This scenario belongs to standard B1 (Information to care seekers about available services). The PHC appropriately provided pre-procedure counseling and referred the patients to a higher center since abortion services were not available at that facility, informing the patients about the services available.

2. MUSQAN INITIATIVE
Moderator – Dr. (Prof) M. Basu
Speaker- Dr. Anisha Chaudhary

4. • India has made considerable progress in improving survival of new borns and children.
• One major reason for this achievement – massive scale up of community and facility based care.
• A series of national level initiative has been launched by GoI under its flagship programmes
contributed to these , such as
- National rural health mission (2005)
- National urban health mission (2013)
- Ayushman Bharat (2018)

5. • Various maternal, newborn and child health initiatives programmes ( such as JSY , JSSK , Dakshta,
SUMAN, PMSMA , AMB, RBSK ) have been initiated for having better outcomes for newborns and
children.
• These initiatives have significant impact on newborn and child mortality and morbidity.
( NMR : 44 / 1000 LB in 2000 – 20 /1000, U5 : 96 to 32)

6. Improving maternal and child health has been on the top health priorities of GoI
Primary health care
Comprehensive primary health care

7. • A systemic approach under NQAS implementation has established a well structured institutional
framework from the facility level to the national level.
• There is an inbuilt system of State and National level certification of health facilities those
exhibiting compliance to NQAS norms and sustaing also.

8. INTRODUCTION
• Effects over the past decade to minimise adverse outcomes for newborns and children have been
directed for increasing access to institutional care , which resulted in higher footfalls in health
facilities.
• With increasing utilisation of health services, poor quality of care ( QoC) became a major
roadblock in the quest to end preventable mortality and morbidity.
• For ensuring child friendly services in public health facilities, MoHFW is introducing a new
QUALITY improvement initiative “MusQan” for the pediatric age group (0-12 years) , within the
existing National Quality Assurance Standards ( NQAS) framework.

9. MusQan aims to ensure quality services in public health care facilities, which is :
• Timely
• Effective
• Efficient
• Safe
• Person-centred
• Equaitable
• Integrated

10. GOAL :
MusQan aims to ensure provision of quality child –friendly services in public health facilities to
reduce preventable newborn and child morbidity and mortality.

11. OBJECTIVES
• To reduce preventable mortality and morbidity among children below 12 years of age
• To enhance QoC as per NQAS
• To promote adherence to evidence based practices and standard treatment guidelines and protocols
• To provide child friendly services to newborn and children in humane and supportive environment
• To enhance satisfaction of mother and family, seeking healthcare for their child

12. Provision of child friendly services

14. Framework of MusQan quality initiative and key actions

15. Breastfeeding Corner

16. Child friendly ambience

17. Transforming facility to child friendly facility

18. MusQan Institutional Framework

19. Roles and Responsibilities at the Facility Level
• Ensuring adherence to protocols and key clinical practices
• Conduct regular assessments using NQAS checklists
• Prioritisation and action planning for traversing the gaps
• Ensure achievement of indicators using RI events approaches
• The quality circles shall undertake various RI events for improving outcome indicators leading to
achievement of defined targets

20. Roles & Responsibilities at the District Level
• Mentoring of the facilities or department level quality circles
• Capacity building of facility staff for undertaking assessment, generating scores, measuring target
indicators, progression on quality and clinical care practices, gaps using improvement cycles
• Ensure conduct of baseline assessment of targeted health facilities within stipulated timelines
and measurement of key performance indicators
• Competence assessment of staffs deputed in various departments

21. • Conduct assessment and prepare facilities for state and national assessment and certification
• Ensure regular reporting of indicators to the state and validate reported data at regular intervals
or as and when required
• Provide onsite support to the regularly low/ underperforming facilities

22. Roles & Responsibilities at the State Level
• Ensure availability of required technical resources, such as programme guidelines, standard
treatment protocols, standard operating procedures, etc
• Capacity building of quality team and departmlent quality circles
• Ensure conduct of baseline assessment of targeted health facilities within stipulated timeline ,
and measurement of the key performance indicators
• Mobilise state support, including provision of human resources, drugs, equipment, finance and
other inputs

23. • Develop resource materials/tools for competency evaluation, and organise trainings for skill
enhancement of both clinical and non clinical staffs
• Provide onsite support to continuously underperforming facilities
• Provide inputs for improvement in guidelines and ensure implementation of recommended
mid course corrections
• Organise and undertake state level assessments and provide support for the national
certification
• Ensure regular monitoring and validation of indicators at the State level. Also support reporting
of indicators at the national level

24. Roles & Responsibilities of Central Quality Supervisory Committee
(CQSC)
• Dissemination of guidelines, standards and assessment tools to the state
• Ensure orientation, capacity building and continuous support for MusQan’s implementation
• Conduct periodic visits to the state and provide mentoring to a sample of health facilities
• Recommend mid course corrections, whenever required
• Ensure a system for reporting and sharing State’s achievements in terms of indicator/ target improvement of
services
• Handhold Quality Assurance Committee and units at the State level
• Develop monitoring and evaluation protocols and ensure their implementation

25. MusQan – Operational Framework
• Essential quality circle at each department
• Conduct assessment using NQAS and measure Performance indicators
• Identify gaps and perform Root Cause Analysis
• Plan interventions and RI events – PDCA
• Filling the gaps in time-bound manner
• Achieve MusQan Certification and targets
• Sustenance

26. Departments

28. Rapid Improvement Events
1. Providing emergency services
2. Improving breastfeeding, temperature maintenance, KMC practices in eligible neonates and
developmental supportive care
3. Improving documentation and record management practices.
4. Ensuring improvement in infection prevention practices and reduction in Hospital Acquired
Infections
5. Ensuring implementation of clinical protocols such as rational use of Abx , oxygen, fluids etc
6. Providing respectful care and improving engagement of mothers and families and enhancing
parents’ and families’ satisfaction

29. Steps for implementation of MusQan at facility level
1. Constituting quality teams and quality circles at facility and department level, respectively
2. Assessing quality of care
3. Identifying critical gaps
4. Planning interventions and RI events
5. Undertaking improvement activities
6. Traversing gaps in a time bound manner
7. Certification
8. Surveillance

30. Assessment Method
• Observation
• Staff intervew
• Record review
• Patient review

31. Certification
• Internal assessment
• State level
• National level

32. Criteria for becoming a MusQan certified facility
• NQAS certification of SNCU/ NBSU , Pediatric ward, OPD and NRC
• Attainment of at least 75% or more facility level indicator .
It’s verification by national assessors at the time of external assessment and by SQAC at the time
of surveillance .
• 80% of the patient families are either satisfied or highly satisfied.
National assessors shall evaluate the component at the time of external assessment.

33. Incentive
Incentives will be awarded for three consecutive years subject to submission of surveillance report
by the states to QI division NHSRC and Child Health division of MoHFW. Surveillance will be done to
ascertain status of the NQAS scores , sustenance or further improvement of targets and parent
attendant group satisfaction scores.

34. Measuring, Improving and Learning
• MusQan initiativeis linked with 21 Key Performance Indicators (KPIs)
• Additional 3 indicators added later
E.g : Average waiting time for the initial assessment by physicians ,Follow up rate , Referral rate,
Mortality rate, LAMA rate
e.t.c
* Bed : nurse ratio, percent of doctors and staff nurses trained in FBNC and observership training,
newborn and cihild death audit on monthly basis

36. Checklist

37. A : Service Provision
A1 : Facility provides curative services
A2 : RMNCH services
A3 : Diagnostic services
A4: Facility provides services as indicated in National health scheme/ State health scheme
A5 : Support services and administrative services
A6: Health services provided at the facility are appropriate to community needs

38. B : Patient rights
B1 : Information to care seekers about available services
B2 : Services delivered is sensitive to gender, religious and cultural needs
B3 : Maintains privacy
B4 : Informing patients about their medical conditions and involving them in trt planning and
decision making
B5: Financial protection from cost of hospital services

39. C : Inputs
C1 : Infrastructure for delivery of assured services
C2: Physical safety including fire safety of infrastructure
C3: Adequate, qualified and trained staff
C4: Drugs and consumables required
C5: Equipments and instruments

40. Exercise
A couple visited nearby PHC to undergo abortion. When they reach the facility pre procedure
councelling is provided to them and referred the case to higher center, as facility is not providing
abortion services.
The scenario belongs to which standard?

41. During a surprise visit to a CHC in a NBSU , it was observed that newborns were referred to higher
facility with a referral slip. The staff informed that they were maintaining referral in and referral out
register to follow up the patients. However, as informed by the beneficiaries, referral vehicle was
not available to them for timely referral.
The scenario belongs to which standard?

42. Dr. Chandni Sharma , an assessor went to a DH for assessment. She observed that despite of being
an informed visit, the cleaning was not satisfactory. She discussed the matter with hospital
superintendent of the facility. She was informed that the cleaning service outsourced to an agency
with a political background and agency did not sent cleaning staffs since yesterday evening. They
managed to do the cleaning work with only 4 cleaning staffs of the agency.
Under which area of concern you will assign the non compliance?