Evaluation of the Implementation of Laqshya Initiative Programme In Labour Room at District Hospital, Mulugu, Telangana

Maternal and new-born health remains one of the most significant and pressing public health challenges globally, with disparities sharply defined across economic and geographic boundaries. Despite concerted international and national efforts, including the push toward the Sustainable Development Goals (SDG 3.1 and 3.2), India carries a disproportionately high share of the global burden of maternal and new-born mortality [1]. Effective policies must target the crucial period of intrapartum and immediate postpartum care, as the majority of preventable maternal and neonatal deaths occur due to complications during delivery and the first 24 hours of life[2]. A consistent finding in implementation research is that these adverse outcomes are often linked not just to a lack of resources, but to suboptimal quality of care (QoC) and system inefficiencies within facilities [3]. To address this critical gap in quality, the Ministry of Health and Family Welfare, Government of India, launched the LaQshya (Labour Room Quality Improvement Initiative) program. This ambitious, national-level initiative operates on a time-bound, multi-pronged framework designed to ensure sustained improvement in the quality of care provided in all public health labour rooms and maternity operation theatres. The core objective of LaQshya is to reduce preventable maternal and new-born mortality and morbidity by standardizing services across three interconnected pillars: Infrastructure and Equipment, Clinical Processes and Protocols, and Human Resources and Capacity [4]. Previous studies evaluating national quality improvement initiatives have consistently highlighted that successful implementation hinges on factors assessed in this research, including:

• Adequate Staffing and Training: Research has shown that even with clear protocols, high patient load and critical staff shortages often lead to protocol non-adherence and burnout, directly compromising care quality [5].
• Knowledge Gaps: While training is provided, inconsistent knowledge retention among healthcare providers (Doctors, Staff Nurses, and Midwives) regarding critical protocols, such as Active Management of Third Stage of Labour (AMTSL) and new-born resuscitation, remains a persistent barrier to high implementation fidelity [6].
• Respectful Maternity Care (RMC): The integration of RMC, which addresses issues of dignity, privacy, and non-abuse, is a key metric of quality. However, systemic barriers, including lack of privacy screens and institutional policies prohibiting birth companions, are often reported as major obstacles at the facility level [7].

The current study focuses on the District Hospital, Mulugu, Telangana, India, which serves as the sole tertiary-level public healthcare provider for a vast, newly formed district. This region is characterized by a significant rural and historically marginalized tribal population, creating specific public health challenges related to geographical accessibility, cultural sensitivity, and resource allocation [8]. Operating as a 24/7, 220-bed capacity facility with high-risk specialized units, including a dedicated Labour Room, Maternity Operation Theatre, and Special New-born Care Unit (SNCU), the hospital represents a high-volume, resource-constrained environment where the gap between policy intent and operational reality can be most pronounced. Given the complex interplay between national policy, facility characteristics, and staff competency, a systematic, localized evaluation is essential. Existing literature often relies on audit data or focuses on metropolitan centres, leaving a significant gap regarding the practical challenges, implementation fidelity, and specific staff perceptions in rural district hospitals like Mulugu. This study aimed to systematically evaluate LaQshya implementation at the District Hospital, Mulugu, Telangana, and assess staff knowledge, skills, and adherence to standardized maternal and new-born care protocols.

METHODOLOGY

Study Design and Setting

This research employed a descriptive, cross-sectional, mixed-methods design to systematically evaluate the implementation status of the LaQshya initiative. Data were collected at a single point in time across a three-month period (April to June 2025) in the Labour Room of the District Hospital, Mulugu, Telangana, India. This hospital serves as the primary referral centre for a high-volume, resource-constrained district.

Study Population and Sampling

The study population comprised all healthcare professionals (HCPs) directly involved in Labour Room care, including Medical Officers and Staff Nurses. A convenience sample of N=30 was selected for in-depth data collection.

Data Collection Tools

Two primary instruments, based on National Quality Assurance Standards (NQAS) and LaQshya guidelines, were used:

1. Observational Checklist: Collected quantitative data on objective clinical practices, skills, infrastructure, and infection control.
2. Semi-structured Interview Schedule: Collected data on staff knowledge, attitudes, and perceptions, specifically focusing on LaQshya objectives, Continuous Quality Improvement (CQI) cycles, and Respectful Maternity Care (RMC).

Both tools underwent pre-testing and content validation by subject-matter experts to ensure clarity and scientific alignment with the study objectives.

Data Analysis

Quantitative data (from the checklist and closed-ended questions) were analysed using descriptive statistics (frequencies, percentages) using statistical software MS-Excel.

RESULTS

This descriptive cross-sectional study was conducted to evaluate the baseline implementation status of the LaQshya quality improvement initiative by surveying N=30 healthcare providers (HCPs) at the Labour Room of the District Hospital, Mulugu, Telangana. The participant cohort included 18 doctors (60.0%) and 12 nursing staff (40.0%).

Table 1: Demographic Characteristics of Participants

The study population demonstrated a relatively mature and experienced composition, with the largest age group being 30–39 years, comprising 36.7% (n=11) of the total sample. A significant portion of the staff (23.3%, n=7) were senior professionals aged 50–59 years, signalling a substantial presence of long-tenured personnel. The staff composition was overwhelmingly female (n=24, 80.0%), with all nursing staff being female and two-thirds of the doctors being female. reflecting typical gender ratios in the maternal and nursing workforce. Hindu participants formed the dominant group, representing 73.3% (n=22) of the sample. Christian participants accounted for 23.3% (n=7), with a single Muslim participant making up the remaining 3.3% (n=1).  The collective tenure within the labour room was high. The staff exhibited deep institutional knowledge, with the largest segment, 36.7% (n=11), reporting more than 10 years of experience in the labour room. This highly experienced group was predominantly composed of doctors (n=8). Furthermore, 20.0% (n=6) reported 6-10 years of experience, all of whom were doctors. Only 6.7% (n=2) reported less than one year of experience, indicating high tenure and low recent turnover within the specialized labour room setting which suggests a high level of collective stability and clinical expertise in the department.