Presenter: Grace Galvin, Ariadne Labs/ Harvard T.H. Chan School of Public Health
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Background: The BetterBirth Program is testing the impact of a WHO Safe Childbirth Checklist (SCC) based coaching intervention on maternal and neonatal outcomes in Uttar Pradesh, India. The SCC includes 30 Essential Birth Practices (EBP); 22 of 30 require supplies, without which EBPs cannot be performed. During observation of birth attendants, inadequate supplies were barriers to EBP in 16% of cases. No equipment or supplies are provided to facilities. Facility leaders and birth attendants are coached to identify gaps, facility-based demand is increased, and availability of facility and bedside supplies should improve through existing supply chains.
Methodology: Baseline supply availability was collected between November 2014 and March 2015. During coaching visits, BetterBirth staff recorded supply availability (i.e., easily accessible and not broken/expired). During coaching of labor and delivery practices, identified barriers to EBP were documented, including supply gaps. Counts and proportions of available supplies were compared.
Results: At baseline, 65% of assessed supplies (30 of 46) were available. After 4 weeks of coaching, preliminary results indicate an average of 6 (range 4-9) additional supplies were available at each facility. Across all 5 facilities, 16 new supplies were made available since coaching initiated, including: infrastructure (water); equipment (thermometers); and medicines (oxytocin), primarily through standard procurement channels, ensuring access to existing facility supplies. In some cases patients and staff provided supplies.
Conclusions: Coaches focused on therapeutic benefits of supplies, cultivated intrinsic motivation of staff, and provided hand-holding through problem-solving and options for supply procurement. Unintended consequences may include burdening the patient or staff member to provide supplies. A stronger focus on coaching to increase supplies through established channels could reduce this burden. Coaching on supplies appears to be a promising approach to strengthen supply availability at the facility to the bedside.