Assessing provider performance of intrapartum care using simulated encounters and clinical vignettes: A comparison study from Tanzania

OBJECTIVE To compare clinical vignettes (CV) and objective structured clinical examination (OSCE) as methods for assessing quality of intrapartum care among skilled providers in rural primary level health facilities of Tanzania. METHODS Cross sectional study conducted at six health facilities in Simiyu region of Tanzania. Providers were assessed using OSCE and CV in spontaneous delivery, neonatal resuscitation, and management of postpartum hemorrhage. Trained researchers used a structured clinical checklist. Frequency of items are presented as percentages and the agreement of the methods of assessment were reported using Kappa statistics (high: Kappa >0.80, moderate: 0.60-0.80, low: <0.60). RESULTS Most health care providers were female (60.7%), registered nurses by training (29.0%), and worked in a dispensary (56.1%) with an average age of 33 years and an average of 7.4 years of experience in their respective profession. Five items had high agreement between OSCE and CV: postpartum vital signs every 15 minutes, oxytocin within one minute of birth, diagnosis of postpartum hemorrhage, elevating legs of the mother, and deciding on manual compression of the uterus. CONCLUSION OSCE and CV should be viewed as complimentary to one another in assessment of provider knowledge and skill with priority given to OSCE, particularly in intrapartum care.