Quality improvement collaborative to increase access to caesarean sections: lessons from Bihar, India

Area of Science:

• Global Health
• Health Systems Strengthening
• Surgical Access

Background:

• Resource-poor health systems face challenges in providing quality caesarean sections (C-sections).
• C-section access in Bihar State remains critically low compared to other regions.
• Public health facilities are central to addressing disparities in surgical care.

Purpose of the Study:

• To implement and test quality improvement (QI) strategies combined with resource management to increase C-section delivery.
• To evaluate the impact of interventions on C-section rates in public hospitals.
• To identify drivers of improvement and sustainability for C-section services.

Main Methods:

• A quality improvement (QI) collaborative model was implemented in eight hospitals.
• Interventions focused on targeted resource management and system changes.
• C-section delivery percentages were compared between intervened (QI) and non-intervened (non-QI) hospitals.

Main Results:

• C-section rates in QI hospitals increased from 2.9% to 5.9% during the intervention phase.
• Non-QI hospitals showed minimal change (2.6% to 3.3%) during the same period.
• Adding skilled personnel significantly boosted C-section rates in QI hospitals (3.6% to 5.9%).

Conclusions:

• Quality improvement initiatives effectively increased C-section availability in a low-income setting.
• Resource addition alone, without system change interventions, is insufficient to improve C-section rates.
• The adaptive implementation model shows promise for resource-limited settings seeking to expand C-section access.