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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, 6770]
*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]