Table 4 Sample size considerations for the assessment

Observations:

Health centres

All deliveries in HCs will be observed up to a maximum of 5 deliveries. However, any complicated pregnancy such as pre-eclampsia, antepartum haemorrhage, preterm labour will be observed

Hospitals

3 delivery observations per facility every other day: one per morning, afternoon and night shifts and therefore a total of 21 per hospital over the 2 weeks. Complications e.g. antepartum haemorrhage, pre-eclampsia, eclampsia, preterm labour, premature rupture of membranes, chorioamnionitis, etc. will be prioritized.

Health worker interviews

Health centres

Because these facilities are usually poorly staffed, we will aim to conduct interviews with 2–3 staff at the facility

Hospitals

The following interviews will be conducted per facility:

1. Specialist Paediatrician/Obstetrician gynaecologist (1 each);

2. Medical Officers working in the labour ward (2–4);

3. Physician assistant (1–3);

4. Neonatal nurse (1);

5. Midwives (3–5);

6. Staff Nurse (2–3);

7. Other professionals who attend delivery in the labour ward (1–3)

Client exit interviews

All health facilities

All clientele who are admitted and discharged from the facility over the two weeks of the facility. All records of admissions and discharges over the period of the facility contact will be collected.

Records Review

Health centres

1. All deliveries in the past 3-months to the date of the visit will be reviewed. If less than 50 records are found, the review should be extended to cover the previous 6 months.

2. Partographs: Partographs for all delivery records picked will be reviewed but where rarely completed, the last 25 done with the previous 12 months should be reviewed.

3. Treatment records for all complications of delivery or newborn health will be reviewed.

Hospitals

1. Deliveries in the 8 weeks to the date of the visit will be reviewed. This allows for capturing delivery up to mandatory postpartum visits to the facility. Where the previous 4 weeks coincide with a special event such as Ramadan etc., the other 4 weeks may compensate for the numbers and spectrum of cases. Assessors will review 25–30 delivery records each day starting with the most recent and working backwards.

2. Partographs: That for 20% of all deliveries in the previous 8 weeks will be reviewed. Selection will be by systematic sampling: each day, the reviewer will conduct a simple ballot to choose one out of the first five delivery records to be reviewed in the order in which the records were picked. Partographs of the 5th delivery after the one selected from the ballot will be reviewed. Where records are few, a minimum of 120 partographs should be reviewed.

3. Treatment records for all complications of delivery will be reviewed

4. All newborn health complications or illnesses will be reviewed

5. Records for all caesarean sections will also be reviewed.