6.1. Anticipated impact on the organization of care and resources

Several factors (barriers) may hinder the effective implementation and scale-up of this recommendation. These factors may be related to the behaviours of women, parents, caregivers or families, or health workers and to the organization of care or health service delivery. As part of efforts to implement this recommendation, health system stakeholders may wish to consider the following potential barriers:

• lack of understanding of GBS and of the purpose of GBS screening among health workers, women giving birth, families and/or communities;
• lack of opportunities for continuing education and professional development for health workers;
• lack of human resources with the necessary training and skills in patient communication and consent, infection control, rectovaginal swab technique and specimen handling, as well as in the administration of intravenous IAP;
• lack of infrastructure to support the interventions (such as lack of physical space to conduct individual care and counselling; lack of access to laboratory services to carry out culture-based testing; lack of electricity for refrigeration);
• concerns from skilled care personnel and system managers regarding the safety and potential consequences of intravenous IAP, including antimicrobial resistance;
• lack of reliable supply systems and sustained availability and equitable access to antibiotics for use in obstetrics listed in the WHO model list of essential medicines (29); and
• lack of current systems in place to monitor the use of antibiotics and antimicrobial resistance.

6.2. Monitoring and evaluating guideline implementation

The implementation and impact of this recommendation will be monitored at the health service, country and regional levels, as part of broader efforts to monitor and improve the quality of maternal and newborn care. The WHO document Standards for improving quality of maternal and newborn care in health facilities (33) provides a list of prioritized input, output and outcome measures that can be used to define quality of care criteria and indicators and that should be aligned with locally-agreed targets. In collaboration with the monitoring and evaluation teams of the WHO Departments of SRH and MCA, data on country- and regional-level implementation of the recommendation can be collected and evaluated in the short to medium term to assess its impact on national policies of individual WHO Member States.

Information on recommended indicators can also be obtained at the local level by interrupted time series or clinical audits. In this context, the GDG suggests the following indicators to be considered:

• Proportion of women undergoing screening for risk of early onset group B Streptococcus disease in newborns where intrapartum antibiotic prophylaxis was administered for eligible women, calculated as the number of women who undergo screening and have intrapartum antibiotic prophylaxis administered divided by the total number of birthing women.
• Incidence of early onset group B Streptococcus disease in newborns, calculated as the number of newborns diagnosed with early onset group B Streptococcus disease divided by the total number of live births.

The first indicator provides an assessment of the use of screening procedures among women, while the second provides information on the efficacy of the intervention in preventing early onset group B Streptococcus disease in newborns.