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Competence of health workers in emergency obstetric care: an assessment using clinical vignettes in Brong Ahafo region, Ghana
OBJECTIVES: To assess health worker competence in emergency obstetric care using clinical vignettes, to link competence to availability of infrastructure in facilities, and to average annual delivery workload in facilities. DESIGN: Cross-sectional Health Facility Assessment linked to population-base...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BMJ Publishing Group
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4916610/ https://www.ncbi.nlm.nih.gov/pubmed/27297010 http://dx.doi.org/10.1136/bmjopen-2015-010963 |
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author | Lohela, Terhi Johanna Nesbitt, Robin Clark Manu, Alexander Vesel, Linda Okyere, Eunice Kirkwood, Betty Gabrysch, Sabine |
author_facet | Lohela, Terhi Johanna Nesbitt, Robin Clark Manu, Alexander Vesel, Linda Okyere, Eunice Kirkwood, Betty Gabrysch, Sabine |
author_sort | Lohela, Terhi Johanna |
collection | PubMed |
description | OBJECTIVES: To assess health worker competence in emergency obstetric care using clinical vignettes, to link competence to availability of infrastructure in facilities, and to average annual delivery workload in facilities. DESIGN: Cross-sectional Health Facility Assessment linked to population-based surveillance data. SETTING: 7 districts in Brong Ahafo region, Ghana. PARTICIPANTS: Most experienced delivery care providers in all 64 delivery facilities in the 7 districts. PRIMARY OUTCOME MEASURES: Health worker competence in clinical vignette actions by cadre of delivery care provider and by type of facility. Competence was also compared with availability of relevant drugs and equipment, and to average annual workload per skilled birth attendant. RESULTS: Vignette scores were moderate overall, and differed significantly by respondent cadre ranging from a median of 70% correct among doctors, via 55% among midwives, to 25% among other cadres such as health assistants and health extension workers (p<0.001). Competence varied significantly by facility type: hospital respondents, who were mainly doctors and midwives, achieved highest scores (70% correct) and clinic respondents scored lowest (45% correct). There was a lack of inexpensive key drugs and equipment to carry out vignette actions, and more often, lack of competence to use available items in clinical situations. The average annual workload was very unevenly distributed among facilities, ranging from 0 to 184 deliveries per skilled birth attendant, with higher workload associated with higher vignette scores. CONCLUSIONS: Lack of competence might limit clinical practice even more than lack of relevant drugs and equipment. Cadres other than midwives and doctors might not be able to diagnose and manage delivery complications. Checking clinical competence through vignettes in addition to checklist items could contribute to a more comprehensive approach to evaluate quality of care. TRIAL REGISTRATION NUMBER: NCT00623337. |
format | Online Article Text |
id | pubmed-4916610 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-49166102016-06-24 Competence of health workers in emergency obstetric care: an assessment using clinical vignettes in Brong Ahafo region, Ghana Lohela, Terhi Johanna Nesbitt, Robin Clark Manu, Alexander Vesel, Linda Okyere, Eunice Kirkwood, Betty Gabrysch, Sabine BMJ Open Health Services Research OBJECTIVES: To assess health worker competence in emergency obstetric care using clinical vignettes, to link competence to availability of infrastructure in facilities, and to average annual delivery workload in facilities. DESIGN: Cross-sectional Health Facility Assessment linked to population-based surveillance data. SETTING: 7 districts in Brong Ahafo region, Ghana. PARTICIPANTS: Most experienced delivery care providers in all 64 delivery facilities in the 7 districts. PRIMARY OUTCOME MEASURES: Health worker competence in clinical vignette actions by cadre of delivery care provider and by type of facility. Competence was also compared with availability of relevant drugs and equipment, and to average annual workload per skilled birth attendant. RESULTS: Vignette scores were moderate overall, and differed significantly by respondent cadre ranging from a median of 70% correct among doctors, via 55% among midwives, to 25% among other cadres such as health assistants and health extension workers (p<0.001). Competence varied significantly by facility type: hospital respondents, who were mainly doctors and midwives, achieved highest scores (70% correct) and clinic respondents scored lowest (45% correct). There was a lack of inexpensive key drugs and equipment to carry out vignette actions, and more often, lack of competence to use available items in clinical situations. The average annual workload was very unevenly distributed among facilities, ranging from 0 to 184 deliveries per skilled birth attendant, with higher workload associated with higher vignette scores. CONCLUSIONS: Lack of competence might limit clinical practice even more than lack of relevant drugs and equipment. Cadres other than midwives and doctors might not be able to diagnose and manage delivery complications. Checking clinical competence through vignettes in addition to checklist items could contribute to a more comprehensive approach to evaluate quality of care. TRIAL REGISTRATION NUMBER: NCT00623337. BMJ Publishing Group 2016-06-13 /pmc/articles/PMC4916610/ /pubmed/27297010 http://dx.doi.org/10.1136/bmjopen-2015-010963 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ |
spellingShingle | Health Services Research Lohela, Terhi Johanna Nesbitt, Robin Clark Manu, Alexander Vesel, Linda Okyere, Eunice Kirkwood, Betty Gabrysch, Sabine Competence of health workers in emergency obstetric care: an assessment using clinical vignettes in Brong Ahafo region, Ghana |
title | Competence of health workers in emergency obstetric care: an assessment using clinical vignettes in Brong Ahafo region, Ghana |
title_full | Competence of health workers in emergency obstetric care: an assessment using clinical vignettes in Brong Ahafo region, Ghana |
title_fullStr | Competence of health workers in emergency obstetric care: an assessment using clinical vignettes in Brong Ahafo region, Ghana |
title_full_unstemmed | Competence of health workers in emergency obstetric care: an assessment using clinical vignettes in Brong Ahafo region, Ghana |
title_short | Competence of health workers in emergency obstetric care: an assessment using clinical vignettes in Brong Ahafo region, Ghana |
title_sort | competence of health workers in emergency obstetric care: an assessment using clinical vignettes in brong ahafo region, ghana |
topic | Health Services Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4916610/ https://www.ncbi.nlm.nih.gov/pubmed/27297010 http://dx.doi.org/10.1136/bmjopen-2015-010963 |
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