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FOR WOMEN, STILLBIRTHS, NEWBORNS, THE TIME OF HIGHEST RISK IS THE SAME

FOR WOMEN, STILLBIRTHS, NEWBORNS, THE TIME OF HIGHEST RISK IS THE SAME. GOAL & OBJECTIVES of LA Q SHYA. APH , PPH Retained placenta Preeclampsia & eclampsia etc. Reduce preventable maternal and newborn mortality, morbidity and stillbirths. Stabilization of complications

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FOR WOMEN, STILLBIRTHS, NEWBORNS, THE TIME OF HIGHEST RISK IS THE SAME

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  1. FOR WOMEN, STILLBIRTHS, NEWBORNS, THE TIME OF HIGHEST RISK IS THE SAME

  2. GOAL & OBJECTIVES of LAQSHYA • APH, PPH • Retained placenta • Preeclampsia & eclampsiaetc Reduce preventable maternal and newborn mortality, morbidity and stillbirths • Stabilization of complications • Timely referrals • Effective two-way follow-up Improve Quality of care during the delivery and immediate post-partum care • Respectful Maternity Care (RMC) Enhance satisfaction of beneficiaries

  3. QUALITY DRIVERS LEVEL QUALITY STRUCTURE PROGRAM STRUCTURE

  4. STRATEGIES Strategies Reorganizing / aligning LR & OT Dedicated Obstetric HDUs/ ICUs • Government medical college hospitals and high case-load district hospitals • For management and stabilization of the complications before referral to higher centres. Strict adherence to clinical protocols • As per ‘Labour Room Standardization Guidelines’ and ‘Maternal & Newborn Health Toolkit’

  5. Scope All Government Medical College Hospitals All District Hospitals & equivalent health facilities All designated FRUs and high case load CHCs with over 100 deliveries/ 60 (per month) in hills and desert areas

  6. INTERVENTIONS

  7. SUMMARY OF ACTIVITIES

  8. SIX RAPID IMPROVEMENT CYCLES

  9. Expected Outcomes Medical Colleges Rs. 6 lakhs Labour Room Certification Facility Level Incentives District Hospitals 75% achievement of targets for quality Rs. 3 lakhs 80% satisfaction of beneficiaries SDH/ CHCs Rs. 2 lakhs

  10. Platinum Badge – Achieving more than 90% Score • Gold Badge – Achieving More than 80% Score • Silver Badge – Achieving more than 70% Score

  11. NEXT STEPS Set up Institutional Structures – State Mentoring Groups, District Coaching Teams & Quality Circles Undertake baseline assessment and identify gaps Propose funds for gap filling in Annual PIPs Institute Mechanisms for collaborative work between Department of Health , Department of Medical Education & other stakeholders

  12. Operationalizing Obstetric ICUs and HDUs

  13. Challenge – High institutional maternal mortality • More than one third of maternal deaths recorded either at medical college hospitals or district hospitals • Majority of these mothers required critical care • Existing medical/surgical ICUs 100% occupied most of the time delaying critical care to pregnant mothers

  14. Operational guidelines to complement the already existing guidelines : • Human resource details • Capacity Building Plan • Equipment details • Recording and Reporting formats etc

  15. All Centres of Excellence to be proposed by 2018-19 PIP • All Hybrid ICUs & HDUs to be proposed in 2018-19 and 2019-20 PIP.

  16. Safe Delivery Application Empowering skilled birth attendants to provide a safer birth for mothers and newborns

  17. Developed in 2015 by Maternity Foundation in collaboration with the University of Copenhagen and the University of Southern Denmark • Tested in a randomized controlled trial in Ethiopia (2014) JAMA Pediatr. 2016;170(8):765-771. doi:10.1001/jamapediatrics.2016.0687. OSATS: Objective Structured Assessment of Technical Skills; KFQ: Key Feature Questions

  18. Results from field testing in 4 states in India (June 2017):

  19. KEY FEATURES Aligned to Government of India’s clinical guidelines Available in Hindi and English Easy availability for anytime direct access by end users Handy resource for facility staff to refresh knowledge on BEmONC signal functions Available for free-of-cost download mobile phones Offline access to entire content of App

  20. HOW TO GET THE APP?? • For GooglePlay goto:   https://play.google.com/store/apps/details?id=dk.maternity.safedelivery • For iTunes go to: https://itunes.apple.com/dk/app/safe-delivery/id985603707?l=da&mt=8 • Or simply search ‘Safe Delivery ‘ in either Switch between both versions on one device by going to "Settings" in the lower right corner of the App! Choose – India English/ India – Hindi Version Install

  21. Entitlement based assured, comprehensive & quality care to pregnant women – critical step towards Universal Health Coverage

  22. Key Components LaQshya| लक्ष्य (Labour Room Quality Improvement Initiative) Expected Outcomes LaQshya Badges – Platinum/ Gold/ Silver Labour Room Certification 75% achievement of targets for quality 80% satisfaction of beneficiaries Facility level Incentives Facility level Incentives Organization and standardization of Labour rooms, OTs and Obstetric HDUs/ ICUs as per national guidelines and standards Structured Quality Improvement efforts/processes to improve adherence to critical practices around childbirth Improved client satisfaction - “Respectful Maternity Care” (RMC).

  23. Safe Delivery App Videos Action Cards EDL Procedures mHealth tool for training of skilled birth attendants (SBA) Great value as a post-training reinforcement system and demonstration purposes. App has been field tested in four districts across 4 EAG States - found to be useful and easy to use by health workers Covers 7 signal functions of Basic Emergency Obstetric and Neonatal Care

  24. Guidelines for Obstetric HDU and ICU • Need for critical Care Units - More than one third of all maternal deaths are recorded either at medical college hospitals or district hospitals (MDR Software) • National Guidelines for Obstetric ICU/HDU were developed and released in 2016 • Operational guidelines to complement the already existing guidelines in terms of: • Human resource details • Capacity Building Plan • Equipment details • Recording and Reporting formats etc

  25. Goal GOAL Reduce preventable maternal and newborn mortality, morbidity and stillbirths associated with the care around delivery in Labour room and Maternity OT and ensure respectful maternity care.

  26. Interventions Interventions Components of QOC Improvement in Labour Room

  27. Introduction to the App • Instant access to evidence-based clinical guidelines on BEmONC • 7 signal BEmONC functions and 3 additional videos • Developed in 2015 by Maternity Foundation in collaboration with the University of Copenhagen and the University of Southern Denmark • Tested in a randomized controlled trial in Ethiopia (2014) • Significant increase in skills and knowledge of health workers using app. JAMA Pediatr. 2016;170(8):765-771. doi:10.1001/jamapediatrics.2016.0687. OSATS: Objective Structured Assessment of Technical Skills; KFQ: Key Feature Questions

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