Table 5.

Health worker competence

Question	No of studies	Evidence synthesis	Quality
What is health workers knowledge of assessment using the partograph?	n = 10	Knowledge of assessment using the partograph is generally poor, particularly when to start the partograph, the plotting of normal labour and the function of the action and alert lines. Knowledge is better in health workers with professional qualifications and those in tertiary settings. There is a little available evidence of health workers’ understanding of the partograph as a tool to aid decision making.	**Low [33, 36, 41, 43, 48] *V low [26, 30, 32, 42, 71]
Do education, training and experience impact on knowledge of the partograph?	n = 5	Professional education and/or training in partograph use improve knowledge of the partograph. There does not appear to be a link between length of experience in using the partograph and knowledge of the partograph.	**Low [41, 43, 48] *V low [30, 32]
What is the level of competence in partograph completion?	n = 11	The overall standard of partograph recording is poor and frequently not in accordance with WHO or other guidance. Particular aspects of the partograph are more likely to be completed; these are cervical dilatation, fetal heart rate, and condition of the neonate. Maternal observations are least likely to be completed well.	**Low [25, 33, 36] *V low [24, 26–31, 66]
Do training interventions increase knowledge and use of the partograph?	n = 8	Training interventions do appear to improve knowledge and use of the partograph. Individualised training sessions and self-directed training (e.g., CD-ROM or maternal care manual) are most effective in increasing knowledge (in the included studies). Health workers desire training in partograph use, even if they have already received training.	***Medium [56] **Low [54] *V low [34, 35, 37, 53, 72]