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Article History

Received: 21 March 2018

Accepted: 6 July 2018

First Online: 18 July 2018

Ethics approval and consent to participate

: Approval to undertake the study has been granted by two research ethics committees: Chesapeake IRB where approval was granted on 15 June 2017 (Pro00022097) and ERES Converge IRB where approval was granted on 8 July 2017 (2017-May-066). The study also has approval from the National Health Research Authority in Zambia. Health worker consent for delivery observations :At the beginning of the data collection process the evaluation and observers will be introduced to all skilled birth personnel in the facility and they will be asked to provide written informed consent for their services to be observed. Data collectors will not interfere with clinical care during their observations. For ethical reasons, they will be instructed to notify HCWs if they observe a potentially harmful condition or practice. Patient consent for delivery observations :At the time when a pregnant woman presents at the health facility in labor, the HCW that will be managing the delivery process will be asked to inform the woman that a review of the childbirth services in that facility is going on and that a data collector will be approaching her to ask about observing the services provided during her delivery. The observers will be asked to obtain written informed consent from each woman for their delivery to be observed. For the sake of anonymity of the mother and considering the circumstances under which the potential participant will be under, the HCW performing the delivery services will be asked to act as the witness on the consent form, if the woman agrees to participate. Health worker questionnaires at SCC training and end line :When questionnaires are passed around, study staff will explain that participation is voluntary, responses are anonymous, and the decision on whether to participate will have no impact on the health workers’ relationship with the MOH.

: Not applicable.

: The authors declare that they have no competing interests.

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