Essential newborn care: Two methods of promoting evidence-based practices in Bolivia

Background: New evidence-based clinical practices for safe delivery and care of newborns have been introduced in Bolivia and are now supported by government policies. However, reports indicate that these new practices are not completely incorporated into clinical routines.

Methods: In 2008, the Management and Quality in Health Project, set out to promote some of these practices, including the delayed clamping of the umbilical cord and early attachment. The project tested two approaches. The first (Strategy A) introduced the practices to providers in two hospitals through a workshop. The second (Strategy B), conducted in a third hospital, included the workshop and also supervisory visits by peers for all participating providers. 492 vaginal deliveries were observed prior to the intervention (281 in Strategy A facilities and 212 in Strategy B facilities) and 459 were observed two months after the intervention (261 and 198 in Strategy A and B facilities, respectively).

Findings: At baseline, clamping of the umbilical cord was never delayed by more than a minute. By endline, clamping was delayed by at least two minutes in 24% of deliveries observed in Strategy A hospitals and in 71% of deliveries in the Strategy B hospital. Likewise, early attachment increased from less than 2% of all observed vaginal deliveries to 42% and 68% of deliveries in Strategy A and B hospitals, respectively.

Conclusion: The addition of a peer supervisory visit produced significantly greater provider adherence to new clinical practices than the in-service workshop alone.