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Table 7 Health Workforce for perinatal care: domains and indicators

From: A health system framework for perinatal care in South African district hospitals: a Delphi technique

Domains Indicators
Skill mix ratio 1. Availability of the following staff in labour wards guided by staff norms, per shift.
a. Advanced midwives
b. Midwives
c. Enrolled nurses
d. Doctors
 2. Availability of an advanced midwife in every shift
Number of health care professionals 1. Availability of the following staff in labour wards, with respect to staff numbers guided by staff norms, per shift.
a. Advanced midwives
b. Midwives
c. Enrolled nurses
d. Doctors
 2. Minimal staff turnover for advanced midwives, midwives, doctors and enrolled nurses per year
Clinical mentorship All new staff (i.e. newly qualified and those who have been working in other hospital units) in latent phase and labour wards are allocated a clinical mentor until they are competent to provide perinatal care
Training 1. Per shift in latent phase and labour wards, there is at least one midwife or advanced midwife who has participated in all Essential Steps in the Management of Obstetric Emergencies (ESMOE) drills
 2. Per shift in latent phase and labour wards, there is at least one midwife or advanced midwife who has attended the Helping Babies Breathe (HBB) drill
 3. Per shift in neonate wards there is at least one midwife, advanced midwife or enrolled nurse who has attended the Initiative for Newborn Care(INC) training
 4. All staff allocated per shift have attended training on the proper use of medical equipment
Drills 1. All ESMOE modules are covered every month in labour ward drills
2. HBB drills occur monthly in labour ward
Staff rotation At least 50 % of staff in labour and neonate units are non-rotating over one year
Teamwork 1. Doctors and nurses conduct ESMOE drills together
 2. Doctors and nurses conduct HBB drills together
 3. Doctors and nurses doing hospital rounds together
 4. Advanced / experienced midwives work co-operatively with doctors in clinical decision making for perinatal care
Anchor doctor In hospitals that have less than 300 births per month, the availability of a doctor who is primarily responsible for the maternity unit, but also services other hospital units in the hospital
Dedicated doctor In hospitals that have at least 300 births per month, availability of a doctor who is solely responsible for the maternity unit on a full-time basis