Metrics for maternity unit staffing in low resource settings: Scoping review and proposed core indicator

Abstract

BackgroundThe lack of usable indicators and benchmarks for staffing of maternity units in health facilities has constrained planning and effective program implementation for emergency obstetric and newborn care (EmONC) globally.ObjectivesTo identify potential indicator(s) and benchmarks for EmONC facility staffing that might be applicable in low resource settings, we undertook a scoping review before proceeding to develop a proposed set of indicators.Eligibility criteriaPopulation: women attending health facilities for care around the time of delivery and their newborns. Concept: reports of mandated norms or actual staffing levels in health facilities.Contextstudies conducted in healthcare facilities of any type that undertake delivery and newborn care and those from any geographic setting in both public and private sector facilities.Sources of evidence and chartingSearches were limited to material published since 2000 in English or French, using Pubmed and a purposive search of national Ministry of Health, non-governmental organization and UN agency websites for relevant documents. A template for data extraction was designed.ResultsData extraction was undertaken from 59 papers and reports including 29 descriptive journal articles, 17 national Ministry of Health documents, 5 Health Care Professional Association (HCPA) documents, two each of journal policy recommendation and comparative studies, one UN Agency document and 3 systematic reviews. Calculation or modelling of staffing ratios was based on delivery, admission or inpatient numbers in 34 reports, with 15 using facility designation as the basis for staffing norms. Other ratios were based on bed numbers or population metrics.ConclusionsTaken together, the findings point to a need for staffing norms for delivery and newborn care that reflect numbers and competencies of staff physically present on each shift. A Core indicator is proposed, “Monthly mean delivery unit staffing ratio” calculated as number of annual births/365/monthly average shift staff census.

Evaluation of Midwifery Practices among Registered Midwives in Selected Hospitals in Limpopo Province, South Africa

“…Most of the respondents indicated that they gave health education to mothers during the postpartum period. In contrast to this study's findings, another study found a lack of general health education after childbirth [34].…”

Causes of stillbirths at Kgapane hospital, Limpopo province

“…The recommended ratio in low-resource settings by FIGO (The international federation for gynaecologists and obstetricians) is 1.71 births per midwife, and the FIGO ideal ratio would be 1.52. 11 However, in the maternity section where the present study was conducted, the ratio was 3.5 births per midwife. Focussing training and improvement strategies on the most common causes of stillbirths could assist with improving perinatal outcomes in understaffed healthcare settings.…”

“… 16 Maternity ward staffing norms should be standardised. 11 The inability to establish a cause hampers the grieving process and the ability to prevent stillbirths in future. 7 The evidence-based guidelines referred to earlier were developed and widely available.…”

Neonatal death audits at Kgapane Hospital, Limpopo province

“…The inadequate intrapartum monitoring is frequently due to insufficient staffing and resources, including equipment such as cardiotocographs. 3,4,5,12,13,14,16 The recommended midwife to birth ratio in low resource settings by the International Federation of Gynecology and Obstetrics (FIGO) is 1.71 births per midwife, with an ideal FIGO ratio of 15.2. 14 In contrast, at the maternity section where this study was conducted, the midwife to birth ratio was 3.5.…”

“…Monthly, there are 16 full-time midwives allocated to the maternity section, including labour ward, ante-and post-natal wards resulting in a midwife to birth ratio of 3.5. 14 Individual file audits were performed on all perinatal deaths that occurred at Kgapane Hospital and its catchment area between February 2018 and October 2021. Data from these audits were captured for each individual perinatal death and used to do a retrospective observational study investigating the causes of NND.…”