Experiences and challenges during implementation of operational guidelines of Maternal Near Miss Review of the Government of India at tertiary hospitals in Maharashtra.

The Government of India released operational guidelines for Maternal Near Miss-Review (MNM-R) in December 2014 for implementation at all the tertiary hospitals in India. An implementation research study was conducted at two selected tertiary hospitals in Maharashtra to assess the feasibility of implementation of the MNM-R guidelines at these hospitals and document the experiences and challenges during this process. The study findings suggest that for implementation of MNMR guidelines at these tertiary hospitals, there is need of dedicated staff; revision of MNM facility based form and critical review of the criteria for identification of MNM cases. MNM meetings could not be conducted with Maternal Death Review Committee meetings as mentioned in the guidelines. More efforts are needed for follow-up of the implementation of the corrective measures recommended by the MNM Committee. The study findings indicate that it is feasible to implement the MNM-R guidelines at the tertiary hospitals, if the above points are considered at these hospitals.

Psychosocial impact of COVID-19 pandemic on healthcare workers in India & their perceptions on the way forward - A qualitative study.

Background & objectives: The healthcare system across the world has been overburdened due to the COVID-19 pandemic impacting healthcare workers (HCWs) in different ways. The present study provides an insight into the psychosocial challenges faced by the HCWs related to their work, family and personal well-being and the associated stigmas. Additionally, the coping mechanisms adopted by them and their perceptions on the interventions to address these challenges were also explored. Methods: A qualitative study was conducted between September and December 2020 through in-depth telephonic interviews using an interview guide among 111 HCWs who were involved in COVID-19 management across 10 States in India. Results: HCWs report major changes in work-life environment that included excessive workload with erratic timings accentuated with the extended duration of inconvenient personal protection equipment usage, periods of quarantine and long durations of separation from family. Family-related issues were manifold; the main challenge being separated from family, the challenge of caregiving, especially for females with infants and children, and fears around infecting family. Stigma from the community and peers fuelled by the fear of infection was manifested through avoidance and rejection. Coping strategies included peer, family support and the positive experiences manifested as appreciation and recognition for their contribution during the pandemic. Interpretation & conclusions: The study demonstrates the psychological burden of HCWs engaged with COVID-19 care services. The study findings point to need-based psychosocial interventions at the organizational, societal and individual levels. This includes a conducive working environment involving periodic evaluation of the HCW problems, rotation of workforce by engaging more staff, debunking of false information, community and HCW involvement in COVID sensitization to allay fears and prevent stigma associated with COVID-19 infection/transmission and finally need-based psychological support for them and their families.