Article Text

Download PDFPDF

Improving quality of antenatal care services in a high case load tertiary care teaching hospital (Ganesh Shankar Vidyarthi Memorial (GSVM) Medical College) in Kanpur, Uttar Pradesh, India
  1. Praveen Kumar Sharma1,
  2. Sebanti Ghosh1,
  3. Vikrant Prabhakar2,
  4. Mahtab Singh1,
  5. Thomas Forissier1,
  6. Rajendra Prasad1,
  7. Anjali Datta1,
  8. Benazir Patil1,
  9. Kiran Pandey3,
  10. Neena Gupta3,
  11. Seema Nigam4
  1. 1 Alive & Thrive, FHI 360 India, New Delhi, Delhi, India
  2. 2 Department of Community Medicine, Adesh Medical College & Hospital, Kurukshetra, Haryana, India
  3. 3 Department of Obstetrics and Gynecology, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, Uttar Pradesh, India
  4. 4 Department of Community Medicine, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, Uttar Pradesh, India
  1. Correspondence to Praveen Kumar Sharma; psharma{at}


In India, half of all pregnant women between the ages of 15 and 49 years are anaemic. In Uttar Pradesh (UP), this figure is slightly higher at 51%. Unfortunately, only 5.4% pregnant women received full antenatal care (ANC) (National Family Health Survey 4, 2015–2016). A formative research conducted in UP in 2016 found that only 9% of pregnant women in UP consume the five recommended food groups, as per global recommendations.

Ganesh Shankar Vidyarthi Memorial Medical College Hospital is one of the four high case load tertiary care facilities in Kanpur, UP, with an obstetrics and gynaecology (OBGY) outpatient department (OPD) of 2500–3000 consultations with delivery load of 250–300 deliveries per month and paediatric OPD of approximately 5400–6000 consultations per month. It was identified that pregnant women visiting the OPD for ANC were not receiving maternal nutrition-related services, and anthropometric measurements to assess nutritional status and gestational weight gain were also not done.

The department of OBGY decided to apply the four-step Point of Care Quality Improvement (POCQI) approach using Plan–Do–Study–Act cycle for implementation of the maternal nutrition protocol during ANC.

In April 2019, with the support of A&T, the hospital team applied the POCQI methodology to improve ANC service provision. By the end of 2019, the measurement and recording of anthropometric parameters increased to 84% and 74% for height and weight, respectively, from the baseline of zero. Hb testing increased from 58% to 84% and blood pressure (BP) monitoring from zero to 84%. Maternal nutrition counselling was delivered to 76% of the pregnant women visiting the OPD, which was a significant achievement for a new practice introduced into the system.

The improved practices identified and implemented by the department are being sustained through active engagement of the staff and supportive leadership of the department of OBGY.

  • quality improvement
  • quality improvement methodologies
  • women's health
  • healthcare quality improvement

Data availability statement

All data relevent to the study are included in the article or uploaded as supplementary information.

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

All data relevent to the study are included in the article or uploaded as supplementary information.

View Full Text


  • Twitter @parvisharma, @DrMahtabSingh1

  • Contributors PKS is responsible for overall content of the work. PKS, SG, VP, TF, KP, NG and SN were responsible for conceptualising the project and providing technical support to the project in terms of applying quality improvement methodology and service protocols. PKS, VP, MS, RP, AD, KP, NG and SN provided the mentoring support to the QI team in identification the problems through applying various tools, applying Plan–Do–Study–Act, etc, and collected the data. PKS, BP, SG, TF and VP analysed data and developed draft manuscripts. All listed authors have contributed significantly in various steps of project, starting from conceptualising, designing the project and in its conduct, compilation, analysis and contributing to the manuscript.

  • Funding Alive & Thrive is global project, Managed by FHI Solutions, funded by Bill & Melinda Gates Foundation, Grant ID OPP 1135090. Publication of this article is made open access with funding from the Bill and Melinda Gates Foundation.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.