TY - JOUR
T1 - Authorization of midwives to perform basic emergency obstetric and newborn care signal functions in Argentina, Ghana, and India
T2 - A multi-country validation study of a key global maternal and newborn health indicator
AU - Ramesh, Sowmya
AU - Chakraborty, Suchandrima
AU - Adanu, Richard M.
AU - Bandoh, Delia A.B.
AU - Berrueta, Mabel
AU - Gausman, Jewel
AU - Khan, Nizamuddin
AU - Kenu, Ernest
AU - Langer, Ana
AU - Nigri, Carolina
AU - Odikro, Magdalene A.
AU - Pingray, Verónica
AU - Saggurti, Niranjan
AU - Vázquez, Paula
AU - Williams, Caitlin R.
AU - Jolivet, R. Rima
N1 - Publisher Copyright:
Copyright: © 2023 Ramesh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2023/4
Y1 - 2023/4
N2 - Background Midwives’ authorization to deliver the seven basic emergency obstetric and newborn care (BEmONC) functions is a core policy indicator in global monitoring frameworks, yet little evidence supports whether such data are captured accurately, or whether authorization demonstrates convergence with midwives’ skills and actual provision of services. In this study, we aimed to validate the data reported in global monitoring frameworks (criterion validity) and to determine whether a measure of authorization is a valid indicator for BEmONC availability (construct validity). Methods We conducted a validation study in Argentina, Ghana, and India. To assess accuracy of the reported data on midwives’ authorization to provide BEmONC services, we reviewed national regulatory documents and compared with reported country-specific data in Countdown to 2030 and the World Health Organization Maternal, Newborn, Child and Adolescent Health Policy Survey. To assess whether authorization demonstrates convergent validity with midwives’ skills, training, and performance of BEmONC signal functions, we surveyed 1257 midwives/midwifery professionals and assessed variance. Results We detected discrepancies between data reported in the global monitoring frameworks and the national regulatory framework in all three countries. We found wide variations between midwives’ authorization to perform signal functions and their self-reported skills and actual performance within the past 90 days. The percentage of midwives who reported performing all signal functions for which they were authorized per country-specific regulations was 17% in Argentina, 23% in Ghana, and 31% in India. Additionally, midwives in all three countries reported performing some signal functions that the national regulations did not authorize. Conclusion Our findings suggest limitations in criterion and construct validity for this indicator in Argentina, Ghana, and India. Some signal functions such as assisted vaginal delivery may be obsolete based on current practice patterns. Findings suggest the need to re-examine the emergency interventions that should be included as BEmONC signal functions.
AB - Background Midwives’ authorization to deliver the seven basic emergency obstetric and newborn care (BEmONC) functions is a core policy indicator in global monitoring frameworks, yet little evidence supports whether such data are captured accurately, or whether authorization demonstrates convergence with midwives’ skills and actual provision of services. In this study, we aimed to validate the data reported in global monitoring frameworks (criterion validity) and to determine whether a measure of authorization is a valid indicator for BEmONC availability (construct validity). Methods We conducted a validation study in Argentina, Ghana, and India. To assess accuracy of the reported data on midwives’ authorization to provide BEmONC services, we reviewed national regulatory documents and compared with reported country-specific data in Countdown to 2030 and the World Health Organization Maternal, Newborn, Child and Adolescent Health Policy Survey. To assess whether authorization demonstrates convergent validity with midwives’ skills, training, and performance of BEmONC signal functions, we surveyed 1257 midwives/midwifery professionals and assessed variance. Results We detected discrepancies between data reported in the global monitoring frameworks and the national regulatory framework in all three countries. We found wide variations between midwives’ authorization to perform signal functions and their self-reported skills and actual performance within the past 90 days. The percentage of midwives who reported performing all signal functions for which they were authorized per country-specific regulations was 17% in Argentina, 23% in Ghana, and 31% in India. Additionally, midwives in all three countries reported performing some signal functions that the national regulations did not authorize. Conclusion Our findings suggest limitations in criterion and construct validity for this indicator in Argentina, Ghana, and India. Some signal functions such as assisted vaginal delivery may be obsolete based on current practice patterns. Findings suggest the need to re-examine the emergency interventions that should be included as BEmONC signal functions.
UR - http://www.scopus.com/inward/record.url?scp=85153413687&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0283029
DO - 10.1371/journal.pone.0283029
M3 - Article
C2 - 37079621
AN - SCOPUS:85153413687
SN - 1932-6203
VL - 18
JO - PLoS ONE
JF - PLoS ONE
IS - 4 April
M1 - e0283029
ER -