Table 4.

Effectiveness of the NMCR cycle on the structure

Authors	Physical structure	Staffing	Equipment and supplies	Training, monitoring and supervision	Local policies and organisation of services
Lumala et al, 201713
Mgaya et al, 201714				Training on partograph, improved supervision	Improved dissemination and use of guidelines, Improved team work and internal communication among hospital staff
Kayiga et al, 201615					Re-engineering hospital Red Alert System: list of responsible person to be contacted during Red Alert activation was put up in all obstetrics facilities; information on the importance of activating the Red Alert in eclampsia cases was disseminated to all staff; hospital telephone operator was informed regarding existence of this system and how it functioned
Mohd Azri et al, 201516		Better specification of roles and responsibilities		Training, improved awareness of standards, improved patient education	Reorganisation of ‘red alert’ system
Gebrehiwot and Tewolde, 201417	Some hospitals expanded accommodate more cases	Staff organisation: duties assignment; staff rotation every 12 hours to avoid tiredness	Contribution of resources (stationery, transport)	Provision of training and feedback to health centres	Improved dissemination of protocols, increased use of partograph, Improved documentation and reporting improved coordination with health centres
Baltag et al, 201218			Improved equipment and supplies		Improved dissemination of protocols, organisation of care and management
Kidanto et al, 201219		Improved doctor availability 24/24 hours	Additional equipment purchased	Training	Improved dissemination of protocols, monitoring forms, reorganisation of daily routine and setting of priorities, doctors assigned to manage cases of eclampsia
Sukhanberdiyev et al, 201120 and Hodorogea, 201021		Rational use of staff by internal redistribution, optimisation of human resources by reducing the working hours, increased role of mid-level staff (midwives and nurses)	Mobile devices for timely alert and warning, drugs and blood components, prostaglandins and uterotonics	Training on protocols and standards, periodic drills, improving time management skills	Developing, diffusing and use new evidenced-based protocols, developing emergency care algorithms and conditions for transportation from remote areas, identifying the responsible person for the readiness of the emergency kit, monitoring forms, weighing of blood losses and documenting systematically
Van den Akker et al, 201122				Training, regular on job coaching, improved supervision, monitoring of ambulance use	Improved dissemination of protocols and use of partograph, doctors to visits critically ill patients at least once a day
Bailey et al, 201023			Purchase of equipment (lab, car for on-call, telephone for emergency), wall flow charts	Training, supervision	Leadership on implementing changes, standardisation of treatment with protocols and checklists, team work record keeping
Van den Akker et al, 200924			More ambulances	Training, supervision, follow-up visits in health centres	Improved dissemination of protocols, transport organisation, organise session for theatre staff with the intention to reduce delay in surgical care
Hunyinbo et al, 200825			Pharmacy supply including oxytocins, MgSO4, blood and coagulation tests		Improved dissemination of protocols, clinical meetings, observational and fluid balance charts
Kongnyuy et al, 200826	The number of comprehensive and basic EmOC facilities did not change
Kongnyuy et al, 200827		Autonomy in decision making in MW-N	Better equipment and set up of service	Training	Reorganisation of emergency care service, including use of ambulances
Weeks et al, 200528		Staff in the labour room reorganised giving each member a specific role in the management of emergencies; two extra MW	Equipment (urine dipstick, BP machines)		Triage established, leadership (direct of labour appointed), protocol and chart, commitment to improve medical files, departmental meetings, fundraising (a fundraising committee was established to raise funds for the drugs and equipment in recommendations)
Wagaarachchi et al, 200129			Record storage, blood cultures, structured patient records		Improved dissemination of protocols, reviewing supervisory responsibilities, organisation of regular clinical meetings

BP, blood pressure; EmOC, Emergency Obstetric Care; MW, midwives; N, nurses.