title: Assessment of provider competence and quality of maternal/newborn care in selected Latin American and Caribbean countries.
abstract: OBJECTIVE
  To obtain a snapshot of the maternal and newborn care provided by different types of maternal and child health providers in Latin America and the Caribbean (LAC) to 1) better inform advocacy and programmatic strategies and interventions to improve the quality of those services in the region, and 2) determine the need for more rigorous study of the issues.
  
  
  METHODS
  A rapid assessment of 83 health workers providing antepartum, intrapartum, and immediate postpartum and newborn care (within two hours of birth) in eight LAC countries was conducted in November and December of 2011. Health workers were observed by two-person expert maternal/newborn clinician teams using pretested forms based on international quality-of-care standards. A total of 105 care encounters were observed, primarily in urban, public, referral-level settings. Providers of care included obstetricians, midwives, generalist physicians, medical residents, registered nurses, auxiliary nurses, and students of medicine, midwifery, and nursing.
  
  
  RESULTS
  Hand washing, as an indicator of quality of antepartum care, was observed in only 41% of the observed encounters. Labor management often lacked certain elements of respectful maternity care across all provider groups. Several clinical tasks of high importance in the identification and prevention of common complications of antepartum, intrapartum, and immediate postpartum/newborn care were not documented as performed during the observation periods. Providers self-reported limited competence (ability to perform to a defined level of proficiency) in manual removal of the placenta, bimanual compression of the uterus, and newborn resuscitation.
  
  
  CONCLUSIONS
  The findings suggest that 1) the quality of maternal and newborn care and 2) the competence of maternal and child health providers in the diverse selection of LAC countries that were studied require substantial attention.
authors.forename: Joyce E
authors.initials: JE
authors.lastname: Thompson
authors.forename: Sandra
authors.initials: S
authors.lastname: Land
authors.affiliation: United Nations Population Fund-Latin America and Caribbean Region, Clayton, Panama, vcamacho@unfpa.org.
authors.forename: Alma Virginia
authors.initials: AV
authors.lastname: Camacho-Hubner
authors.forename: Judith T
authors.initials: JT
authors.lastname: Fullerton
mesh_terms: D017691:Caribbean Region; D002983:Clinical Competence; D005260:Female; D006282:Health Personnel / Q000706:statistics & numerical data*; D006801:Humans; D007224:Infant Care / Q000592:standards; D007231:Infant, Newborn; D007843:Latin America; D008880:Midwifery; D009726:Nurses; D018743:Perinatal Care / Q000592:standards; D010820:Physicians; D011181:Postnatal Care / Q000592:standards; D011247:Pregnancy; D011295:Prenatal Care / Q000592:standards; D011787:Quality of Health Care / Q000592:standards; D013337:Students, Medical; D013338:Students, Nursing