Experiences in nine medical colleges in India have shed light on how the institutions can play a critical role in strengthening maternal, infant, and young child nutrition (MIYCN). The experiences have been summarized in a series of case studies developed by Alive & Thrive.
“In India, medical colleges are strategically placed in the health care delivery system, making them an excellent platform to apply the latest scientific evidence to improve the quality of care,” explained Dr. Sebanti Ghosh, the director of Alive & Thrive’s program in India. “With the right support, these colleges and their attached hospitals can play a critical role in strengthening MIYCN.”
Improving MIYCN practices via medical colleges could potentially reach a significant number of doctors. About 50,000 students graduate every year from Bachelor of Medicine and Bachelor of Surgery programs at 542 government colleges across the country recognized by the Medical Council of India. The schools enroll about 65,000 students annually and place doctors throughout the country.
After a 2017 baseline assessment indicated significant gaps in MIYCN knowledge, A&T forged partnerships with nine government medical colleges in Bihar and Uttar Pradesh states to address the gaps. The goal of the partnerships was to build the capacity of future generations of medical practitioners in evidence-based MIYCN practices by strengthening the undergraduate medical curriculum and improving the quality of MIYCN service delivery at critical contact points in the attached hospitals and district health facilities.
With Alive & Thrive support, stakeholders developed a roadmap and an implementation plan to address the identified knowledge gaps. Expert committees were formed at the state and national level comprised of the college principals/deans, senior national experts, faculty members from the departments of Paediatrics, Obstetrics and Gynaecology (OBGY), Community Medicine (CFM), and Preventive and Social Medicine (PSM), partner medical colleges, and senior government officials from the Directorate of Medical Education (DGME) and State National Health Mission under the Health Department.
The committees had the ability to revise the undergraduate curriculum and update service delivery protocols at hospitals. A competency-based national curriculum was subsequently developed, which medical colleges can opt to use.
Within the hospitals attached to each college, a coach worked with medical teams to show them how to apply Point of Care Quality Improvement (POCQI) to address MIYCN service delivery gaps (like delayed initiation of breastfeeding). They looked at the processes underlying an identified problem and developed and implemented ways to address it and test and monitor the impact on practices.
“The training and support by Alive & Thrive on MIYCN and quality improvement have enabled the team to ensure early initiation of breastfeeding, even in C-section delivery,” said Dr. Jyoti Bala, Head of Department, Obstetrics and Gynecology, at the Anugraha Narayan Magadh Medical College and Hospital in Gaya, Bihar State. “My team feels proud being a pioneer practicing this in our medical college hospital. Our efforts are giving results, which are being appreciated and replicated in other hospitals.”
The case studies demonstrate the application of the POCQI approach and show some of the specific steps that the nutrition and medical community can take to improve key indicators for MIYCN.