Bulletin of the World Health Organization

Are skilled birth attendants really skilled? A measurement method, some disturbing results and a potential way forward

Steven A Harvey, Yudy Carla Wong Blandón, Affette McCaw-Binns, Ivette Sandino, Luis Urbina, César Rodríguez, Ivonne Gómez, Patricio Ayabaca, Sabou Djibrina, the Nicaraguan maternal and neonatal health quality improvement group

Volume 85, Number 10, October 2007, 783-790

Table 2. Number of Phase II participants by evaluation component and professional cadre

Professionalcadre Knowledge component
Skills component
Total Obstetric/gynaecologic test Paediatric test General test Partograph exercise Active management Manual removal Bimanual compression Immediate newborn care Neonatal resuscitation
Doctors 506 159 149 198 343 170 170 170 159 159
Obstetrician/gynaecologist 82 82 79 49 49 49
Paediatrician 82 82 48 48
Obstetric/gynaecologic resident 41 41 38 16 16 16
Paediatric resident 27 27 9 9
General practitioner – gynaecologist 35 35 34 20 20 20
General practitioner – paediatrician 40 40 18 18
General practitioner – ER 199 1 198 192 85 85 85 84 84
Medical students 148 28 31 89 116 41 41 41 40 40
Social service physician 91 3 2 86 89 36 36 36 33 33
Medical intern 57 25 29 3 27 5 5 5 7 7
Professional nurses 339 96 83 160 118 93 87 87
Nurse-midwifea 5 4 1 5 3
Maternal and child health nurse 68 37 16 15 34 27 16 16
Professional nurse 266 55 67 144 79 63 71 71
Auxiliary nurses 365 52 58 255 89 81 83 83
Technical nurse 20 6 7 7 4 2 2 2
Auxiliary nurse 345 46 51 248 85 79 81 81
Total 1358 335 321 702 666 385 211 211 369 369

ER, emergency room.a Nurse-midwives have received both nursing and midwifery training, and therefore theoretically belong in a separate category from nurses. However, Nicaragua no longer trains this cadre and very few remain in practice. Since our sample contained only five nurse-midwives (< 0.5% of total), we grouped them with professional nurses.

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