Web-based reverse tracking of anaemic and hypertensive pregnant women to monitor quality of integrated antenatal care in Haryana India

Anaemia and postpartum haemorrhage continue to be major cause of maternal deaths (around 45%) in Haryana India. More than two-thirds of all pregnant women are either severely or moderately anaemic in the state. More than 90% women get at least one antenatal care (ANC), but the quality of antenatal care (ANC) given by midwives was found to be suboptimal in mid-2012 at the health Sub-centres (SCs). Truthful assessment and control of anaemia and hypertension for pregnant women was found to be unsatisfactory in the state. Description and methods: The midwives working at SCs were monitored through supportive supervision exercise for quality ANC of pregnant women. All necessary equipment, reagents were provided and refresher on-site trainings were provided to midwives. Pregnant full-term women were assessed for anaemia, hypertension, urine sugar and albumin when they reported for delivery at public health facilities. All data was entered into a web-based anaemia tracking module (ATM) to assess and track the quality of ANC provided at around 2500 SCs in all 21 districts of the state. Results: Almost 8.5% of full term pregnant women (out of 58464 women) were assessed as severely anaemia, 58.6% moderately anaemic, and 6.1% women were hypertensive when they reported at public health facilities for deliveries. Almost 22% of women were severely anaemia in backward and minority district of Mewat. Based on demographic data of women, around 400 SCs have been identified (16% of total 2500 SCs), where quality of ANC was found to be severely compromised. Monthly assessment of data is done to update the list of such SCs. Conclusions and Discussion: Data and information systems have been harnessed in the state to provide evidence to address the problem of sub-optimal ANC in the state. This provides an innovative solution to monitor the quality of ANC done by midwives at SCs, and have made them accountable for providing integrated quality care to pregnant women.