title: Designing the WHO Safe Childbirth Checklist program to improve quality of care at childbirth.
abstract: BACKGROUND
  Poor-quality care during institutional births in low- and middle-income countries is a major contributing factor to preventable maternal and newborn harm, but progress has been slow in identifying effective methods to address these deficiencies at scale. Based on the success of checklist programs in other disciplines, WHO led the design and field testing of the WHO Safe Childbirth Checklist-a 29-item tool that targets the major causes of maternal and newborn mortality globally.
  
  
  METHODS
  The development process consisted of comprehensive evidence and guideline review, in-person consultation with content experts and other key stakeholders, iterative refinement through ongoing discussions with a wide collaborator network, and field evaluation for usability in 9 countries, primarily in Africa and Asia. Pilot testing in South India demonstrated major improvement in health workers' delivery of essential safety practices after introduction of the program.
  
  
  RESULTS
  WHO has launched a global effort to support further evaluation of the program in a range of contexts, and a randomized trial is underway in North India to measure the effectiveness of the program in reducing severe maternal, fetal, and newborn harm.
  
  
  CONCLUSIONS
  A novel checklist program has been developed to support health workers in low-resource settings to prevent avoidable childbirth-related deaths.
authors.affiliation: Department of Health Policy and Management, Harvard School of Public Health, Boston, USA.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Spector
authors.forename: Angela
authors.initials: A
authors.lastname: Lashoher
authors.forename: Priya
authors.initials: P
authors.lastname: Agrawal
authors.forename: Claire
authors.initials: C
authors.lastname: Lemer
authors.forename: Gerald
authors.initials: G
authors.lastname: Dziekan
authors.forename: Rajiv
authors.initials: R
authors.lastname: Bahl
authors.forename: Matthews
authors.initials: M
authors.lastname: Mathai
authors.forename: Mario
authors.initials: M
authors.lastname: Merialdi
authors.forename: William
authors.initials: W
authors.lastname: Berry
authors.forename: Atul A
authors.initials: AA
authors.lastname: Gawande
mesh_terms: D057189:Checklist; D002662:Child Health Services / Q000592:standards*; D003906:Developing Countries; D005260:Female; D014943:Global Health; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000592:standards*; D008428:Maternal Mortality; D011247:Pregnancy; D016730:Program Development; D011787:Quality of Health Care; D014944:World Health Organization