Table 1 Summary of solution themes and proposed actions for quality care during labour and birth (part A).
Health system building blocks | Solution Themes | Proposed actions from programme experience and literature review |
|---|---|---|
|  | Advocacy and political will | • Active involvement and coordination from national advocates (academic and professional bodies, policy makers, hospital management committees) on quality care for labour & birth and emergency obstetric care. |
Leadership and Governance | Review and disseminate policies and guidelines | • Develop a unified national implementation plan for SBA, BEmOC and CEmOC. |
|  |  | • Improve context specific planning and policy on referral systems for births, birth companionship and standard operating guidelines for different level facilities, including the private sector. |
|  | Budget allocation | • Prioritise, increase and sustain funding for emergency obstetric care to ensure multi-year predictable financing of services based on need. |
Health Financing | Innovative funding and removal of user fees | • Ensure there is accountability and in-built mechanisms to minimise financial corruption at the facility, local and national level. |
|  |  | • Apply learning from existing schemes to reduce financial barriers to care-seeking, such as incentive and voucher schemes and consider public private partnerships. |
|  |  | • Ensure existing systems cover care at birth including transport, referral and care for complications (e.g. caesarean section). |
|  | Human resource management | • Develop clear job descriptions with appropriate remuneration mechanisms and career development pathways (e.g. national accreditation system for SBAs and a midwifery cadre). |
|  | Competency based training | • Increase the number of sanctioned posts, including specialists, within the public sector and ensure systems exist for adequate recruitment, rational deployment and ongoing retention working towards universal skilled attendance. |
Health Workforce |  | • Scale up of simplified, skills and competency based training programmes on basic emergency obstetric care, including assisted vaginal delivery and respectful care practices. |
|  |  | • Where appropriate, involve the private sector in training programmes. |
|  | Task shifting | • Maximise existing resources and assess competencies for lower level health workers to take on tasks such as assisted vaginal deliveries and anaesthesia. |
|  | Mentoring and supervision | • Improve mentoring through robust performance monitoring and supervision systems for SBAs. |