Assessment and Evaluation of the Safe Childbirth Checklist --Phase II
Condition: Intrapartum Mortality
Study type: Interventional

Summary: 
      PHFI independently evaluated the effectiveness of the Safe Childbirth Checklist program in
      preventing stillbirths and early neonatal deaths. Evaluation used a quasi-experimental design
      with data collection from 34 facilities across six intervention districts and four control
      districts. The study with a sample of 137,000 births has 88% power to detect 15% reduction in
      intrapartum mortality. Data on this was collected over a period of 17 months (November 2013
      to April 2015).
    

Detailed description: 
      The Safe Childbirth Checklist (SCC), a tool that provides reminders and is a job aid to
      health care providers is a new maternal and newborn care intervention that is being
      implemented by the Government of Rajasthan with technical support from Jhpeigo. SCC is thus
      expected to improve the quality of delivery care practices and was implemented in Community
      Health Centres (CHCs) and District Hospitals (DHs) across seven districts in Rajasthan over a
      two-year time period (2013 to 2015). PHFI independently evaluated the effectiveness and
      cost-effectiveness of the SCC in preventing intrapartum (stillbirths and very early neonatal
      deaths within 3-days after births). Data on 137,000 births was collected over a period of 17
      months (November 2013 to April 2015) from 34 facilities with sick newborn care centres (SNC).

      Facility records were main source of outcome data. Labor room provided data on stillbirths
      whereas information on very early neonatal deaths came from SNCs. All Data collection and
      management was done through software specifically developed for this purpose.

      For a better understanding on how maternal and neonatal complications are diagnosed and
      managed at the facility, in-depth interviews were conducted with the service providers
      (specialists, physicians, labor room staff nurses, and pharmacists) from the District
      hospitals and CHCs. In addition, interviews focused on understanding the use, acceptability
      and feasibility of the SCC among various types of providers.

      Cost of this intervention was estimated from a program perspective, and cost effectiveness in
      terms of cost per perinatal death prevented was calculated.

      Preliminary analysis has found that SCC is significantly associated with a 11% reduction in
      intrapartum deaths.

      Permission for this study and data collection has been obtained from the Department of Health
      and Family Welfare, Government of Rajasthan.
    

Intervention name(s): SCC
Intervention type(s): Behavioral
Intervention description(s): The intervention involves introducing and orienting health providers on the SCC, facilitating availability of a specific set of commodities and regular targeted supervision. These are expected to improve adherence to life saving interventions immediately before, during and after birth, and reduce intrapartum mortality (still births and very early neonatal deaths).
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Safe Childbirth Checklist; Intrapartum mortality, Quality of Institutional delivery care; Maternal & newborn care practices