Implementation of the Who Labor Care Guide Within Continuous Quality Improvement to Improve Intrapartum Care in Kenya: A Systematic Literature Review

Background: WHO's Labor Care Guide (LCG) is a person-centered solution designed to streamline labor monitoring, respectful care and timely clinical judgement. This effect is not just a result of the form, but also due to the training of providers, readiness of the facilities, and continuous quality improvement (CQI). Objective: To pull together relevant evidence on LCG implementation and utilization, documentation quality, evidence-based intrapartum practices, and maternal and newborn outcomes, specifically for Kenya. Methods: Focused narrative systematic review was organized around PRISMA 2020. Literature, with a focus on the keyword LCG, implementation, CQI, labor monitoring, documentation and outcomes, was searched from accessible peer-reviewed and literature cited in Google Scholar. Results: Implementation research conducted in multiple countries demonstrates the feasibility and acceptability of using LCG, but not the effectiveness of implementation country-wide.
Conclusion: There are no statistically significant differences in certain maternal or newborn outcomes identified from a pilot cluster randomized study conducted in India, and skills review of implementation research identifies training, audit and feedback, leadership and resources as important enabling conditions. Evaluation of uptake and completeness and quality of records, as well as compliance with care recommendations and prespecified maternal and newborn outcomes should be measured in relation to Kenya-specific.

Labor Care Guide, Continuous Quality Improvement, Implementation, Kenyan Experiences, Quality of Care, Maternal and Newborn Health

1. Amboko, Beatrice, Jacinta Nzinga, Anita Musiega, Benjamin Tsofa, Peter Mugo, Rahab Mbau, Anne Musuva, Felix Murira, Ethan Wong, Caitlin Mazzilli, Wangari Ng’ang’a, Nirmala Ravishankar, Salim Hussein, and Edwine Barasa. 2025. “Examining the Emergence and Implementation Experience of Primary Health Care Networks (PCNs) in Kenya: A Qualitative Process Evaluation.” BMC Health Services Research 25(1):1479. doi:10.1186/s12913-025-13652-2. [Google Scholar] [Crossref]

2. Damschroder, Laura J., David C. Aron, Rosalind E. Keith, Susan R. Kirsh, Jeffery A. Alexander, and Julie C. Lowery. 2009. “Fostering Implementation of Health Services Research Findings into Practice: A Consolidated Framework for Advancing Implementation Science.” Implementation Science 4(1):50. doi:10.1186/1748-5908-4-50. [Google Scholar] [Crossref]

3. Musonda, Makasa, Mangala Benedictus, Kachali Lambwe, and Vwalika Bellington. 2026a. “Effect of the WHO Labour Care Guide Implementation on Maternal and Newborn Outcomes in Selected Referral Hospitals of Zambia: A Difference-in-Differences Analysis.” [Google Scholar] [Crossref]

4. Musonda, Makasa, Mangala Benedictus, Kachali Lambwe, and Vwalika Bellington. 2026b. “Effect of the WHO Labour Care Guide Implementation on Maternal and Newborn Outcomes in Selected Referral Hospitals of Zambia: A Difference-in-Differences Analysis.” [Google Scholar] [Crossref]

5. Oladapo, Ot, Ö. Tunçalp, M. Bonet, Ta Lawrie, A. Portela, S. Downe, and Am Gülmezoglu. 2018. “WHO Model of Intrapartum Care for a Positive Childbirth Experience: Transforming Care of Women and Babies for Improved Health and Wellbeing.” BJOG: An International Journal of Obstetrics & Gynaecology 125(8):918–22. doi:10.1111/1471-0528.15237. [Google Scholar] [Crossref]

6. Ollerhead, Elizabeth, and David Osrin. 2014. “Barriers to and Incentives for Achieving Partograph Use in Obstetric Practice in Low- and Middle-Income Countries: A Systematic Review.” BMC Pregnancy and Childbirth 14(1):281. doi:10.1186/1471-2393-14-281. [Google Scholar] [Crossref]

7. Page, Matthew J., Joanne E. McKenzie, Patrick M. Bossuyt, Isabelle Boutron, Tammy C. Hoffmann, Cynthia D. Mulrow, Larissa Shamseer, Jennifer M. Tetzlaff, Elie A. Akl, Sue E. Brennan, Roger Chou, Julie Glanville, Jeremy M. Grimshaw, Asbjørn Hróbjartsson, Manoj M. Lalu, Tianjing Li, Elizabeth W. Loder, Evan Mayo-Wilson, Steve McDonald, Luke A. McGuinness, Lesley A. Stewart, James Thomas, Andrea C. Tricco, Vivian A. Welch, Penny Whiting, and David Moher. 2021. “The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews.” BMJ n71. doi:10.1136/bmj.n71. [Google Scholar] [Crossref]

8. Proctor, Enola, Hiie Silmere, Ramesh Raghavan, Peter Hovmand, Greg Aarons, Alicia Bunger, Richard Griffey, and Melissa Hensley. 2011. “Outcomes for Implementation Research: Conceptual Distinctions, Measurement Challenges, and Research Agenda.” Administration and Policy in Mental Health and Mental Health Services Research 38(2):65–76. doi:10.1007/s10488-010-0319-7. [Google Scholar] [Crossref]

9. Sudhinaraset, May, Katie M. Giessler, Michelle Kao Nakphong, Meghan M. Munson, Ginger M. Golub, Nadia G. Diamond-Smith, James Opot, and Cathy E. Green. 2023. “Can a Quality Improvement Intervention Improve Person-Centred Maternity Care in Kenya?” Sexual and Reproductive Health Matters 31(1):2175448. doi:10.1080/26410397.2023.2175448. [Google Scholar] [Crossref]

10. Tunçalp, Ӧ., Wm Were, C. MacLennan, Ot Oladapo, Am Gülmezoglu, R. Bahl, B. Daelmans, M. Mathai, L. Say, F. Kristensen, M. Temmerman, and F. Bustreo. 2015. “Quality of Care for Pregnant Women and Newborns—the WHO Vision.” BJOG: An International Journal of Obstetrics & Gynaecology 122(8):1045–49. doi:10.1111/1471-0528.13451. [Google Scholar] [Crossref]

11. Vogel, Joshua P., Liz Comrie‐Thomson, Veronica Pingray, Luis Gadama, Hadiza Galadanci, Shivaprasad Goudar, Rose Laisser, Tina Lavender, David Lissauer, Sujata Misra, Yeshita Pujar, Zahida P. Qureshi, Taiwo Amole, Mabel Berrueta, Faisal Dankishiya, George Gwako, Caroline S. E. Homer, Jonathan Jobanputra, Sam Meja, Carolina Nigri, Vandana Mohaptra, Alfred Osoti, Javier Roberti, Dennis Solomon, Maryam Suleiman, Gianna Robbers, Shireen Sutherland, Sunil Vernekar, Fernando Althabe, Mercedes Bonet, and Olufemi T. Oladapo. 2021a. “Usability, Acceptability, and Feasibility of the World Health Organization Labour Care Guide: A Mixed‐methods, Multicountry Evaluation.” Birth 48(1):66–75. doi:10.1111/birt.12511. [Google Scholar] [Crossref]

12. Vogel, Joshua P., Veronica Pingray, Fernando Althabe, Luz Gibbons, Mabel Berrueta, Yeshita Pujar, Manjunath Somannavar, Sunil S. Vernekar, Alvaro Ciganda, Rocio Rodriguez, Saraswati A. Welling, Amit Revankar, Savitri Bendigeri, Jayashree Ashok Kumar, Shruti Bhavi Patil, Aravind Karinagannanavar, Raveendra R. Anteen, M. R. Pavithra, Shukla Shetty, B. Latha, H. M. Megha, Suman S. Gaddi, Shaila Chikkagowdra, Bellara Raghavendra, Elizabeth Armari, Nick Scott, Katherine Eddy, Caroline S. E. Homer, and Shivaprasad S. Goudar. 2023. “Implementing the WHO Labour Care Guide to Reduce the Use of Caesarean Section in Four Hospitals in India: Protocol and Statistical Analysis Plan for a Pragmatic, Stepped-Wedge, Cluster-Randomized Pilot Trial.” Reproductive Health 20(1):18. doi:10.1186/s12978-022-01525-4. [Google Scholar] [Crossref]

13. Vogel, Joshua P., Yeshita Pujar, Sunil S. Vernekar, Elizabeth Armari, Veronica Pingray, Fernando Althabe, Luz Gibbons, Mabel Berrueta, Manjunath Somannavar, Alvaro Ciganda, Rocio Rodriguez, Savitri Bendigeri, Jayashree Ashok Kumar, Shruti Bhavi Patil, Aravind Karinagannanavar, Raveendra R. Anteen, Pavithra Mallappa Ramachandrappa, Shukla Shetty, Latha Bommanal, Megha Haralahalli Mallesh, Suman S. Gaddi, Shaila Chikkagowdra, Bellara Raghavendra, Caroline S. E. Homer, Tina Lavender, Pralhad Kushtagi, G. Justus Hofmeyr, Richard Derman, and Shivaprasad Goudar. 2024. “Effects of the WHO Labour Care Guide on Cesarean Section in India: A Pragmatic, Stepped-Wedge, Cluster-Randomized Pilot Trial.” Nature Medicine 30(2):463–69. doi:10.1038/s41591-023-02751-4. [Google Scholar] [Crossref]

14. WHO labour care guide: implementation resource package. n.d. Retrieved October 18, 2026. https://www.who.int/publications/i/item/9789240109346. [Google Scholar] [Crossref]

15. WHO Labour Care Guide: User’s Manual. 2020. 1st ed. Geneva: World Health Organization. [Google Scholar] [Crossref]

16. WHO recommendations for prevention and treatment of maternal peripartum infections. n.d. Retrieved October 18, 2026. https://www.who.int/publications/i/item/9789241549363. [Google Scholar] [Crossref]

17. WHO recommendations: intrapartum care for a positive childbirth experience. n.d. Retrieved October 18, 2026. https://www.who.int/publications/i/item/9789241550215. [Google Scholar] [Crossref]

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