Effectiveness of a WHO Safe Childbirth Checklist Coaching-based intervention on the availability of Essential Birth Supplies in Uttar Pradesh, India

Objective: Evaluate the impact of a World Health Organization Safe Childbirth Checklist coachingbased intervention (BetterBirth Program) on availability and procurement of essential childbirthrelated supplies. Design: Matched pair, cluster-randomized controlled trial. Setting: Uttar Pradesh, India. Participants: 120 government-sector health facilities (60 interventions, 60 controls). Supplyavailability surveys were conducted quarterly in all sites. Coaches collected supply procurement sources from intervention sites. Interventions: Coaching targeting implementation of Checklist with data feedback and action planning. Main Outcome Measures: Mean supply availability by study arm; change in procurement sources for intervention sites. Results: At baseline, 6 and 12 months, the intervention sites had a mean of 20.9 (95% confidence interval (CI): 20.2-21.5); 22.4 (95% CI: 21.8-22.9) and 22.1 (95% CI:21.4-22.8) items, respectively. Control sites had 20.8 (95% CI: 20.3-21.3); 20.9 (95% CI: 20.3-21.5) and 21.7 (95% CI: 20.8-22.6) items at the same time-points. There was a small but statistically significant higher availability in intervention sites at 6 months (difference-in-difference (DID) = 1.43, P < 0.001), which was not seen by 12 months (DID = 0.37, P = 0.53). Greater difference between intervention and control sites starting in the bottom quartile of supply availability was seen at 6 months (DID = 4.0, P = 0.0002), with no significant difference by 12 months (DID = 1.5, P = 0.154). No change was seen in procurement sources with ~5% procured by patients with some rates as high as 29% (oxytocin). Conclusions: Implementation of the BetterBirth Program, incorporating supply availability, resulted in modest improvements with catch-up by control facilities by 12 months. Supply-chain coaching may be most beneficial in sites starting with lower supply availability. Efforts are needed to reduce reliance on patient-funding for some critical medications.