Competence of health workers in emergency obstetric care: an assessment using clinical vignettes in Brong Ahafo region, Ghana

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work noncommercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http:// creativecommons.org/licenses/by-nc/4.0/Objectives: To assess health worker competence in emergency obstetric care using clinical vignettes, to link competence to availability of infrastructure in facilities, and to average annual delivery workload in facilities. Design: Cross-sectional Health Facility Assessment linked to population-based surveillance data. Setting: 7 districts in Brong Ahafo region, Ghana. Participants: Most experienced delivery care providers in all 64 delivery facilities in the 7 districts. Primary outcome measures: Health worker competence in clinical vignette actions by cadre of delivery care provider and by type of facility. Competence was also compared with availability of relevant drugs and equipment, and to average annual workload per skilled birth attendant. Results: Vignette scores were moderate overall, and differed significantly by respondent cadre ranging from a median of 70% correct among doctors, via 55% among midwives, to 25% among other cadres such as health assistants and health extension workers ( p