LAUSR

developed based on evidence based national and international guidelines. Quality Improvement and Patient Safety (QIPS): Jhpiego’s StandardsBased Management and Recognition– performance and quality improvement approach was adapted to produce a self-assessment checklist. The assessment was conducted bi-yearly followed by datadriven action plan. The assessment methodology was validated through lots quality assurance sampling process. QIPS score was calculated as percentage of elements that met the standard criteria. Statistical analysis: Training packages were recorded as binomial variable. Difference in QIPS score was calculated by subtracting the scores of baseline and last assessment. Data was skewed and had indelible outliers. Hence median and interquartile range was used for univariate analysis and Man-Whitney U test was used for bivariate analysis. Statistical significance cut off was set at 0.05. Analysis was stratified by type of facilities. SPSS version 24 (IBM, Chicago, USA) was used for analysis. Results: There were 112 CMW led clinics, 93 DOH facilities, 109 private facilities and 327 public private partnership led facilities. Preliminary analysis indicated that significant improvement in quality of antenatal, labor and delivery and postnatal care was observed in CMW centers that received trainings (p-value<0.001) as compared to those CMW centers that did not receive trainings. Similar results were observed among PPP led facilities. Ironically, no difference in quality score was observed in public and private facilities. Conclusion: The improvement in CMW and PPP led centers could be explain through Nolan’s model which states that ‘any initiative seeking system wide changes needs three essential elements; will, ideas and execution’. Our capacity building methodology was willingly accepted by CMWs and PPP facilities. The firm administrative support from the decision makers of these centers helped in aligned execution of the activities. Contrarily, the idea was not accepted with utter will by public and private facilities, hence smooth execution was hindered due to multiple factors including schedule conflicts, prolong training durations and indifferent attitude towards transformation for improvement. Reference 1. Nolan T.W., Execution of strategic improvement initiatives to produce system-level results, Innovation Series white paper, 2007.