Volume 122, Issue 2 p. 164-168
Special articles

Designing the WHO Safe Childbirth Checklist program to improve quality of care at childbirth

Jonathan M. Spector

Jonathan M. Spector

Department of Health Policy and Management, Harvard School of Public Health, Boston, USA

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Angela Lashoher

Corresponding Author

Angela Lashoher

Patient Safety Programme, World Health Organization, Geneva, Switzerland

Corresponding author at: Patient Safety Programme, World Health Organization, 20 Avenue Appia, 1211, Geneva 27, Switzerland. Tel.: + 41 22 791 1270; fax: + 41 22 791 1388.Search for more papers by this author
Priya Agrawal

Priya Agrawal

Faculty of Epidemiology and Population Health, Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK

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Claire Lemer

Claire Lemer

London Deanery, Barnet and Chase Farm Hospitals NHS Trust, Enfield, UK

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Gerald Dziekan

Gerald Dziekan

Department of Patient Safety, World Health Organization, Geneva, Switzerland

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Rajiv Bahl

Rajiv Bahl

Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland

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Matthews Mathai

Matthews Mathai

Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland

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Mario Merialdi

Mario Merialdi

Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland

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William Berry

William Berry

Department of Health Policy and Management, Harvard School of Public Health, Boston, USA

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Atul A. Gawande

Atul A. Gawande

Department of Health Policy and Management, Harvard School of Public Health, Boston, USA

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First published: 03 June 2013
Citations: 56

Abstract

Background

Poor-quality care during institutional births in low- and middle-income countries is a major contributing factor to preventable maternal and newborn harm, but progress has been slow in identifying effective methods to address these deficiencies at scale. Based on the success of checklist programs in other disciplines, WHO led the design and field testing of the WHO Safe Childbirth Checklist—a 29-item tool that targets the major causes of maternal and newborn mortality globally.

Methods

The development process consisted of comprehensive evidence and guideline review, in-person consultation with content experts and other key stakeholders, iterative refinement through ongoing discussions with a wide collaborator network, and field evaluation for usability in 9 countries, primarily in Africa and Asia. Pilot testing in South India demonstrated major improvement in health workers' delivery of essential safety practices after introduction of the program.

Results

WHO has launched a global effort to support further evaluation of the program in a range of contexts, and a randomized trial is underway in North India to measure the effectiveness of the program in reducing severe maternal, fetal, and newborn harm.

Conclusion

A novel checklist program has been developed to support health workers in low-resource settings to prevent avoidable childbirth-related deaths.