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Table 2 Health system support

From: A realist review of the partograph: when and how does it work for labour monitoring?

Question

No of studies

Evidence synthesis

Quality

What is the organisational commitment to partograph use?

n = 2

There is very little available evidence of organisational commitment.

There is limited evidence of organisational commitment in high-resource settings.

**Low [23]

*Very Low [29].

What is the policy and guidance related to partograph use?

n = 4 studies

n = 5 guideline documents

The main guidance documents are those produced by WHO.

There is a lack of available guidance at the facility level.

Limited evidence suggests that available facility level guidance promotes partograph use in practice.

Guidance [64, 65, 67–70]

*V low [24, 25, 30, 49]

Is the partograph available?

n = 8

There is a lack of availability of the partograph in some settings, particularly health centres.

**Low [25, 33, 38, 43, 48]

*V low [29, 30, 47]

Is there support for partograph use in terms of resource provision?

n = 2

Equipment required for partograph completion may not be available; for example sphygmomanometers, thermometers and fetoscopes.

*V low [29, 31]

How can the partograph be implemented effectively?

n = 2, plus 1 audit

There is little evidence to determine the most effective method of partograph implementation.

Pre-implementation training and post-implementation audit and feedback may have a positive impact on accuracy and frequency of partograph completion.

***Medium [18]

*V low [20, 50]