The document discusses India's Labour Room Quality Improvement Initiative (LaQshya) which aims to improve quality of care in labour rooms and maternity operating theaters. The key points are: - LaQshya aims to reduce preventable maternal and newborn mortality, morbidity and stillbirths associated with delivery care. - Objectives include reducing mortality from various causes, improving quality of delivery care, ensuring timely referrals, and providing respectful maternity care. - Strategies include aligning labour room layouts and workflows, ensuring obstetric HDUs, and adhering to clinical protocols before referral. - The program targets government medical colleges, district hospitals, and other high-volume

1. Dr. Anjalatchi Muthukumaran
Vice principal
Era College of Nursing , Era University
,Lucknow 226003
Labour Room Quality Improvement
Initiative (LaQshya)
case report status

2. Point to be discussed
 About the Scheme
 Aim
 Goal
 Objectives
 Strategies
 Scope
 Institutional Arrangement
 Targets

3. About the Scheme
 After launch of the National Health Mission (NHM), there
has been substantial increase in the number of institutional
deliveries.
 However, this increase in the numbers has not resulted
into commensurate improvements in the key maternal and
new-born health indicators.
 It is estimated that approximately 46% maternal deaths,
over 40% stillbirths and 40% newborn deaths take place
on the day of the delivery.
 A transformational change in the processes related to the
care during the delivery, which essentially relates to intra-
partum and immediate postpartum care, is required to
achieve tangible results within short period of time.
 ‘LaQshya’ programme of the Ministry of Health and Family
Welfare aims at improving quality of care in labour room
and maternity Operation Theatre (OT).

4. Introduction
 It’s a multipronged approach focused at Intra-
partum and immediate postpartum period.
Aim
 To reduce preventable maternal and newborn
mortality, morbidity and stillbirths associated with
the care around delivery in Labour room and
Maternity Operation Theatre and ensure
respectful maternity care.

5. Objectives
 To reduce maternal and newborn mortality &
morbidity due to APH, PPH, retained placenta,
preterm, preeclampsia & eclampsia,
obstructed labour, puerperal sepsis, newborn
asphyxia, and sepsis, etc.
 To improve Quality of care during the delivery and
immediate post-partum care, stabilization of
complications and ensure timely referrals, and
enable an effective two-way follow-up system.
 To enhance satisfaction of beneficiaries visiting
the health facilities and provide Respectful
Maternity Care (RMC) to all pregnant women
attending the public health facility.

6. Strategies
 Reorganizing/aligning Labour room & Maternity
Operation Theatre layout and workflow as per ‘Labour
Room Standardization Guidelines’ and ‘Maternal &
Newborn Health Toolkit’ issued by the Ministry of
Health & Family Welfare, Government of India.
 Ensuring that at least all government medical college
hospitals and high case- load district hospitals have
dedicated obstetric HDUs 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 centres.

7. Scope of services
 Following facilities would be 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.

8. Institutional Arrangement
 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 structure.

9. Targets of the program
 Immediate (0-4 Months)
 80% of the selected Labour rooms & Maternity
OTs assess their quality and staff competence
using defined NQAS checklists and OSCE.
 80% of Labour rooms & Maternity OTs have
setup functional quality circles and facility level
quality tea ms.

10. Short Term (up to 8 Months)
 80% of Labour Room and OT Quality Circles are
oriented to latest labour room protocols, quality
improvement processes and respectful maternity care
(RMC).
 50% of deliveries take place in presence of the Birth
Companions.
 60% of deliveries conducted using safe birth checklist
and Safe Surgery Checklist in Labour Room &
Maternity OT respectively.
 60% of the deliveries are conducted using real-time
partograph.
 30% increase in Breast Feeding within one hour of
delivery
 80% labour rooms and Maternity OTs take
microbiological samples from defined areas every

11. Intermediate Term (Up to 12
Months)
 30% increase in antenatal corticosteroid administration in
case of preterm labour.
 30% reduction in pre-eclampsia, eclampsia& PIH related
mortality.
 30% reduction in APH/PPH related mortality.
 20% reduction in new-born asphyxia related admissions in
SNCUs for inborn deliveries.
 20% reduction in newborn sepsis rate in SNCUs for inborn
deliveries.
 20% reduction in Stillbirth rate.
 80% of all beneficiaries are either satisfied or highly
satisfied
 60% of the labour rooms are reorganized as per
‘Guidelines for Standardisation of Labour Rooms at
Delivery Points’.

12. Continued
 100% compliance to administration of Oxytocin,
immediately after birth.
 30% improvement in OSCE scores of labour room staff.
 100% Maternal death, Neonatal Death audit and clinical
discussion on near miss/maternal and neonatal
complications
 80% Labour Room and OTs are reporting zero stock-outs
of drugs and consumables.
 Long Term (up to 18 Months)
 60% of labour rooms achieve quality certification against
the NQAS.
 50% of labour rooms are linked to Obstetrics HDU/ICU.
 15% improvement in short term & Intermediate targets.
 After 18 months, this initiative would be continued through
sustained mentoring.

13. Integration of Safe Delivery App
 in LaQshya Safe Delivery Application is a mobile
based educational tool to improve the quality of
care around birth by empowering skilled birth
attendants on basic, emergency obstetric and
newborn care
 SDA supports improvement of quality of clinical
care in LaQshya program by promoting self-
learning and acting as a ready reckoner to
supplement the skill based trainings like SBA,
Dakshata, NSSK etc.

14. Total safe delivery app status

15. Achievements & Outcomes
 Capacity building is important step towards
LaQshya certification. A total of 1,920 health care
providers were trained on LaQshya across the 7
states.
 Training on Quality Improvement and QI tools
was done in 57 % of these training batches.
 Most states had separate training for Safe
Delivery App as it was introduced later, while
some incorporated the same in the ongoing
LaQshya trainings.
 Nearly 2,000 health care providers have been
trained on SDA. (Table 8)

16. Table :8 health care provider under
laqshya

17. Outcome of project
 Support to Aspirational Districts In the 7 Vriddhi supported states,
state support included district level focused support for 25
Aspirational districts (Jharkhand 19, Uttarakhand 2, Himachal
Pradesh 1, Punjab 2 and Haryana 1).
 In Odisha and Chhattisgarh support was provided from state
level only. The project supported:
 •Baseline assessment of prioritized facilities- 126 LRs and 102
maternity OTs in the ADs of 7 states.
 • Mentored LaQshya facilities in the ADs regularly and provided
need based inputs provided - training, capacity building, and
support for documentation.
 Outcome of the project support to medical colleges: 3 labor
rooms and 3 maternity OTs received state certification
 Outcome: In the 45 Aspirational Districts of the 7 states 60 units -
35 labor rooms and 25 maternity OTs- received state
certifications. Of these, of these 25 LRs and 12 maternity OTs
have achieved national certification

18. Document support for vriddhi
team

19. Five Criteria For laQshya
Certification

20. Leveraging PIP FUNDS for
Sustaining Interventions
 LaQshya Certification LaQshya certification is a
tangible outcome. All 7 project states have made
considerable progress towards it. In total there
have been 132 state certifications of LRs (78) and
OTs (54) in the project states. Out of these 86
have been National certified till September 2020
(LR – 51 and OT – 35). State wise details
LaQshya certification status is mentioned in Table
9.

21. Table : LaQshya certification
2020

22. Challenges & Learnings
The Common Challenges Included:
• Lack of stable leadership at state and district levels and
frequent change in the decision-making cadres slowed
down the implementation process.
• Over stretched state/district officers with multiple
responsibilities led to conflicting priorities at the state
and district level.
•LaQshya certification required infrastructure and equipment
as per quality standards. Timely procurement of equipment
and furnishings and infrastructure changes were a huge
challenge
Coordination between different departments (Maternal health
and Child health divisions; MH and State Quality division;
NHM and Medical Education and Research) was
challenging slowed down inter-departmental activities
towards a common goal

23. Infection Prevention Training
 The project developed a standardized
presentation on Infection prevention practices.
 Telephonic/online platforms were used to train the
labor room staff on Infection Prevention.
 5149 providers were trained on Infection
Prevention from April 2020 – August 2020.

24. COVID-19 Module for Safe Delivery
App
 Vriddhi project as a technical partner of
Maternity Foundation, provided support for the
development of the COVID-19 Module for Safe
Delivery App.
 The COVID-19 Module was rolled out in the 7
states and orientation was given to staff of LRs in
Aspirational District and LaQshya facilities. 2115
users have enrolled as Learners for COVID-19
module in the Vriddhi supported states and 1886
have attained COVID-19 Expert level (As of
August 2020).

25. Client survey satisfactory report
 Improving Client Experience in a Medical College
in Jharkhand Rajendra Institute of Medical
Sciences, Ranchi, Jharkhand reported low scores
for availability and quality of food (3.66/5) in the
month of July 2019.
 The facility conducted several rounds of
sensitisation meetings with kitchen staff and
catering vendors, and also informed the
appropriate authorities. And the score improved
to 4.28/5 in the month of November 2019.

26. Thank you so much for listening