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Skilled Birth Attendant Results Presented at PAHO Conference
by Cynthia Young, Senior Writer

Steven A. Harvey, MHS, Quality Assurance Specialist with the Quality Assurance Project (QAP), was invited to attend the Pan American Health Organization’s Regional Technical Consult on Skilled Attendance at Birth in Santa Cruz, Bolivia, in June. More than a dozen countries from Latin America and the Caribbean were represented, with 120 participants from Bolivia, Brazil, the Dominican Republic, Ecuador, El Salvador, Guatemala, Haiti, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Puerto Rico and Uruguay.

Mr. Harvey presented the results from QAP's recent Skilled Birth Attendant (SBA) Competency Study. He helped facilitate two group sessions on evaluation of skilled attendance at delivery. He also visited several local health centers and hospitals in Bolivia to observe quality improvement methods and maternal and child health care. Individual country participants and representatives of international health organizations expressed interest in working with QAP to further develop tools for assessing SBA competency. 

Several multilateral organizations, nongovernmental organizations, and contracting agencies also participated in the event, including the Latin American Center for Perinatology, Family Care International, the Population Council, UNICEF, UNFPA, the U.S. Agency for International Development (USAID), and the World Health Organization.

QAP has been studying the competency of skilled birth attendants at managing labor and delivery. A major objective of the Safe Motherhood movement worldwide is to increase the number of pregnant women whose newborns are delivered by skilled birth attendants; however, there is little data on the competency of SBAs at managing labor and delivery, immediate postpartum care, or common life-threatening obstetric complications.

In November 2001, QAP pilot-tested tools for measuring key SBA competencies (the knowledge and skills necessary to comply with predefined clinical standards) in Quito, Ecuador. The study measured knowledge with a 54-question test on labor and delivery, postpartum care, and obstetric complications. Also tested was SBA ability to utilize a partograph for clinical decision making. Finally, clinical specialists used anatomical models to evaluate SBA skills at managing common life-threatening complications such as postpartum hemorrhage and neonatal asphyxia.

These instruments were then revised and, in early 2002, were used to measure SBA competence in four countries: Benin, Rwanda, Ecuador, and Jamaica. There, QAP tested 164 doctors, midwives, and nurses from 17 hospitals and four clinics. The study found that SBA competence levels are generally low. Results suggest that two key life-saving skills in particular, active management of third-stage labor and bimanual uterine compression, are rarely taught and rarely performed.

These methods for measuring SBA competence could help improve targeting of scarce training and supervisory resources and serve as a key component of a comprehensive effort to improve the quality of maternal and obstetric care in developing countries.

QAP is further refining the tools developed through this study and is preparing a Spanish language report on the study for distribution in the LAC region. English language articles are also in progress and should be published by late 2003 or early 2004.  Meanwhile, QAP has been invited to present more study results at the 5th International Conference on the Scientific Basis of Health in September and at the 20th International Society for Quality in Health Care Conference in November.

QAP’s SBA competency research is supported with Maternal Health funds from USAID.

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