Table 3

Challenges to implementation and suggested solutions

Resistance to using the Checklist and a lack of staff motivationEducation, ongoing supervision and training specifically addressing knowledge gaps;
Educating physicians and their supervisors on the importance and value of the Checklist
Lack of understanding on how to use the ChecklistEducating staff on how to use the Checklist, developing leaflets and other job aids
Perception of increased workload related to Checklist useEducation on the importance of the Checklist and essential practices
Limited Checklist supplyWorking with management to develop a supply system; Identifying a leader responsible for ensuring supplies
Lack of essential birth suppliesAdvising management to request the identified critical drugs/equipment; Implementers to conduct assessments and arrange provision of missing supplies
Inadequate staff including intermittent attendanceFocus on attendance; Encourage birth attendants to ask birth companions for assistance
Staff turnoverConducting ongoing periodic training sessions
Care of women and newborns at different places in the facilitySplitting Checklist pause points into separate documents for each of the different sites for care
Forgetting to use the ChecklistPlacing the Checklist in visible places; creating large posters for walls
Insufficient trained birth attendants to manage several women presenting in labour at the same timeEncouraging birth attendants to use birth companions for assistance
Inconsistencies with local and national guidelinesAdaptation/modification of the Checklist
Lack of clinical skills required by ChecklistArranging trainings for essential birth practices