The demonstration site program is a training, clinical supervision and quality improvement program being tested for the first time in India. The program focuses on two major concerns in maternity care today – use of evidence based care and respectful maternity care.

The goals of the demo site are to:

• Improve care during birth in order to save lives and prevent harm from the overuse of obstetric technological interventions

• Promote care during labour and birth and breastfeeding that is centered on normal physiology

• Promote and provide evidence based maternal health care emphasizing a humanistic, respectful approach to care most conducive to good outcomes, including midwifery knowledge and skills, hands on support for the mother, and recognition of the MotherBaby continuum

• Improve quality of care in public institutions in light of GoI’s policy of 100% institutional deliveries

• Provide women of lower SES with a community based center of excellence in MotherBaby-friendly evidence based care.

By the end of the project we aim to achieve the following objectives in the Demonstration Site hospital:

1) A significant increase in respectful maternity care and women’s satisfaction with care

2) Increased use of certain evidence based practices that have an important impact on health outcomes

3) An observable increase in demand for and use of care

4) A positive impact on the staff job satisfaction including increased retention of skilled staff

6) Increased referrals to the Demonstration Site hospital

7) Demonstration Hospital becoming a model for the changes in other maternity facilities

Outcomes for the project will include maternal and newborn outcomes, behavioral outcomes related to respectful care (such as women’s ratings of care quality and staff attitude/behavior) and clinical outcomes related to the use of evidence based medicine (such as use of oxytocin for labour induction/augmentation, caesarean section, use of antibiotics, fundal pressure, episiotomy).

Process measures for the project include issues such as acceptability of the intervention and of the chosen step(s) for staff and women, increase in respectful care behaviors from baseline and the degree to which the chosen step(s) were implemented.

Before implementation of the intervention program a considerable amount for time will be spent collecting baseline data, forming participatory action groups, collectively deciding on priorities for improvement and adapting and translating IMBCI materials to fit the BBMP culture and practice environment. Participatory action groups will be comprised of BBMP staff, administrators, member of BBMP Board of Visitors and service users and their work will focus on identification of priorities and barriers.

A pilot program will be undertaken to test procedures and apply lessons before the full project begins.

Program implementation itself focuses on human resources development in the form staff training with emphasis on priority, high impact care practices. Apart from staff training best practice methodologies to be employed in clinical dissemination of the Ten Steps include supportive supervision, checklists, reminders, regular audit and feedback, and clinical practice modules (for emergency protocols). Particular attention will be paid to methodologies proven to have the greatest impact on sustainability of the intervention.

Baseline data will be collected to assess the areas of greatest need with focus on interventions yielding the highest impact on outcomes. Baseline data collection will include extraction of clinical practice data from clinical records, observations of birth practices, in depth interviews and focus groups with staff and a maternal satisfaction survey with service users. Data on targeted evidence based care and respectful care practices will be collected during the life of the project and will be compared pre and post intervention as well as between an intervention and control hospitals.