LAQSHYA PROGRAMMEThe keep of Institutional births In india has doubled fro 38.7% to 78.9% in the desade 2015-16, according to ™ the National Family Health Survey . However, this Increase In coverage has not translated in connerarat reduction of maternal and newborn mortality and stilisirths. One of the major factors being inadequacies in the quality of care provided in health facilities 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 recognized 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 ‘Le enya Goatty improvement Initiative In labour room & maternity OT.BACKGROUND » 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 . » However, this increase in coverage has not translated in commensurate reduction of maternal and newborn mertality and stillbirths. ® One of the major factors being inadequacies in the quality of care provided in health facliities » Itls estimated that approximately 46% maternal deaths, over 40% stillbirths: agd 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 recognized mainly with respect fo care around labour and delivery and in the immediate postnatal period, » In this respect, Ministry of Health and Family Welfare has launched program ‘LaGshya’- quality improvement initiative in labour room & maternity OT,LAQSHYA- LABOUR ROOM QUALITY IMPROVEMENT NITIATIVE GUIDELINE » Started in 11th December 2017 » Goal-To reduce maternal and newborn mortality, morbidity and still births associated with care around delivery in labour room and maternity OT >» To ensure respectful maternity care. Certification, Incentives: 1. Qwgality Certification of Labour Room and/or OT - through the existing system Le as per protocol under the NQAS 2. Attainment of 75% of Facility level targets 3. Atleast 80% beneficiaries are satisfied with the care* Toreduce matemal and newborn mortality & morbidity due to APH, PPH, retained placenta, preterm, preeclampsia & eclampsia, obstructed labour, puerperal sepsis, newborn asphyxia, etc. = Toimprove Quality of care during the delivery and immediate ost-partum care, stabilization of complications and ensure imely referrals. * To enhance satisfaction of beneficiaries visiting the health facilities and provide Respectful Maternity Care (RMC) to all pregnant women attending the public health facility.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, matemity Operation Theatre and Obstetrics Intensive Care Units (ICUs) & High Dependency Units (HDUs) Scope 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ABOUR ROOM Do's Providing privacy to pregnant women during the intrapartum period, by way of separate labour room or at least a private cubicle Presence of birlh companion during the labour Freedom to comfortable birthing (squatting, etc.) Adherence fo Clinical protocols for management of labour Use of Labour beds instead of tables Place baby on mother's abdomen Initiation of Breast feeding within one hour of birth choose a position during standing. DON'TS. Induction and augmentation of labour without sound clinical indications Any verbal or physical abuse of the pregnant women Insisting on conventional lithotomy position for the delivery Immediate clamping and cutting of the umbilical cor Separating baby from the mother for routine care & procedure Out of Pocket Expenditures (OOPE) on drugs, diagnostics, including demand by the staff for ratuitous payment by families for celebration of the baby's birthN@QAS: AREAS OF CONCERN Service Patients’ Support Rights. Services > Se. Infection Quality Outcome Control Management 308 (NQAP) -National Quality Assurance Programme.HIERARCHY OF LAQSHYA TEAM “igure 1; Institutional Arrangement under NQAP & LaQshya => —— => rs _- => - --- — Se (NQAP) -National Quality Assurance Programme. (SQAC) -State Quality Assurance Committee, (DQAC) -District Quality Assurance CommitteeFigure 2: Components of QOC Improvement in Labour Room Assessment Improvement Enablers Outcome Dimensions (QOC) -Quality of Care