SPARQ Project To Improve Care For Women In India, Kenya

UC San Francisco's Global Health Sciences is launching a new project to improve care for women in India and Kenya. The Strengthening People-centered Accessibility, Respect, and Quality (SPARQ) project, funded by the Bill and Melinda Gates Foundation and The David and Lucile Packard Foundation, will be led by Dominic Montagu, DrPH, associate professor of epidemiology and biostatistics and May Sudhinaraset, PhD, assistant professor of epidemiology and biostatistics.

Growing urbanization has driven enormous growth in the use of hospitals for maternal and reproductive health services, but this growth hides a critical shortcoming: Increased use is not leading to improvements to care as models predicted. Very often, this is not poor premises structural quality, but poor process quality including lack of respect, abuse, poor patient-provider communication and education, and lack of support for women which might include failing to respond to their preferences and cultural values. This poor service stops women from seeking care and coming to facilities for child birth, family planning, and other reproductive services. The SPARQ Project incorporates two related but independent streams of work that aim to improve the quality of people-centered care by identifying strategies that can be replicated and scaled up in local contexts and generalized to larger locales.

People-centered health care is identified by the World Health Organization as care that encapsulates the foremost consideration of the patient across all levels of health systems, and that is exactly what SPARQ intends to do by working in existing facilities in Kenya and India. Future plans include partnering with three hospitals in central Kenya and six in Uttar Pradesh, India, the team will be developing a metric to measure the effectiveness of interventions through use of adherence to procedures and refinement of delivery.

Project activities include:

• Develop and validate culturally appropriate measures of person-centered quality for delivery, family planning, and abortion services
• Collect baseline person-centered measures of women¹s experiences associated with seeking and receiving health care
• Conduct facility-level observations and in-depth interviews with women and providers to understand barriers to care 
• Implement, monitor and evaluate quality improvement cycles to determine which locally-generated initiatives can be adapted and scaled to other facilities

"Our goal [with SPARQ] is to work as partners with our collaborators in Kenya and India to understand what is failing from the perspectives of clients; why it¹s failing, from the perspective of providers and managers; and to work together to address the issues in ways that are measureable, affordable, and replicable," says Montagu.

With support from the Bill and Melinda Gates Foundation, the project will focus on quality measurement and improvement for facility-based maternal and newborn health and family planning; while funding from The Packard Foundation will support work on quality measurement and improvement for facility-based family planning and abortion. SPARQ is funded as a 4.5 year program with initial funding of $6.35 million (two-thirds Gates; one-third Packard), with an expectation of a supplement after completion of the first 18-month scoping exercise.

The SPARQ project is based within Global Health Sciences and the team includes partners in India (Public Health Foundation of India) and Kenya (Jacaranda Health and Mott MacDonald). Additional UCSF team members include assistant professor of epidemiology and biostatistics Nadia Diamond-Smith, PhD, MS, post-doctoral fellow Patience Afulani PhD, MD, MPH, research assistant Ruby Warnock, and program manager Sun Cotter.