Babban Dodo Primary Health Centre (PHC) is a busy facility nestled in the heart of a semi-urban community in Zaria LGA of Kaduna state. Despite the perennial challenge of an inadequate workforce and limited resources, coupled with local religious beliefs and cultural practices which fostered poor maternal health outcomes, the facility is renewing the hope for improved quality maternal care in its host community through the revival of a simple, yet, potentially lifesaving tool.

The partograph – a graphical representation of a pregnant mother’s labor and delivery progress- is an often overlooked and underutilized tool. First developed in 1972, it has for over five decades proved effective in predicting and averting adverse maternal and fetal health outcomes when correctly used. With the efforts of a dedicated facility leadership and a budding quality improvement (QI) team, Babban Dodo PHC has reprioritized the consistent and correct use of partograph at the Labor and Delivery Unit in a fresh effort to improve the quality of maternity care and reduce preventable maternal and neonatal deaths.

This improvement journey began with PROJECT AISHA’S implementation of the Maternal Healthcare Quality Improvement Learning Session (LS) workshops series. The name ‘Aisha’ means ‘alive and well’ which is the goal of the project –safer outcomes for pregnant mothers and their babies. During the LS workshops, Midwives, Nurses, Community Health Extension Workers (CHEWS) and Medical Records Officers receive training on quality improvement (QI) methods and tools and use the platform for peer learning and exchange of best practices. At this first LS workshop session in August 2023, participants enhanced their competency by learning the importance of the partograph and how to use it correctly to better monitor labor and improve outcomes.

Following the LS workshop, Babban Dodo PHC conducted a 6-week retrospective review and audit of patients’ delivery records to establish their baseline performance on the correct use of partograph. This audit was conducted using a standardized partograph scoring tool the QI team had received training on. For the partograph to be correctly used in monitoring labor and delivery, all the eligible components of care for each woman in labor need to have been provided and documented on the partograph. The median performance from these audits shaped the aim statement set for this prioritized clinical process to be tested in the PHC.

While the audits showed 50% of deliveries were monitored with a partograph, the quality of monitoring (correct use) was 0% at baseline, with none of the audited partograph meeting the standard care on the partograph scoring tool. Thus, the QI team agreed to achieve an increase in the correct use of partograph to monitor all labor and delivery cases from a baseline score of 0% to 80% within a 3-month period. To achieve this, the six skilled birth attendants in the facility were trained on the correct use of the partograph, ensured consistent availability of partographs, attachment of a partograph to the client’s ANC cards to promote adherence, and continuous monitoring of the newly adopted practice through weekly audits of delivery case notes.