Implementing the World Health Organization (WHO) Safe Childbirth Checklist (SCC) effectively requires a nuanced approach that considers local contexts, engages key stakeholders, and provides ongoing support. This guide explores the key factors for successful implementation, drawing on experiences from diverse settings and highlighting best practices for integrating the checklist into routine childbirth care.
The experiences of end-users and implementation teams across various settings, from high to low-income countries, underscore the importance of engaging local leadership, fostering local ownership, and ensuring local relevance and acceptability to facilitate initial implementation and successful adoption of the WHO SCC. Adapting the checklist to align with local guidelines is crucial to encourage end-users to embrace it. Numerous studies have highlighted similar factors as vital for successful implementation. Obstetricians and non-specialist medical doctors showed the most resistance to using the checklist, while midwives felt it did not improve their practice. Implementation efforts should prioritize addressing the reluctance of these professional groups through early engagement and education.
Furthermore, it’s essential to provide consistent training and supervision throughout the implementation process. Those who received training or supervision were more likely to perceive the checklist as improving practice, enhancing patient safety awareness, and fostering better communication and teamwork. This aligns with previous research and reinforces the importance of coaching. Common challenges faced during implementation included busy schedules, understaffing, lack of awareness among staff, and inadequate supplies. Multidisciplinary education and regular training sessions were effective solutions.
While the insights gathered were subjective, formal external evaluation is crucial. This evaluation should measure checklist compliance, its impact on adherence to essential birth practices, and, most importantly, its effect on maternal and neonatal outcomes. Many members of the Collaboration have conducted research in these areas and are publishing their findings. Ariadne Labs is also conducting a randomized controlled trial in India to assess the impact of checklist use on maternal and newborn outcomes. The WHO SCC Collaboration played a vital role in developing the final version of the WHO SCC and its Implementation Guide, officially launched in December 2015 and available on the WHO website. The Guide offers detailed insights into key facilitating factors identified during the evaluation and emphasizes the significance of engagement, checklist launch, and ongoing support. While targeted at the facility level, the implementation guide also provides advice for a national-level approach.
The checklist aligns with the comprehensive WHO Framework for Improvement of the Quality of Maternal and Newborn Care, which aims to ensure coverage of key practices, people-centered outcomes, and improved health outcomes. Eight standards of care have been developed to help countries translate the framework into practice. Each standard includes quality statements designed to drive measurable improvements in childbirth care. These tools provide a valuable foundation for policymakers to develop broader national-level quality improvement strategies. WHO encourages low and middle-income countries to implement the WHO SCC in health facilities, utilizing the implementation guide to inform the process and sustain checklist use as part of national efforts.
