inj Labetalol/Inj Hydralazine for pre-

eclampsia .

vii. Ensuring Magnesium Sulphate & Diazepam for management

of eclampsia in the labour room.

viii. Administering 1st dose of Mag-Sulph to every case of

eclampsia before referral to higher center.

Processes of Objective-4(Goal-2): To ensure manual

removal of placenta.

i. Procuring instruments for labor room require for delivery

and removal of placenta.

ii. Ensuring functionality of all equipments.

iii. Training and orienting labour room nurses and medical

officers on manual removal of placenta.

iv. Stabilizing mothers with post natal emergency like retained

placenta.

Processes of Objective-5(Goal-2): To perform assisted

vaginal delivery.

i. Procuring instruments for labor room required for delivery

and episiotomy.

ii. Keeping sterilized episiotomy tray ready in labour room.

iii. Ensuring availability of services like Episiotomy and

suturing of cervical tear round the clock.

iv. Ensuring services of Assisted vaginal deliveries like

outlet forceps, vacuum extraction of fetus.

Processes of Objective-6(Goal-2): To perform basic

neonatal resuscitation in a baby born with birth asphyxia.

i. Training the labour room nurses and medical officers on

Navjaat Shishu Suraksha Karyakram(NSSK).

ii. Displaying the protocol of “Golden 1 minute of

Resuscitation” in the labour room.

iii. Keeping ready the labour room with functional radiant

warmer, AMBU bag and mask, clean suction device, two

towels, wall clock with second hand, functional oxygen

cylinder etc round the clock.

Goal-3: To perform all signal functions of CEmONC(Comprehensive Emergency Obstetric and New Born Care) at DH/Selected SDH/RH round the clock.

Objective-1: To perform all signal functions of BEmONC(Basic Emergency Obstetric and New Born Care) round the clock.

Objective-2: To perform Caeserian Section for complicated cases round the clock.

Objective-3: To ensure Blood Transfusion Service round the clock.

Objective-4: To run fully equipped NBSU(for FRU) and Special Care Newborn Unit-SCNU(for DH).

Processes of Objective-1(Goal-3): To perform all

signal functions of BEmONC (Basic Emergency

Obstetric and New Born Care) round the clock.

*Same as mentioned under Goal-2

Processes of Objective-2(Goal-3): To perform CaeserianSection for complicated cases round the clock.

i. Posting of obstetricians and anaesthetists/doctor trained on LSAS and Grade-A nurses in Labour duty.

ii. Managing obstructed labour and other complicated labour(Shock,Eclmpsia, Sepsis,PPH, retained placenta etc).

iii. Performing caeserian section round the clock.

iv. Placing referral linkage with higher facility like Medical college.

iv. Keeping OT ready for Blood transfusion & C-section round the clock.

Processes of Objective-3(Goal-3): To ensure Blood

Transfusion Service round the clock.

i. Running in house blood storage center or blood storage

unit.

ii. Training of Medical officers and nurses on blood

transfusion management.

iii. Linking with Blood Bank with nearest ICTC/PPTCT

centre for voluntary counselling and testing for HIV and

PPTCT services.

iii. Monitoring Blood Bank services.

Processes of Objective-4(Goal-3): To run fully equipped

NBSU(for FRU) and Special Care Newborn Unit-

SCNU(for DH).

i. Running fully equipped New Born Stabilization Unit-

NBSU for FRU/SDH/RH for sick new born.

ii. Running SCNU at district hospital for sick new born care.

iii. Establishing linkage with Medical College for referral.

Goal-4: To ensure quality Essential New Born Care for every baby born at PHC.

Objective-1: To provide immediate newborn care of warmth, hygiene, feeding to every baby.

Objective-2: To manage all the new born in NBCC who require special care and management there only.

Objective-3: To ensure Kangaroo Mother Care for every weak newborn at facility and after discharge from facility.

Objective-4: To give adequate post delivery and pre discharge advice to mothers and their family members on post partum care of baby.

Processes of Objective-1(Goal-4): To provide immediate newborn care of warmth, hygiene, feeding to every baby.

i. Ensuring a draught free, clean, warm labour room (temperature >25°C).

ii. Ensuring two clean and warm towels for drying and wrapping of the new born.

iii. Putting each new born on mother’s abdomen for skin-to-skin contact.

iv. Initiating Breast Feeding within 1 hour of delivery.

SUB-ACTIVITIES FOR INITIATION OF EARLY BREAST

FEEDING AMONG 80% OF NEW BORN

S.NO Activity Responsibility Timeline

1 Training on importance of EIBF

and helping mothers how to

initiate breast feeding

MOIC/BHM As per

discussion in QI

meeting/ One

time process

2 Counseling of Mothers for EIBF Mamata At the time of

Admission

3 Ensuring early initiation of breast

feeding

ANM/Mamata After delivery

4 Report and record keeping in the

register

ANM After delivery

5 Monitoring and Review MOIC/BHM Weekly/Fortnight

ly/Monthly

Processes of Objective-1(Goal-4): To provide immediate

newborn care of warmth, hygiene, feeding to every baby.

v. Cutting the cord with sterilized scissor/blade and using

sterilized thread or cord clamp for tying/clamping.

vi. Advising mother and family for a clean and dry cord care.

Processes of Objective-2(Goal-4): To manage all the new born in NBCC who require special care and management there only.

i. Equipping the labour room with a functional New Born Care Corner(NBCC).

ii. Giving care to New Born of hypothermia, Birth Asphyxia, Sepsis at NBCC.

iii. Ensuring full functionality and cleaning of equipments like Radiant warmer, Oxygen Concentrator, Oxygen Cylinder, AMBU Bag & Mask, suction device of NBCC round the clock.

iv. Maintaining the records of care given to every baby in NBCC in new born register.

Processes of Objective-3(Goal-4): To ensure Kangaroo

Mother Care for every weak newborn at facility and after

discharge from facility.

i. Identifying every weak new born who are born before 37

weeks/8 months 15 days.

ii. Weighing each new born and identifying the baby who are

less than 2 kg of body weight.

iii. Counseling and demonstrating Kangaroo Mother Care to

mother and family of a weak new born.

iv. Ensuring KMC for all weak new borns at facility.

Processes of Objective-3(Goal-4): To ensure Kangaroo

Mother Care for every weak newborn at facility and after

discharge from facility.

v. Advising the mother, family and respective ASHAs to

continue KMC at home till the weak new born gains

appropriate weight.

vi. Advising the mothers about special care of weak new

born.

Goal-5: To manage Bio-medical Waste as per statutory

and policy norms.

Objective-1: To segregate each Bio-Medical Waste(BMW) into

appropriate colored bins.

Objective-2: To dispose BMW appropriately.

Processes of Objective-1(Goal-5): To segregate each

Bio-Medical Waste into appropriate colored bin.

i. Organizing training for hospital staff on BMW management.

ii. Procuring Electrical Needle Syringe Terminators/Hub

cutters and puncture proof Jars for labour room,

immunization room, minor OT, Injection room.

iii. Procuring color coded bins/buckets and plastic bags for

segregation and collection of BMW.

iv. Regular procuring of Bleaching powder.

Processes of Objective-1(Goal-5): To segregate each

Bio-Medical Waste into appropriate colored bin.

v. Procuring multi utility gloves and gum boots for the staff

who are collecting and transporting BMW.

vi. Handling sharp wastes carefully and collecting them into

puncture proof jar/container.

vii. Treating the wastes with 1% Hypochlorite solution before

disposal.

viii. Storing the BMW properly before transport.

Processes of Objective-2(Goal-5): To dispose BMW

appropriately.

i. Constructing and securing Sharp Pit as per norm for sharp

wastes inside the premises of facility.

ii. Constructing and securing Waste Pit inside the premises

of facility.

iii. Ensuring final treatment and disposal of hazardous

BMW.

ACTIVITIES FOR BMW MANAGEMENT

S.No Activity Responsibility Time

1. Procurement

1.1 Color coded bins, Needle

cutter/Burner Storage bins,

Transportation Trolley

MOIC/BHM As per decision in

QI meeting/One

time process

1.2 Color coded plastic bags,

Utility gloves, bleaching

powder etc.

MOIC/BHM/ANM/

Store Keeper

As per decision in

QI meeting/

Regular process

2 Training on BMW

management to the Staff

MOIC/BHM As per decision in

QI meeting/One

time process

ACTIVITIES FOR BMW MANAGEMENT

S.No Activity Responsibility Time

3 Collection of waste ANM After each

Procedure

4 Segregation of Waste ANM After each

procedure

5 Packing and storage in the

Storage bin

4th Grade Daily

6 Transportation (Outsourced) BHM/MOIC/

ANM/Outsourced

Agency

Daily or within

48 hrs

7 Disposal of waste Out sourced agency

8 Monitoring and record keeping BHM/ANM/MOIC Daily

Goal-6: To minimize and prevent hospital acquired

infections through meticulous and scientific infection

control measures.

Objective-1: To do medical hand washing before and after care.

Objective-2: To use sterilized instruments and items in labor room for

each and every delivery.

Objective-3: To disinfect labour room and to sterilize OT regularly.

Objective-4: To clean, disinfect and sterilize laboor room and OT

equipments.

Processes of Objective-1(Goal-6): To do medical hand washing before and after care.

i. Organizing training for hospital staff on infection control measures ie Hand Washing and use of Personal Protective Equipments(PPE).

ii. Procuring and fixing an elbow tap in labor room, Operation Theatre and Hand Washing area.

iii. Procuring and putting Soap, Detergent, scrubbing brush at wash area.

iv. Displaying protocols on Universal Precaution against infection and following them.

SUB-ACTIVITIES FOR PROPER HAND WASHING

S.NO Activity Responsibility Time

1 Establishment of Hand-

washing area in Labour

Room

MOIC/BHM As per discussion in

QI meeting/ one

time process

1.1 Procurement of Elbow-tap,

Surgical sink,

MOIC/BHM As per discussion in

QI meeting/

one time process

1.2 Establishment of water

connection and ensuring

24hrs water supply

MOIC/BHM As per discussion in

QI meeting/

one time process

1.3 Availability of Soap ANM/Store keeper

/MOIC/BHM

Regular process

2 Training on proper steps and

importance of hand washing

in infection control

MOIC/BHM One time process

3 Washing Hand by following

proper steps

ANM After every clinical

procedure

4 Monitoring and Review of

process

MOIC/BHM Regular

SUB-ACTIVITIES FOR USE OF PPE IN LABOUR ROOM,

NBCC AND OT

S.No Activity Responsibility Time

1 Procurement of PPE (Gloves,

Cap, Mask, Apron)

MOIC/BHM As per decision in

QI meeting/

Regular Process

2 Ensuring regular supply of

PPE

MOIC/BHM/

ANM/Store Keeper

As per decision in

QI meeting/

Regular Process

3 Training wearing and use of

PPE

MOIC/BHM One Time process

4 Monitoring and Review of

Use of PPE

MOIC/BHM Regular process

Processes of Objective-2(Goal-6): To use sterilized

instruments and items in labor room for each and

every delivery.

i. Procuring new instruments used in labour room, for family

planning procedures(IUCD insertion, Tubal Ligation,

Vasectomy) and replace old worn out instruments timely.

ii. Procuring Autoclave and instrument boiler and ensuring

their full functionality.

iii. Procuring Bleaching Powder, Lysol (40% carbolic acid),

Cidex (2% Glutarldehyde) for decontamination and

chemical sterilization.

Processes of Objective-3(Goal-6): To disinfect labour

room and to sterilize OT regularly.

i. Cleaning of labor table and labour room floor with

soap/detergent and moping them with 0.5% Hypochlorite

Solution after each delivery.

ii. To fumigate and sterilize OT 48 hours before the camp

days.

Processes of Objective-4(Goal-6): To clean, disinfect

and sterilize laboor room and OT equipments and

instruments.

i. Regular cleaning of the equipments like Radiant Warmer,

Bag and Mask, etc with soap water.

ii. Decontaminating and disinfecting labour room

instruments, OT instruments with freshly prepared 0.5%

Hypochlorite solution before cleaning with soap water.

iii. Sterilizing labour room instruments, OT instruments only

after decontamination and cleaning.

ACTIVITIES FOR DISINFECTION & STERILIZATION

Activities Responsibility Timing

1 Decontamination with 0.5%

hypochlorite solution

ANM After every

delivery

1.1 Daily Preparation of hypochlorite

solution

ANM Daily at 8:30

am

2 Cleaning with detergent solution ANM/MAMTA Daily

3 Autoclaving/Boiling ANM After every

use. IF not

used then

after 72 hrs.

4 Packing ANM After every

Autoclave/Boi

ling

5 Storage ANM After every

Packing

6 Maintaining Checklist ANM After every

storage

7 Monitoring of Process MOIC/BHM Daily

Goal-7: To provide quality family planning services.

Objective-1: To run Family Planning Corners(FPC) at PHC for quality

counseling and correct client selection.

Objective-2: To ensure availability of all temporary FP methods at

PHC as per cafeteria choice.

Objective-3: To ensure quality IUCD services to correctly selected

and adequately counseled clients.

Objective-4: To conduct quality Tubal Ligation and vasectomy

camps.

Processes of Objective-1(Goal-7): To run Family Planning Corners at facility for quality counseling and correct client selection.

i. Running a FPC in facility.

ii.Training of FLWs about FP methods, FP counseling and mobilization of clients from community to FPC.

iii. Ensuring counseling of women on spacing and limiting by FLWs during pregnancy.

To organize OT for quality tubectomy and vasectomy services.

Processes of Objective-2(Goal-7): To ensure

availability of all temporary FP methods at facility as per

cafeteria choice.

i. Procuring temporary FP methods like OC Pills, Condoms,

IUCDs for facility.

ii. Procuring pregnancy test kits for the facility.

Processes of Objective-3(Goal-7):To ensure quality

IUCD services to correctly selected and adequately

counseled clients.

i. Training at least 2 nurses and 1 Medical Officer of PHC

for quality IUCD insertion service.

ii. Selecting the correct client and adequate counseling of

the selected client for IUCD.

iii. Ensuring a fixed day service for IUCD insertion.

iv. Ensuring sterilization and asepsis for IUCD insertion.

Processes of Objective-4(Goal-7): To conduct quality

Tubal Ligation camps.

i. Selecting the appropriate client for TL & Vasectomy.

ii. Organizing Operation Theatre before camp day.

iii. Ensuring the TL & vasectomy protocols.

Goal-8: To provide quality Immunization Services at

PHC/CHC/SDH/RH/DH.

i. To prepare a microplan for Routine Immunization.

ii. To ensure supply and logistics for cold chain points

and session sites.

iii. To achieve 100% Routine Immunization coverage.

Processes of Objective-1(Goal-8): To prepare a

microplan for Routine Immunization.

i. Training of Medical Officers, Block Health Manager and

Health Workers on Routine Immunization.

ii. Preparing a monthly comprehensive microplan for

institutional and outreach sessions.

iii. Ensuring due list preparation and reducing the number of

left outs.

Processes of Objective-2(Goal-8): To ensure supply

and logistics for cold chain points and session sites.

i. Timely indent of vaccines, diluents, carriers, hub cutters etc

from higher cold chain point.

ii. Ensuring timely delivery of logistics to session site on a

session day.

iii. Ensuring alternative vaccine delivery to hard to reach

sites/missed sites.

Processes of Objective-2(Goal-8): To achieve 100%

Routine Immunization coverage.

i. Placing a Routine Immunization Monitoring system under

facility.

ii. Delegating an officer of the facility the charge of RI.

iii. Monitoring and making supporting supervision of

sessions.

iv. Robust monitoring of 2% of total sessions weekly.

v. Special monitoring of hard to reach session sites.

Goal-9: To provide safe abortion services.

Objective-1: To ensure Medical Methods of abortion( up to 7 weeks of pregnancy) at PHC.

Objective-2: To ensure Manual Vaccum Aspiration and desirable 1st trimester MTP services up to 8 weeks in PHC.

Objective-3: To give post abortion contraceptive services.

Objective-4: To manage and treat incomplete/inevitable/ spontaneous abortions.

Objective-5: To establish refferal linkages with higher centre for cases beyond 8 weeks of pregnancy up to 20 weeks.

Objective-6: To ensure Second trimester MTP services at CEmONC level facilities as per MTP Act and Guidelines.