Promising practices for adapting and implementing the WHO Safe Childbirth Checklist: case studies from India and Rwanda

Abstract

Background The World Health Organization (WHO) Safe Childbirth Checklist (SCC) was published in 2015 as a patient safety tool to improve facility-based childbirth care through boosting adherence with essential practices around the major causes of maternal and newborn morbidity and mortality. We brought together partners who led implementation of the SCC in India and Rwanda to: (i) contextualize the findings from surveys and interviews about SCC adaptation and implementation around the world (data published separately) with our partners’ implementation experiences in India and Rwanda, and (ii) identify promising practices for SCC implementation. Methods We identified two partners–one from Tamil Nadu, India and one from Masaka District, Rwanda–to work together in identifying key promising practices regarding the SCC based on their direct experiences and data we collected from other implementers around the world. From June-September 2020, we held 4 virtual design workshops using brainwriting exercises to explore promising practices for adaptation and implementation of the SCC. We consolidated the implementation experiences in India and Rwanda into the WHO SCC Implementation Guide phases of Engage, Launch, and Support, and included two additional phases: Project Design and Evaluation. Results We present two case studies of SCC implementation that demonstrate improved adherence with essential birth practices after implementation of the SCC. Based on the case studies, we developed promising practices according to five implementation stages: Project Design, Engage, Launch, Support, and Evaluation. Clarifying the purpose and users of the tool, applying human-centered design principles, and developing evaluation plans for the specified purpose were some promising practices that emerged. Conclusions Our partnership with direct implementers of the SCC yielded important insights about how to adapt, implement, evaluate, and sustain use of the Checklist. Such partnerships are critical in building an evidence base for promising practices regarding SCC implementation around the world.