Improving Maternal Health: Implementing the WHO Safe Childbirth Checklist Facilitates Compliance with Best Practices

Ogu Rosemary1, Osita John1, Maduka Omosivie2, Tobin-West Charles 2, Orazulike Ngozi1, Inimgba Nestor1, Uzoigwe Samuel1. University of Port Harcourt Teaching Hospital, Port Harcourt, Nig; Department of Obstetrics & Gynaecology1; Department of Preventive & Social Medicine2.

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Declaration of Interests:

• None

Background

• Sub-Saharan Africa suffers some of the highest rates of maternal and perinatal mortality in the world. Poor quality of care and errors in clinical management are some of the key factors implicated.

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WHO SCC Collaboration • As part of efforts to reduce maternal morbidity and

mortality, WHO piloted the Safe Childbirth Checklist Collaboration in selected centres from 2012 to 2015.

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A total of 34 implementation projects across 29 countries and over 230 pilot sites joined the Collaboration. The University of Port Harcourt Teaching hospital was one of such sites in a low resource setting

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http://www.who.int/patientsafety/implementation/checklists/childbirth

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The WHO Safe Childbirth Checklist

Objectives • To determine the

effectiveness of the Checklist in facilitating compliance with best practices among health care workers & To determine factors that enhance sustainability of the checklist.

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Methodology • A descriptive, cross-sectional design was

used to generate information from doctors and nurses employing quantitative and qualitative methods.

• Quantitative data (questionnaires) was

analysed using SPSS version 22 with level of statistical significance set at P = 0.05.

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Methodology-Qualitative

• Qualitative research was by Focus group discussions (FGDs).

• A total of 4FGDs with 6 – 8 midwives and

doctors were carried out. Discussions covered the usefulness of the checklist in facilitating best practice.

• All interviews were transcribed. Themes and

sub themes were identified using thematic content analysis with Atlas TI software.

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Results: • 26 & 38 midwives and doctors participated

in the FGDs as well as questionnaire survey. 4/

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Demographic Profile of study Participants Variables Frequency

n=36 Percentage (%)

Age 20-29 15 41.7 30-39 12 33.3 40-49 5 13.9 50-59 4 11.1 Sex Male 5 13.9 Female 31 86.1 Mean age Cadre Nurse/Midwife 21 58.3 Doctor 15 41.7 Qualification Specialist Gyn 4 11.1 MBBS 12 33.3 BSC Nursing 4 11.1 RN/RM 16 44.4 Last update/training on labour management Last 3 months 16 44.4 Last 6 months 5 13.9 Last 12 months 5 13.9 Last 24 months 7 19.4 Last 36 months 2 5.6 None 1 2.8 Enjoy working in the labour room Yes 34 94.4 No 2 5.6

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Results - Qualitative

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Checklist & other forms:

• The physical presence of the checklist in the labour ward enhanced sustainability; 64(100%).

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Results:

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• Findings showed that patients were counseled more and professional standard of care improved when the checklist was used.

Discussion Effective Maternal Healthcare entails that all components of the health system be successful: Health service delivery systems, Health workforce, Health facilities/communications networks.

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Health workforce

• A sufficient capacity of well-trained, motivated health workers to provide the services to meet patients’ needs based on the best available evidence.

• Health facilities & communications network

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Facilitating Best Practices

• SDG 3 explicitly relates to health “Ensure healthy lives & promote well-being for all at all ages” & targets RCH; NCD, ….and achieving UHC.

• The workforce is imperative in the achievement of these lofty goals

• Compliance with best practices is an antidote to errors in clinical management.

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Conclusion

• Using the checklist facilitated health workers compliance with best practices, while the mere presence of the checklist in the labour ward served as reminder & promoted its usage.

• Advocating for the use of Checklists in

surgical units may enhance Maternal Health.

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References/Further Reading • WHO Safe Childbirth Checklist. Available @

http://www.who.int/patientsafety/implementation/checklists/childbirth/en/

• Primary health care and the Sustainable Development Goals. The Lancet: Nov 2015· DOI: 10.1016/S0140-6736(15)00949-6. Retrieved on: 16 Sept 2016

• WHO Safe Childbirth Checklist Collaboration. Available @ http://www.who.int/patientsafety/implementation/checklists/collaboration_members/en/. Accessed 16th Sept 2016.

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Acknowledgement

Ariadne Labs, Boston, MA, USA. Sepideh Bagheri Nejad, MD; Technical Officer, and her team at Knowledge Management, WHO Service Delivery and Safety, World Health Organization. 20, Av Appia, CH-1211 Geneva 27 Switzerland Clarissa Fabre; Current President Elect & Medical Women’s International Association Representative to the World Health Organisation.

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Online availability The Checklist and Implementation Guide are available for download on the WHO websites: http://www.who.int

WHO Safe Childbirth Checklist: http://www.who.int/patientsafety/implementation/checklists/childbirth/en/

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Thank You

Baie Dankie

Enkosi Kakhulu

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