Are skilled birth attendants really skilled? A measurement method, some disturbing results and a potential way forward

Harvey, Steven A.; Blandón, Yudy Carla Wong; McCaw-Binns, Affette; Sandino, Ivette; Urbina, Luis; Rodríguez, César; Gómez, Ivonne; Ayabaca, Patricio; Djibrina, S

doi:10.2471/blt.06.038455

Cited by 187 publications

(165 citation statements)

References 13 publications

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“…For example, in an assessment of 1358 skilled birth attendants in Nicaragua, the median competency score was only 52% for fi ve key skills. 95,96 Although these studies, audits, and routine clinical data are useful for monitoring and addressing defi ciencies in quality of care, they are often restricted to specifi c programme sites, meaning that programme planners do not know the quality of care received by most women and babies. Collection of more data on coverage and quality for individual components within pregnancy and childbirth care is a crucial next step for eff ective population-level tracking of programmes.…”

Section: Comparable Definitionmentioning

confidence: 99%

Stillbirths: Where? When? Why? How to make the data count?

et al. 2011

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for The Lancet's Stillbirths Series steering committee* Despite increasing attention and investment for maternal, neonatal, and child health, stillbirths remain invisible-not counted in the Millennium Development Goals, nor tracked by the UN, nor in the Global Burden of Disease metrics. At least 2·65 million stillbirths (uncertainty range 2·08 million to 3·79 million) were estimated worldwide in 2008 (≥1000 g birthweight or ≥28 weeks of gestation). 98% of stillbirths occur in low-income and middle-income countries, and numbers vary from 2·0 per 1000 total births in Finland to more than 40 per 1000 total births in Nigeria and Pakistan. Worldwide, 67% of stillbirths occur in rural families, 55% in rural sub-Saharan Africa and south Asia, where skilled birth attendance and caesarean sections are much lower than that for urban births. In total, an estimated 1·19 million (range 0·82 million to 1·97 million) intrapartum stillbirths occur yearly. Most intrapartum stillbirths are associated with obstetric emergencies, whereas antepartum stillbirths are associated with maternal infections and fetal growth restriction. National estimates of causes of stillbirths are scarce, and multiple (>35) classifi cation systems impede international comparison. Immediate data improvements are feasible through household surveys and facility audit, and improvements in vital registration, including specifi c perinatal certifi cates and revised International Classifi cation of Disease codes, are needed. A simple, programme-relevant stillbirth classifi cation that can be used with verbal autopsy would provide a basis for comparable national estimates. A new focus on all deaths around the time of birth is crucial to inform programmatic investment. Why don't stillbirths count?Stillbirths are invisible in many societies and on the worldwide policy agenda, but are very real to families who experience a death. Despite 30 years of attention to child survival interventions, 1,2 more than 20 years of attention to safe motherhood, 3,4 and increasing recent attention to survival of newborn babies, 5-7 the focus worldwide has remained on survival after livebirth. Stillbirths remain mostly ignored, not counting on policy, programme, and investment agendas, both internationally and often also at the national level. 8 The importance of neonatal deaths has risen on the worldwide policy agenda, mainly because of the Millennium Development Goals (MDGs) and recognition of the increasing proportion of child deaths that happen in the fi rst month of life-from 37% in 2000 7 to 41% in 2008. 9 A baby who dies just after birth counts in the MDG tracking, but a baby who dies in the third trimester or even during labour does not. Neither the MDGs nor the Global Burden of Disease metrics mention stillbirths, and stillbirth data are not routinely compiled by the UN. Even when stillbirths are recorded in surveys, the data are frequently combined with early neonatal deaths and reported as perinatal mortality, a combination that reduces visibility and might mask reporti...

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Section: Comparable Definitionmentioning

confidence: 99%

Stillbirths: Where? When? Why? How to make the data count?

et al. 2011

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“…Attention is increasingly being turned to the supply side, as studies continue to document significant problems with care delivery, including a lack of skilled providers, suboptimal provider effort, provider absenteeism, and lack of necessary infrastructure to provide high-quality care (Barber & Gertler 2009;Das, Hammer & Leonard 2008;Harvey et al 2007;Leonard & Masatu 2010).…”

Section: Introductionmentioning

confidence: 99%

Better Obstetrics in Rural Nigeria study: evaluating the Nigerian Midwives Service Scheme

Okeke¹,

Glick²,

Abubakar³

et al. 2017

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The International Initiative for Impact Evaluation (3ie) is an international grant-making NGO promoting evidence-informed development policies and programmes. We are the global leader in funding, producing and synthesising high-quality evidence of what works, how, why and at what cost. We believe that better and policy-relevant evidence will make development more effective and improve people's lives. 3ie impact evaluations3ie-supported impact evaluations assess the difference a development intervention has made to social and economic outcomes. 3ie is committed to funding rigorous evaluations that include a theory-based design, use the most appropriate mix of methods to capture outcomes and are useful in complex development contexts. About this report SummaryLimited availability of skilled providers, particularly in rural areas, is thought to be an important constraint to increasing rates of use of maternal and child health services in low-and middle-income countries. There are, however, few well-identified studies of the relationship between the supply of skilled workers and outcomes. In this project, we studied the effects of a government program in Nigeria that sought to alleviate supply-side constraints by deploying skilled midwives to primary health facilities in rural communities, to provide round-the-clock access to skilled care.We evaluate the impact of the Midwives Service Scheme (MSS), a government program introduced in 2009 to increase access to skilled care in underserved rural areas in Nigeria. At rollout, the MSS deployed nearly 2,500 midwives to 652 primary health care centers across 36 states. To evaluate the impact of the program, we surveyed 7,104 women with a birth within the preceding five years in 386 communities across 12 states. The intervention group consisted of communities that participated in the initial rollout; the comparison group consisted of communities that would receive the program approximately three years later. To understand implementation challenges and contextualize the quantitative results, we carried out a nested qualitative study in three states, consisting of in-depth interviews and focus group discussions with policymakers, providers, childbearing women, and community stakeholder groups.Overall, we found that the program's effects were smaller than anticipated. The main effect was a 7.3-percentage-point increase in antenatal care use in program clinics (about 12 percent relative to baseline levels) and a 5-percentage-point increase in overall use of antenatal care (6 percent relative to baseline levels) within the first year of the program. We found suggestive but not conclusive evidence of a small increase in skilled birth attendance, but this was confined to the south, where there were fewer challenges with midwife retention. We did not find any significant improvements in postnatal visits or child immunizations. Given this, it is not surprising that we did not find any evidence of improvements in maternal and child health.Our data allow us to shed some light on why ...

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“…Las tasas de mortalidad de ambas regiones también superan la mediana mundial publicada por la Organización Mundial de la Salud en el 2011 (11 por 1000 nacidos vivos), siendo mayores al promedio de Latinoamérica (9 por 1000 nacidos vivos), pero mucho menores que los estimados en África (34 por 1000 nacidos vivos) y Asia (29 por 1000 nacidos vivos) (1) . Se ha reportado que hay menor riesgo de morbilidad y mortalidad neonatal cuando la madre sigue apropiadamente el control médico en el embarazo, y cuando el parto es atendido por un profesional competente (11) . Cada control prenatal representa una oportunidad para identificar complicaciones del embarazo (infecciones, diabetes, preclampsia, etc.)…”

Section: Discussionunclassified