Qualified, skilled or trained delivery care provider: a conundrum of who, where and when

Abstract

### Summary box In the global maternal and newborn health (MNH) literature, care providers have been classified in several ways, engendering the question—whether providers who care for the mother and her newborn(s) have the necessary training and skills to provide quality care. This question underscores the importance of clearly defining who provided care. A specific definition not only facilitates correct interpretation of findings but helps understand potential reasons behind successes or failures of MNH interventions. Additionally, in low- and middle-income countries (LMICs), providers who routinely attend deliveries often receive varying levels of training, even within the same classifications. This inconsistency can result in incomparable estimates of skilled birth attendance, an indicator used to reference MNH care globally. This commentary emphasises the importance of a provider definition that is beyond the use of standard terminology like qualified, skilled or trained. We begin by reviewing the common definitions used globally, then demonstrate, using an example, the effect of definition on study findings. MNH care provider definitions should include who was involved (eg, education and training, licensing, experience and the signal function responsibilities for each provider category), where care was provided (eg, level of the facility, facility vs outreach, current national regulations for adequate contextual description) and when to describe any recent event that …