Estimating maternity ward birth attendant time use in India: a microcosting study

Area of Science:

• Maternal Health
• Healthcare Quality Improvement
• Health Systems Research

Background:

• Global maternal care quality is a concern, yet time demands for essential birth practices are poorly understood.
• The BetterBirth trial evaluated the WHO Safe Childbirth Checklist's impact on facility-based care quality.

Purpose of the Study:

• To assess time utilization and specific time requirements for incorporating the WHO Safe Childbirth Checklist into clinical practice.
• To determine the time burden of essential birth practices on birth attendants.

Main Methods:

• Microcosting data collection methods were employed within the BetterBirth trial in Uttar Pradesh, India.
• Timed observations (1559) of 18 essential birth practices were conducted.
• Surveys (83 respondents) and facility observations (610) assessed checklist impact and staff time use.

Main Results:

• Essential birth practices were completed rapidly, ranging from 18 seconds to 2 minutes.
• Increased patient load led to more clinical care time, but it remained low relative to administrative tasks and downtime.
• WHO Safe Childbirth Checklist clinical care averaged less than 7% of hourly birth attendant time.

Conclusions:

• A coaching-based implementation of the WHO Safe Childbirth Checklist did not impose a significant time burden on birth attendants.
• Further research is needed on practice performance quality and the interpretation of idle/break time.