'Dakshata Program' Dr. Swati Sharma NIHFW

1. DAKSHATA
Empowering Providers for Improved MNH Care during Institutional
Deliveries
A strategic initiative to strengthen quality of intra- and immediate postpartum care
Dr. Swati Sharma
BDS (Pt.B.D Sharma Uni., Rohtak)
PGDPHM(student)
(NIHFW)

2. • A strategic initiative to strengthen
quality of intra- and immediate
postpartum care
• Maternal Health Division Ministry of
Health and Family Welfare
Government of India
• DAKSHATA Empowering Providers for
Improved MNH Care during
Institutional Deliveries
• April 2015
Pregnancy and motherhood are the most beautiful and significantly life-altering events that one can ever experience

3. • The recently launched India Newborn
Action Plan (INAP) recognizes quality of
intra-partum and immediate post partum
care as an important pillar.
• The program brings together maternal and
new born interventions under one umbrella.
• ‘Day of birth’ - uses unique combination of
services.

4. NHM
RMNCH+A
Maternal Health Dakshata
(Mission)
(Approach)/
(Strategy)
(Program)
{maternal care +new born care}
Goal of the initiative: To improve the quality of maternal and newborn care during
the intra- and immediate postpartum period, through providers who are
competent and confident (Dakshata).

5. Dakshata
Rescores
availability
Improved
monitoring and
accountability
Strategy for
transfer of
learning
Focused
customized
training

6. OBJECTIVES
Objective 1: To strengthen the competency of providers of the labor room, including medical officers, staff nurses,
and ANMs to perform evidence-based practices as per the established labor room protocols and standards.
Objective 2: To implement enabling strategies to ensure transfer of learning towards improved adherence to
evidence based clinical practices
Objective 3: To improve the availability of essential supplies and commodities in the labor room and the
postpartum wards.
Objective 4: To improve accountability of service providers through improved recording, reporting and utilization of
data
Objective 5: (intermediate term objective): Implementation of the MNH Tool kit at the delivery points, in a phased
manner.

7. Rationale:
• During childbirth, the risk of maternal and new born mortality and morbidity are significantly
high. Majority of the complications are preventable through appropriate interventions and
intra and postpartum care.
• percentage of women who deliver at a health facility
70.625% (2008-09) 4 years 82.864% (2012-13)
1.Open Government Data. (OGD)

8. • Evidence for sub-optimal
quality of health services during
institutional deliveries.
• Despite of all the efforts and safe motherhood
initiatives, the country has not seen the expected
decline in Maternal and new born Mortality
• So, if we improve the competency level of
Health Care providers,
through competency based training and
supervision, we can improve our statistics of
Maternal Mortality with much less efforts
and resources.
who are reaching to 82.864% of mothers

9. Strategic approach:
Aims to address the major drivers and determinants of the quality of care
time of her
admission
process of
childbirth
time of her
discharge

10. Drivers of Quality of Care in Indian Context
Programs and Guidelines
Human Resources
Competencies
Translation of Skills to Practice
Infrastructure & Commodities
Accountability and Commitment

11. The major determinants for impact clinical practices by providers in the labor room
• Availability of sufficient number of clinically competent providers, which
includes updated knowledge and clinical skills
• Availability of essential commodities, supplies and equipment.
• Strong clinical mentorship and leadership
• 360 degree accountability of all stakeholders, which in turn depends on
recording, reporting, analysis and utilization of data.

12. Key Activities under Dakshata
Sensitization
Workshop for district
and facility level
officials on Dakshata
program
Identification and
mapping of target
facilities with
resource availability
Hiring of quality
improvement mentor
5 days training of
trainers and quality
improvement mentor
Ensuring availability
of essential supplies
and other resources
Rapid Assessment of
resource availability
and practices status
Preparation of training
micro-plan for each
facility
3 days on-site training
of labor room staff at
district hospital
Post-training follow-up
and support to district
hospitals
Implementation of
data recording tools
and dashboard
indicators
Post training follow-up
and support to SDL
facilities by trainers
and mentors
3 days training of staff
from sub district level
facilities at DH

13. PROGRAM MONITORING
1. Program management monitoring: done by supervisors, development partners, and other supervisory cadre
workers using the GoI’s supportive supervision checklist.
2. Clinical monitoring by the mentors: all the trainers and mentors will monitor and report the adherence to quality
of care practices at the target institutions apart from providing post training follow-up and support.
3. Dashboard of indicators: Facilities participating under the program will send monthly reports to districts and
districts will send monthly reports to the states for inclusion into the dashboard of
indicators.

14. BUDGET
• dedicated human resources
• logistics of post-training follow-up and support
• procurement of training materials,
• conducting training of health workers.
• Additional funds will be provided for these activities under the NHM funds.

15. Skill Building through training programs for all categories of service providers
• Training of MBBS doctors in Life Saving Anesthesia Skills (LSAS),
• Emergency Obstetric Care (EMoC)including Caesarean -sections;
• Training of Nurses and ANMs in Skilled Birth Attendance (SBA);
• Training of MOs in Comprehensive Abortion Care (CAC).
• More than 1300 doctors have been trained in EmOC while more than 1800 trained in LSAS as per latest reports
submitted by the states.
• To strengthen the quality of training, a new initiative has been taken for setting up of Skill Labs with earmarked
skill stations for different training programs in the states for which necessary allocation of funds is made under
NHM
mailto:http://www.mohfw.nic.in/WriteReadData/c08032016/Review_of_Performance.pdf

16. Role of NIHFW
• The national institute of health and family welfare
(NIHFW) has a mandate to promote development of a
system for continuing in –service training for Mo&FW
personnel at different levels.
• 17 State institute of health and family welfare have been
identified to laisse with the State /UT allotted to them.

18. REFRENCES
mailto:http://www.mohfw.nic.in/WriteReadData/c08032016/Review_of_Performance.pdf
mailto:https://www.jhpiego.org/wp-content/uploads/2016/10/MNH-factsheet_-July-2016_final.pdf
mailto:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3893075/

19. Thank you!!