Scaling up DAKSH intrapartum application: impact, challenges, and learning

Priyanka Singh, Ansu Narwal


Background: DAKSH is an intrapartum monitoring application. It is easy to use, saves time and requires no interpretation skills. In spite of all these advantages, using a digital partograph alone will lead to less benefits to healthcare workers. So an application was developed which includes workflows for registering the patients during the intrapartum period by entering their investigation details, updating delivery/referral status and postpartum data until hospital discharge. The partograph is a major component of DAKSH. The main aim of this pilot was to simplify the use of partograph for better labour monitoring, which will help them in making early decisions for taking action for referral or intervention.

Methods: This was a cross-sectional study. Permission to conduct a pilot for one block for 1 year was given by the Karnataka government (2017-18). After the results from the pilot district model were tested out in one district of Karnataka (2019). The pilot phase includes the following components: pre-implementation phase, implementation phase, monitoring and evaluation, regular monitoring through the dashboard and monthly evaluation visit to each health centre. The pre-implementation process was the same for both the block and district levels.

Results: The few learnings learnt during the scaling up includes: the dual burden of work is considered as the main cause of not filling the partograph by staff nurses in DAKSH. Behavioural change was seen during the continuous visits while providing them with secondary training and motivation to use the application. The new kiosk provided with an inbuilt printer increased the printing of case sheets and partographs.

Conclusions: This study concluded that the DAKSH application was developed for labour monitoring in healthcare facilities. The application was developed after proper need validation and feedback from OBGYNs. Further modifications and changes were made in the application from various valid user feedbacks and issues faced during the pilot which improved the user experience and sustainability. 


Intrapartum, Maternal health, Monitoring, Partogram

Full Text:



Vora KS, Mavalankar DV, Ramani KV, Upadhyaya M, Sharma B, Iyengar S, et al. Maternal health situation in India: a case study. J Health Popul Nutr. 2009;27(2):184.

WHO. 2020. Maternal Health. Available from: Accessed on 3 December 2020.

Unicef. 2020. Maternal Health. Available from: Accessed on 3 December 2020.

Palo SK, Patel K, Singh S, Priyadarshini S, Patil S. Intrapartum monitoring using partograph at secondary level public health facilities- a cross-sectional study in Odisha, India. J Fam Med Prim Care. 2019;8(8):2685.

GLOWM. 2020. How to use the partograph. Resource: Video. Available from: Accessed on 3 December 2020.

World Health Organization. WHO recommendations for augmentation of labour. World Health Organization; 2014.

Lavender T, Hart A, Smyth R. Effect of partogram use on outcomes for women in spontaneous labour at term. Cochrane Database Systemat Rev. 2013

Dalal AR, Purandare AC. The partograph in childbirth: an absolute essentiality or a mere exercise? J Obstet Gynaecol India. 2018;68(1):3-14.

Chaturvedi S, Upadhyay S, De Costa A, Raven J. Implementation of the partograph in India's JSY cash transfer programme for facility births: a mixed methods study in Madhya Pradesh province. BMJ Open. 2015;5(4).

Fawole AO, Hunyinbo KI, Adekanle DA. 2008. Knowledge and Utilization of the Partograph among obstetric care givers in South West Nigeria. Afr J Reprod Health. 2008;12(1):22-9.

Hofmeyr GJ, Haws RA, Bergström S, Lee AC, Okong P, Darmstadt GL, et al. Obstetric care in low-resource settings: what, who, and how to overcome challenges to scale up? Int J Gynecol Obstet. 2009;107:S21-45.

World Health Organization. Standards for improving quality of maternal and newborn care in health facilities. 2016. Available from: Accessed on 3 December 2020.

World Health Organization, United Nations Population Fund and United Nations Children’s Fund (‎UNICEF)‎‎. Managing complications in pregnancy and childbirth: a guide for midwives and doctors. 2nd edn. World Health Organization; 2017.