Increased utilization of health services may not necessarily improve health outcomes unless the services are characterized by excellence in delivery along with other benchmarks for good quality. But improved quality of care does result in greater use of health facilities and better utilization of health services by individuals and communities, which in turn leads to better health outcomes.
In Nepal, the importance of quality is discussed in several government health plans (1-3), and a Quality Assurance (QA) system is described in the 2007 Policy on Quality Health Services (4). In safe abortion service (SAS), fundamental aspects of high-quality care include women’s care with respect to her social circumstances and individual needs, and delivery of accurate and appropriate information and counseling that supports women in making informed choice on safe abortion technology and post-abortion contraception (5). A hallmark of high-quality services is that which ensures confidentiality, privacy, respect and positive interactions between women and staff of the health facility (6).
To provide high-quality SAS, it is necessary to create an enabling environment and linkages with technical expertise in the facility so that service providers can translate their skills into practice and get support when needed, especially if there are complications. Safe abortion programs conducted in various countries have demonstrated that training for service providers is necessary but is not always sufficient to ensure that providers are competent, confident and able to practice their acquired knowledge and skills. In addition to wellmanaged competency based trainings, standards and guidelines, regular availability of supplies and technologies, clinical and programmatic support and supervision, and attitudes of providers and communities affect a provider’s ability to put skills into practice.
Ipas in coordination and collaboration with Family Health Division (FHD) has been implementing a clinical mentoring approach for several years with the objective of providing need-based support to the provider in delivering high-quality services. Clinical mentors are trained and experienced senior nurses or ob/gyns who can provide ongoing individual support to health-care providers in enhancing their skills in abortion care and related services. Clinical mentors provide appropriate clinical inputs as early as needed and help the provider in achieving competency and confidence.