its one of the quality improvement for labour room especially during intranatal care services

1. D R . A N J A L A T C H I M U T H U K U M A R A N
V I C E P R I N C I P A L
E R A C O L L E G E O F N U R S I N G , E R A
U N I V E R S I T Y , L U C K N O W 2 2 6 0 0 3
LABOUR ROOM & QUALITY
IMPROVEMENT INITIATIVE

2. Background of the laQshya guidelines
 The percentage of institutional births in India has doubled
from 38.7% to 78.9% in the decade 2015-16, according to
the National Family Health Survey (NFHS-4).
 However, this increase in coverage has not translated in
commensurate reduction of maternal and newborn mortality
and stillbirths.
 One of the major factors being inadequacies in the
quality of care provided in health facilities.
 The current figures of maternal mortality ratio of 130
and neonatal mortality rate of 24 suggest that though
there has been tremendous improvement in maternal
newborn healthcare indicators, there still exists a vast scope to
achieve the targets set for our country.

3. Continued
 It is estimated that approximately 46% maternal
deaths, over 40% stillbirths and 25% of under-5
deaths take place on the day of the delivery.
 Half of the maternal death each year can be prevented if
we provide higher quality health care.
 Quality of care is increasingly recognized as a critical
aspect of the unfinished maternal and newborn health
agenda, mainly with respect to care around labour and
delivery and in the immediate postnatal period.
 In this respect, Ministry of Health and Family Welfare
has launched program ‘LaQshya’- quality improvement
initiative in labour room & maternity OT, aimed at
improving quality of care for mothers and newborn
during intra-partum and immediate post-partum period.

4. Overview of LaQshya
 Ministry of Health & Family Welfare, Government of
India launched an ambitious program LaQshyaon
11th December 2017 with following objectives:
 Reduce maternal and newborn morbidity and
mortality
 Improve quality of care during delivery and
immediate post-partum period
 Enhance satisfaction of beneficiaries, positive
birthing experience and provide Respectful
Maternity Care (RMC) to all pregnant women
attending public health facilities.

5. Target Beneficiaries
 LaQshya program will benefit every pregnant woman
and newborn delivering in public health institutions.
 Program will improve quality of care for pregnant
women in labour room, maternity Operation Theatre
and Obstetrics Intensive Care Units (ICUs) & High
Dependency Units (HDUs).

6. LaQshya initiative on priority Area
Following facilities are being taken under
LaQshya initiative on priority:
 All Government Medical College hospitals.
 All District Hospitals & equivalent healthy facilities.
 All designated FRUs and high case load CHCs with
over 100 deliveries/60 (per month) in hills and
desert areas.

7. Institutional Arrangements
Under the National Health Mission, the States have been
supported in creating Institutional framework for the
Quality Assurance – State Quality Assurance Committee
(SQAC), District Quality Assurance Committee (DQAC),
and Quality Team at the facility level.
These committees will also support implementation of
LaQshya interventions. For specific technical activities
and program management, special purpose groups have
been suggested, and these groups will be working
towards achievement of specific targets and program
milestones in close coordination with relevant structures
within institutional arrangement the QA organizational
framework.

8. Key Features of the program:
 LaQshya program envisages to improve quality of care in labour
room and maternity OT.
 Under the initiative, multi-pronged strategy has been adopted such
as improving Infrastructure up gradation, ensuring availability of
essential equipment, providing adequate Human Resources,
capacity building of health care workers and improving quality
processes in labour room.
 Implementation of ‘fast-track’ interventions (NQAS assessment,
Trainings, Mentoring, Reviews etc.)
 Capacity-building of healthcare workers by skill-based training like
Dakshta & improving quality processes in the labour room.
 To strengthen critical care in Obstetrics, dedicated Obstetric ICUs at
Medical College Hospital level and Obstetric HDUs at District
Hospital are operationalized under LaQshya program.

9. LAQSHYA Strategies
 Reorganizing/aligning Labour Room & Maternity Operation
Theatre layout as per Standard Guidelines issued by the Ministry of
Health & Family Welfare, Government of India.
 Ensuring all Government Medical College Hospitals, District
Hospitals have dedicated obstetric HDUs and Obstetric ICU as per
GoI MOHFW Guidelines, for managing complicated pregnancies
that require life-saving critical care.
 Ensuring strict adherence to clinical protocols for management and
stabilization of the complications before referral to higher centers.
 Continued mentoring and hand holding support to improvise skills.
 Regular MDSR, C-section audit and Referral audits & linkage
among lower level facilities.
 Collating best quality practices across States which can be replicated
by other States.

10. Quality Improvement cycles-
 6 focused quality improvement cycles (Documentation,
RMC, Timely management of complications in
pregnancy, judicious use of oxytocin, essential and
emergency newborn care, infection prevention and
biomedical waste management) each for two months.
 First month for improvement followed by second month
for sustaining improvement.
 Improvement using PDCA approach and quality tools.
 Each cycle supported by onsite coaching team visits.
 Support resource package for each cycle.
 Onsite training and monitoring by coaches.
 Documentation of improvement activities.

11. Digital Innovation
 LaQshya Web portal- All LaQshya related data will
be uploaded on the portal for prompt report
generation as well as visualization of dashboard to
monitor progress in key maternal new born
indicators at various levels (facility, District, State &
National)
 Safe delivery App- Job aid as well as training tool for
health workers.

12. Certification, Incentives & Branding
 Quality Improvement in labour room and maternity OT will
be assessed through NQAS (National Quality Assurance
Standards). Every facility achieving 70% score on NQAS will
be certified as LaQshya certified facility.
 Furthermore, branding of LaQshya certified facilities will be
done as per the NQAS score. Facilities scoring more than
90%, 80% and 70% will be given Platinum, Gold and Silver
badge accordingly.
 Facilities achieving NQAS certification, defined quality
indicators and 80% satisfied beneficiaries will be provided
incentive of Rs. 6 lakhs, Rs.3 lakhs and Rs.2 lakhs for Medical
College Hospital, District Hospital and FRUs respectively.


13. Laqshya initiative
 New innovations for escalating quality of health care
services for mothers & newborn.
 Increased satisfaction of beneficiaries and positive
Birthing experience.
 Increased demand of services from beneficiaries of public
health facilities.
 LaQshya certification of all health facilities.
 Sustained efforts to achieve SDG targets and goals
related to maternal newborn health.
 Maintain and accelerate unprecedented progress – end
all preventable maternal, newborn and child deaths.

14. Present status of laqshya initiative
 A total 360 LRs and 305 Maternity OTs across 7
states were prioritized for LaQshya certification.
 Out of these the project in consultation with the state
prioritized 55 LR and 45 OTs for State certification
by December 2020.
 The target was achieved in December 2019 and an
addition 36 LR and 16 maternity OTs were taken up
by the project to support their state certification.

15. Thank you so much for listening ….