Effectiveness of the WHO SCC on improving adherence to essential practices during childbirth, in resource constrained settings

Abstract

BackgroundIndia accounts for 27 % of world’s neonatal deaths. Although more Indian women deliver in facilities currently than a decade ago, early neonatal mortality has not declined, likely because of insufficient quality of care. The WHO Safe Childbirth Checklist (SCC) was developed to support health workers to perform essential practices known to reduce preventable maternal and new-born deaths around the time of childbirth. Despite promising early research many outstanding questions remain about effectiveness of the SCC in low-resource settings.MethodsIn collaboration with the Ministry of Health SCC was modified for Indian context and introduced in 101 intervention facilities in Rajasthan, India and 99 facilities served as comparison to study if it reduces mortality. This Quasi experimental Observational intervention-comparison was embedded in this larger program to test whether a program for introduction of SCC with simple implementation package was associated with increased adherence to 28 evidence-based practices. This study was conducted in 8 intervention and 8 comparison sites. Program interventions to promote appropriate use of the SCC included orienting providers to the checklist, modest modifications of the SCC to promote provider uptake and accountability, ensuring availability of essential supplies, and providing supportive supervision for helping providers in using the SCC.ResultsThe SCC was used by providers in 86 % of 240 deliveries observed in the eight intervention facilities. Providers in the intervention group significantly adhered to practices included in the SCC than providers in the comparison group controlling for baseline scores and confounders. Women delivering in the intervention facilities received on an average 11.5 more of the 28 practices included compared with women in the comparison facilities. For selected practices provider performance in the intervention group increased as much as 93 % than comparison sites.ConclusionUse of the SCC and provider performance of best practices increased in intervention facilities reflecting improvement in quality of facility childbirth care for women and new-born in low resource settings.

The BetterBirth Program: Pursuing Effective Adoption and Sustained Use of the WHO Safe Childbirth Checklist Through Coaching-Based Implementation in Uttar Pradesh, India

“…Still, several organizations across India are currently testing coaching-centered interventions of various intensities, suggesting that a coaching-based model could be realistic for this context, albeit with fewer facility visits. Jhpiego's SCC implementation across the state of Rajasthan, India, includes facility-based coaching visits every 2 weeks for the first 2 months, followed by 4 once-per-month coaching visits, 35 , 36 and the Technical Support Unit in Uttar Pradesh has implemented monthly coaching visits for a period of 6 months for a childbirth case-sheet 37 , 38 . Given contextual limitations (such as high transfer rates of facility staff across Uttar Pradesh, including CQCs, and the safety concerns and significant distances that prevented the all-female nurse coaches from coaching in facilities after dark), we need more research on how to best structure and customize coaching-centered interventions like the BetterBirth Program in order to achieve and sustain the most effective adoption of essential birth practices.…”

Quality of assessment of women at the time of admission for childbirth in secondary and tertiary public sector referral institutes in southern India

“…Authors of a study to measure effectiveness of SCC conducted in Rajasthan, India found that 2-3% women were properly assessed and appropriately referred at time of admission. 21 The partograph usage in study area ranged from 8-13%. Postintervention, the percentage of appropriate assessment improved to 88% and partograph usage to 52%.…”

The growing use of the WHO Safe Childbirth Checklist: Lessons learned at the Yaoundé Gynaeco-Obstetric and Paediatric Hospital, Cameroon

“…Data was collected six months after the introduction of the SCC at the maternity. Six months was chosen because previous research conducted on the SCC in India [21] showed that adherence to essential birth practices could be evaluated within this period.…”

“…It consists of four pause points (or moments of care); on admission, just before pushing or caesarean, within one hour after birth, and shortly before discharge. A study conducted in India in 2016 showed signi cantly improved adherence to practices, six months post-training in the intervention arm [21]. Further, the BetterBirth trial in India reported an increase in providers' adherence to essential birth practices after two months of peer coaching in primary level facilities [22].…”