Outcomes
PPH
Outcomes were total scores in skills and knowledge tests for management of PPH. As no validated tests useful for the purpose was identified at the planning of the study, two new tests were developed by the clinicians and researchers in the SDA group based on existing guidelines and standards of care in management of PPH. The content validity was assured through a structured review by an expert group whereby three levels of competency from beginner to expert were assessed using the developed tool with significant ability to differentiate. To assess skills, role-play scenarios were conducted with each included health worker individually, and an ‘Objective Structured Assessment of Technical Skills’ (OSATS) scale was developed including all the identified key points and “global scores” related to the overall impression of the performance. Full score was given if a key point was performed or mentioned spontaneously and correct, ½ a point was given if prompting was needed or if only partly correct, otherwise no points was given (Fig. Skills test (objective structured observation of technical skills) observation formTo test knowledge a Key Feature Questionnaire (KFQ) was prepared with case-based questions related to clinical situations covering all important key points. The number of answer possibilities varied, one or more would be correct and score positive and some would be wrong and would, if constituted malpractice, deduct all marks related to that question (Fig. Knowledge test (key feature questionnaire) example of question based on a case. Green marked answer possibilities are correct answersDirect measuring of PPH at deliveries at the health facilities during the study period was considered and reported as the primary outcome for clinicaltrials.org. However, it proved unmanageable to oversee a reliable data collection at so many health facilities often situated in remote parts of the study area. The quality of the data was found to be very low and therefore further efforts to pursue this outcome was abandoned.