Quality of Care in a Health Facility is a major concern for Public Facilities in India. Quality Improvement Process should be driven by the Care Providers, Facility Managers and other Stakeholders integrating patient/client satisfaction and scientifically and technically sound treatment protocols.

1. GOAL SETTING FOR QUALITY IMPROVEMENT
IN HEALTH FACILITY
Dr Prabir Ranjan Moharana
MD(Community Medicine), PGDHHM
State Technical Specialist, Care-India, Bihar.

2. WHY QI TEAM & WHAT IT STANDS FOR???
 Step-1:Formation of QI team at each facility.

3. 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.

4. 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 .

5. WHAT ARE QI GOAL, OBJECTIVE AND PROCESS???
 Step-2: Defining QI goals, Objectives & Processes.

6. 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.

7. 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.

8. 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.

9. 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.

10.  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.

11. STEP-3
 Identification of Maternal & Child Health Goals for the
facility.

12. 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.

13. 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.

14. 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.

15.  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.

16. 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.

17. 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.

18. 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.

19. 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.

20. 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.

21. 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.

22. 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.

23. 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.

24.  Processes of Objective-2(Goal-2): To use Uterotonic
drugs 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.

25. 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).

26.  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-eclampsia
recognized in facility.
iv. Encouraging a woman with pre-eclampsia for institutional
delivery.

27. 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.

28. 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.

29. 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.

30.  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.

31.  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).

32.  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

33.  Processes of Objective-2(Goal-3): To perform Caeserian
Section 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.

34.  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.

35. 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.

36. 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.

37.  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.

38. 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

39. 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.

40.  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.

41.  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.

42.  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.

43. 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.

44.  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.

45.  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.

46.  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.

47. 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

48. 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

49. 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.

50.  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.

51. 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

52. 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

53.  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.

54.  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.

55.  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.

56. 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

57. 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.

58.  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.

59.  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.

60.  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.

61.  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.

62.  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.

63.  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.

64.  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.

65.  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.

66.  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.