April 2017

Many travelers to India, my home country, seek out the "golden triangle" that is Delhi, Agra and Jaipur – three distinct destinations, each place offering something different and beautiful and essential to the visitor's experience.

The development community for maternal and child healthcare has its own golden triangle, and it too represents the potentially powerful connection between three points. It is the effective force for change that you get when government, business and civil society all work together toward a common goal – to deliver quality care for the best outcomes.

And that is precisely the kind of multi-sectoral collaboration that is happening in India right now, in an effort to address the issue of maternal and infant mortality and morbidity: a public-private partnership, spearheaded by MSD for Mothers, to sustainably improve quality of care that women receive during childbirth, reduce unnecessary risks, and help end preventable maternal deaths.

I stand on the civil society side of things, as an obstetrician in private practice for over three decades and a president of the Federation of Obstetric and Gynaecological Societies of India (FOGSI) – a national professional association with a membership of over 33,000 specialist OB/GYNs. We are a passionate group dedicated to improving care both in the public and private sector. We are focused presently on an initiative in the private sector, where such a surprisingly high proportion of women turn to seek care. It has been our privilege to work with Jhpiego, an affiliate of Johns Hopkins University and chief implementer of this MSD-supported quality improvement initiative.

During the initial scoping for this program, which began during my term as FOGSI president in 2013, we discovered that many private facilities, even those that had been in business for 5 to 10 years and even longer, were not following recognized, evidence-based, quality standards of care in their labor and delivery wards. They did not have the necessary emergency protocols in place to prevent complications, relying heavily on specialists to manage complications instead.

To bridge this gap between the frontline healthcare providers and the specialists, we created a quality improvement program that emphasized team-based approaches. We worked with nearly 150 facility teams in Jharkhand and Uttar Pradesh to improve their practices. FOGSI members assisted the Jhpiego-led trainings and on-site mentoring, and with some follow up support and a little hand holding, helped their peers build their skills and capacities for delivering quality care. We found that nurses, by changing their own behaviors, serve as powerful change agents.

Once you improve quality, the next step is to assure it, and make it sustainable. And so, through this partnership effort, we are also working with the government to establish a process by which these facilities can achieve accreditation, an official stamp of approval that both recognizes and motivates care quality and increases trust between provider and patient. Peer recognition is a powerful incentive. We are also working with payors – both the government and private insurers – to require quality certification, to help increase the financial incentive for private providers to achieve it.

Going forward, we will continue supporting efforts to bring care quality improvement to more providers in more states across India through the Manyata initiative. As part of that, we are establishing 20 Quality Improvement Hubs (QI Hubs), where we will continue to provide tools and mentorship; where FOGSI volunteers can continue to play a pivotal role in helping providers improve and sustain stronger skill sets; and where providers who have already been through the process will be able to share their experiences. FOGSI champions like me will continue to act as conveners, getting the right people together, generating buzz and attracting interest and participation in the QI program. There are thousands upon thousands of private facilities that need to get involved in this – whether they have five beds in their maternity wing or 50.

As FOGSI ambassador to the Federation of International Gynaecologists and Obstetricians, or FIGO, it is my dream to share our approach and lessons learned with other countries that could benefit, countries in Southeast Asia and Africa that face similar challenges. I was thrilled to represent the MSD-FOGSI-Jhpiego partnership at a recent workshop organized by the World Health Organization in Malawi, where I met maternal health advocates from Uganda, Nigeria, Kenya, Nepal and Bangladesh, to name a few. It was a wonderful opportunity to discuss the role of professional associations in care quality improvement, as USAID and other stakeholders look for solutions.

Working together, we can transform how the broader global health community looks at private sector care. We can help ensure that women get the care they deserve, no matter where they seek it. We are determined to make a difference.

Dr. Hema Divakar

Obstetrician and Medical Director of Divakars Speciality Hospital


Image: Hema Divakar

Dr. Hema Divakar is an obstetrician and medical director of Divakars Speciality Hospital, a privately owned facility in Bengaluru, Karnataka, India. In 2013 she served as president of the Federation of Obstetric and Gynaecological Societies of India (FOGSI), a professional association representing some 33,000 OBGYN practitioners, 80% of whom work in the private sector. In January 2016 she was elected as FOGSI Ambassador to the Federation of International Gynaecologists and Obstetricians, FOGSI's global counterpart with a membership representing 138 countries.


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