Operationalization of LaQshya

LaQshya is a nationwide initiative of the MoHFW, which integrates various approaches of quality of care including quality assurance and quality improvement of Labor Rooms (LR) and maternity Operation Theatres (OT). Project support for LaQshya includes provision of a Program Management Unit (PMU) embedded in the MoHFW to support implementation of the initiative at national level, and in focus states. In addition to its support for certification of facilities under LaQshya, the project will introduce process and technical innovations to further deepen and accelerate the program goals.

Vriddhi in partnership with Laerdal Global Health is working to improve Fetal Heart Rate (FHR) monitoring by introducing a globally recommended device the FHR monitor “MOYO” at selected facilities. The intervention will test the usability and applicability of this device in public health care setting in India. Though a doppler device: MOYO offers considerable improvements over existing devices. The device is easy to use, provides both visual and auditory feedback, detects FHR in 5 seconds, filters out maternal heart rate, has an alarm to detect abnormal heart rate, provides history of last 30 minutes and enables the mother to move freely due to its portability and light weight.

Family Participatory Care (FPC) is an evidence-based intervention using a Quality, Equity and Dignity (QED) approach in which the parents and close relatives of small and sick newborn are trained in simple care practices and become full partners in care. Vriddhi is providing technical assistance to select project states for rolling out the FPC program. The roll out will include advocacy for inclusion of the FPC intervention in the state annual Program Implementation Plans (PIPs), supporting state level trainings, providing implementation support to select SNCUs within the LaQshya ambit, conducting periodic assessments for program monitoring and integrating FPC in state and district review meetings.

Facility Accreditation and Quality Improvement (QI) are the two major components of LaQshya. While accreditation is being tracked using the National Quality Assurance Program (NQAP) based LaQshya checklists, QI is being measured through a set of indicators targeting labor rooms and maternity operation theatres. However, to assess processes and outcomes in the district hospitals, Vriddhi is developing a comprehensive DH Quality of Care (QoC) Index (DQCI) using select HMIS and program indicators to help decision makers and program managers to identify and address issues and take corrective actions thereby improve service delivery mechanisms. The index can also be used at state and district level to track progress in quality improvement in state and district level.

The Vriddhi team has developed a standardized Special Newborn Care Units Quality of Care index (SQCI) to facilitate use of data from SNCUs. The index will triangulate data from service utilization, clinical practices and mortality outcome indicators to help identify issues and develop actionable solutions. The index will target SNCUs associated with district hospitals of project supported Aspirational Districts. It is envisaged that regular analysis and use of data from SNCUs will help to improve the quality of care and service delivery, which will contribute towards decreasing newborn morbidity and mortality.

There has been considerable progress in improving maternal and newborn Resource Center and many new policies and guidelines have been developed for further improvement. However, often the newer interventions need additional support and follow up for effective implementation with quality. Involving medical colleges in efforts to improve quality of clinical care is not a new concept, but the modalities for this support were unclear. Vriddhi is preparing an implementation model for partnering with Medical Colleges. The process involves defining institutional mechanisms, roles and responsibilities, scope of the engagement of medical colleges and expected outcomes. One medical college each has been identified in project states of Jharkhand and Uttarakhand to be developed as the Maternal and Newborn Health Resource Centre.

State teams of the project work closely with respective state governments for achieving the goals of LaQshya that is improving quality of labor rooms and maternity operation theatres and attaining desired standards for certification. The process involves listing of facilities and planning a phase-wise upgradation process, creating a baseline and gap identification, orientation and capacity building, mobilizing state, district and facility level mechanisms for gap closure to achieve certification standards. The project is supporting 100 units for intensive support in the first phase of LaQshya implementation.