The Skilled Attendance Index

Increasing the proportion of deliveries with skilled attendance is widely regarded as key to reducing maternal mortality and morbidity in developing countries. The percentage of deliveries with a health professional is commonly used to assess skilled attendance, but measures only the presence of an attendant, not the skills used or the enabling environment To supplement currently available information on the presence of an attendant at delivery, a method to measure the extent of skilled attendance at delivery through use of clinical records was devised. Data were collected from 416 delivery records in hospitals, government health centres and private non-hospital maternity facilities servicing Kintampo District, Ghana, using a case extraction form. Based on the defined criteria, summary measures of skilled attendance were calculated. Between 32.6% and 93.0% of the criteria for skilled attendance were met in the sample, with a mean of 65.5%. No delivery met all the criteria. A Skilled Attendance Index (SAI) was developed as a composite measure of delivery care. The SAI revealed that 26.9% of delivery records met at least three-quarters of the criteria for skilled attendance. Documentation of haemoglobin, current pregnancy complications, post-partum vital signs and completed partographs were amongst the criteria most poorly recorded. The purpose of applying these measures should be seen not as an end in itself but to advance improvements in delivery care

Attendance · Documentation · Family medicine · Political science · Global Health Care Issues · Global Maternal and Child Health · Healthcare Policy and Management · Medicine · Nursing

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  Open Access•Marge Koblinsky, Zoë Matthews et al.•The Lancet•2006

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• The scale, scope, coverage, and capability of childbirth care

  Open Access•Oona M R Campbell, Clara Calvert et al.•The Lancet•2016

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• Non-professional health practitioners and referrals to facilities

  Open Access•Justin Parkhurst, J O Parkhurst et al.•Health Policy and Planning•2007

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• Please understand when I cry out in pain

  Open Access•Lucia D’ambruoso, Lucia D'Ambruoso et al.•BMC Public Health•2005

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• What the papers say

  Open Access•Sara Mackian, Sara C MacKian•Health & Place•2007

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• Effect of a policy to reduce user fees on the rate of skilled birth attendance across socioeconomic strata in Burkina Faso

  Open Access•Eleanor Langlois, Étienne V Langlois et al.•Health Policy and Planning•2016

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• Technical quality of delivery care in private- and public-sector health facilities in Enugu and Lagos States, Nigeria

  Open Access•Akihiko Hirose, Ibrahim O Yisa et al.•Health Policy and Planning•2018

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• Women's Use of Private and Government Health Facilities for Childbirth in Nairobi's. Informal Settlements

  Open Access•Eva S Bazant, Eva Bazant et al.•Studies in Family Planning•2009

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• Son preference, use of maternal health care, and infant mortality in rural China, 1989-2000

  Jiajian Chen, Zhenming Xie et al.•Population Studies•2007

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• Assessing skilled birth attendants and emergency obstetric care in rural Tanzania

  Sydney A Spangler•Reproductive Health Matters•2012

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• Essential obstetric care

  Open Access•Olusoji Adeyi, Richard Morrow et al.•Social Science & Medicine•1997

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• Rapid appraisal in an urban setting, an example from the developed world

  Open Access•Bie Nio Ong, Gerry Humphris et al.•Social Science & Medicine•1991

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