Effectiveness of a WHO Safe Childbirth Checklist Coaching-based intervention on the availability of Essential Birth Supplies in Uttar Pradesh, India

Int J Qual Health Care. 2018 Dec 1;30(10):769-777. doi: 10.1093/intqhc/mzy086.


Objective: Evaluate the impact of a World Health Organization Safe Childbirth Checklist coaching-based intervention (BetterBirth Program) on availability and procurement of essential childbirth-related supplies.

Design: Matched pair, cluster-randomized controlled trial.

Setting: Uttar Pradesh, India.

Participants: 120 government-sector health facilities (60 interventions, 60 controls). Supply-availability surveys were conducted quarterly in all sites. Coaches collected supply procurement sources from intervention sites.

Interventions: Coaching targeting implementation of Checklist with data feedback and action planning.

Main outcome measures: Mean supply availability by study arm; change in procurement sources for intervention sites.

Results: At baseline, 6 and 12 months, the intervention sites had a mean of 20.9 (95% confidence interval (CI): 20.2-21.5); 22.4 (95% CI: 21.8-22.9) and 22.1 (95% CI:21.4-22.8) items, respectively. Control sites had 20.8 (95% CI: 20.3-21.3); 20.9 (95% CI: 20.3-21.5) and 21.7 (95% CI: 20.8-22.6) items at the same time-points. There was a small but statistically significant higher availability in intervention sites at 6 months (difference-in-difference (DID) = 1.43, P < 0.001), which was not seen by 12 months (DID = 0.37, P = 0.53). Greater difference between intervention and control sites starting in the bottom quartile of supply availability was seen at 6 months (DID = 4.0, P = 0.0002), with no significant difference by 12 months (DID = 1.5, P = 0.154). No change was seen in procurement sources with ~5% procured by patients with some rates as high as 29% (oxytocin).

Conclusions: Implementation of the BetterBirth Program, incorporating supply availability, resulted in modest improvements with catch-up by control facilities by 12 months. Supply-chain coaching may be most beneficial in sites starting with lower supply availability. Efforts are needed to reduce reliance on patient-funding for some critical medications.

Trial registration: ClinicalTrials.gov #NCT02148952; Universal Trial Number: U1111-1131-5647.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Checklist*
  • Delivery, Obstetric*
  • Equipment and Supplies / supply & distribution*
  • Female
  • Health Facilities
  • Humans
  • India
  • Infant, Newborn
  • Mentoring
  • Pregnancy
  • Public Sector
  • Quality Improvement / organization & administration*
  • World Health Organization

Associated data

  • ClinicalTrials.gov/NCT02148952