Adapting the WHO Safe Childbirth Checklist: A collaborative study in West Africa

Background: The World Health Organization Safe Childbirth Checklist (WHO SCC) was developed to increase the uptake of essential birth practices; however, only a few studies have adopted this process in French West African countries. Aim: This study aimed to describe the WHO SCC adaptation process across Burkina Faso, Côte d’Ivoire, and Guinea, and the lessons learned. Setting: Adaptation processes were conducted in the above-mentioned countries. Methods: From May 2022 to November 2022, a cross-country adaptation of the WHO SCC was carried out using a co-creation approach following a modified Delphi process. This process included the contextual adaptation of the tool by local technical advisory groups in each country based on national guidelines, the harmonisation and production of a single modified SCC by the Cross-Country Technical Advisory Group, a pre-test of the modified SCC, and adoption. Results: Minor modifications were made on 27 items. No items were deleted. Two items related to hand hygiene and the use of protective equipment were added at the ‘just before pushing’ pause point. The modified SCC implemented in each country consisted of 31 items, with variations observed in the timing of the monitoring signs when plotting the partograph. The tool was introduced following the A3 and kakemono formats. Conclusion: The study emphasised the importance of engaging all stakeholders and end users in the adaptation process for a sustainable use of the tool. Contribution: This collaborative effort between countries to develop a unified SCC highlights the importance of adaptation based on national guidelines and local contexts.