Using the WHO safe childbirth checklist to improve essential care delivery as part of the district-wide maternal and newborn health quality improvement initiative, a time series study

Abstract Background Care bundles are a set of three to five evidence-informed practices which, when performed collectively and reliably, may improve health system performance patient care. To date, many studies conducted the quality essential birth care (EBPs) have focused primarily on provider- level fallen short predicted impact quality, indicating that systems approach is needed delivery reliable This study evaluates effect integrating use World Health Organization Safe Childbirth Checklist (WHO-SCC) into district-wide improvement collaborative program designed sustain EBPs as measured by “clinical bundle” adherence over-time. Methods The WHO-SCC was introduced in context Maternal Newborn (MNH) four agrarian Ethiopia regions. Three bundles” were created from WHO-SCC: On Admission, Before Pushing, Soon After Birth bundles. outcome each bundle using all- or- none adherence. Adherence assessed monthly reviewing charts live births. A time-series analysis employed assess effectiveness system-level interventions clinical STATA version 13.1 used analyze trend overtime. Autocorrelation checked if assumption independence observations collected overtime valid. Prais-Winsten minimize autocorrelation. Findings Quality targeting resulted improved over time across MNH collaborative. In Tankua Abergele (Tigray Region), overall mean “On Admission” 86% with β = 1.39 (95% CI; 0.47–2.32; P < 0.005) average monthly. Similarly, “Before Pushing” Dugna Fango collaborative; Southern Nations, Nationalities People’s (SNNP) region 80% 2.3 0.89–3.74; Conclusion Using paired system-wide sustained delivery. Further should be evaluate patient-level outcomes.