LAQSHYA Program

Introduction

The LAQSHYA program is a targeted quality improvement initiative launched by the Ministry of Health and Family Welfare (MoHFW), Government of India. It aims to accelerate the decline of maternal mortality, neonatal mortality, and stillbirth rates by systematically improving the quality of care in Labor Rooms (LR) and Maternity Operation Theatres (MOT).

Core Objectives

• Reduce maternal and newborn morbidity and mortality, specifically aiming to reduce stillbirths and neonatal deaths due to birth asphyxia and sepsis.
• Improve the quality of care provided to pregnant women during delivery and the immediate postpartum period.
• Enhance the quality of care for the newborn immediately after birth in the delivery room.
• Ensure Respectful Maternity Care (RMC) for all pregnant women attending public health facilities.

Target Facilities

The initiative encompasses all public health facilities managing deliveries, prioritized as follows:

• Medical College Hospitals.
• District Hospitals (DH) and equivalent health facilities.
• Designated First Referral Units (FRUs) and high caseload Community Health Centers (CHCs) with over 100 deliveries per month (60 in hilly/desert areas).

Key Strategic Interventions

Infrastructure And Equipment Upgradation

• Standardization of Labor Room layout with dedicated triage areas.
• Establishment of fully equipped Newborn Care Corners (NBCC) within every Labor Room and MOT.
• Ensuring the availability of essential emergency drugs, functional radiant warmers, ambu bags, and oxygen delivery systems.

Human Resources And Capacity Building

• Competency-based training of doctors and nursing staff.
• Implementation of the "Dakshata" program for skill building in intrapartum care.
• Mandatory certification of staff in Navjaat Shishu Suraksha Karyakram (NSSK) for neonatal resuscitation.

Clinical Protocols And Quality Management

• Strict adherence to clinical guidelines for the management of pre-eclampsia, postpartum hemorrhage (PPH), and obstructed labor.
• Utilization of the WHO modified partograph for monitoring labor progress.
• Implementation of standardized triage protocols.
• Establishment of Quality Circles at the facility level for continuous monitoring and rapid problem-solving.

Pediatric And Neonatal Focus Areas Under LAQSHYA

For the pediatrician, LAQSHYA mandates strict compliance with immediate newborn care protocols:

• Essential Newborn Care (ENC): Standardized protocols for drying, tactile stimulation, and maintenance of the warm chain to prevent neonatal hypothermia.
• Resuscitation: Immediate availability of a trained provider capable of neonatal resuscitation (Golden Minute protocol) at every delivery.
• Cord Care: Practice of delayed cord clamping (1-3 minutes) in term and preterm vigorous infants to prevent neonatal anemia.
• Nutrition: Ensuring early skin-to-skin contact and initiation of exclusive breastfeeding within one hour of birth.
• Infection Prevention: Strict asepsis during delivery, clean cord care (no harmful applications), and prevention of health-care-associated infections (sepsis) through standardized hand hygiene and instrument sterilization.
• Preterm Care: Administration of antenatal corticosteroids for threatened preterm labor and immediate Kangaroo Mother Care (KMC) post-stabilization.

Certification And Evaluation Process

Facilities are assessed based on National Quality Assurance Standards (NQAS).

• Assessment Tiers: Internal assessment, State-level assessment, and National-level certification.
• Scoring Criteria: Facilities scoring >70% at the national level are certified as "Laqshya Certified".
• Financial Incentives: Certified facilities receive financial rewards based on their score:
  • Platinum Badge: >90% score.
  • Gold Badge: 80-89% score.
  • Silver Badge: 70-79% score.

Key Performance Indicators (Neonatal)

• Stillbirth rate (macerated and fresh).
• Neonatal mortality rate within the facility.
• Rate of newborn asphyxia (Apgar < 7 at 5 minutes).
• Percentage of newborns receiving skin-to-skin contact.
• Percentage of newborns initiating breastfeeding within one hour.