Competence of health workers in emergency obstetric care: an assessment using clinical vignettes in Brong Ahafo region, Ghana
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Date
2016-06
Authors
Lohela, T J
Nesbitt, R C
Manu, A
Vesel, L
Okyere, Eunice
Kirkwood, B
Gabrysch, S
Journal Title
Journal ISSN
Volume Title
Publisher
BMJ Publishing Group
Rights
Copyright © 2016 The authors
Rights Holder
The authors
Abstract
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.
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Keywords
Emergency obstetric care, Clinical vignettes, Ghana, Health worker competence
Citation
Lohela TJ, Nesbitt RC, Manu A, et al. Competence of health workers in emergency obstetric care: an assessment using clinical vignettes in Brong Ahafo region, Ghana. BMJ Open. 2016;6(6):e010963. doi:10.1136/bmjopen-2015-010963.