Assessment of Surgical Safety Checklist Compliance and Fidelity in Obstetrics and Gynecologic Surgeries: Insights from Northern Cameroon

Background: The World Health Organization’s Surgical Safety Checklist (SSCL) is a proven tool to enhance surgical safety globally. However, its adoption and proper use remain inconsistent in low- and middle-income countries (LMICs), including Cameroon, where data on compliance and fidelity in obstetric and gynecologic surgeries are scarce. Aim and Objectives: This study aimed to assess the compliance (usage rate) and fidelity (completeness) of SSCL implementation in obstetric and gynecologic surgeries in northern Cameroon, identifying barriers to effective use through a behavioral framework. Methods: A prospective observational study was conducted across four hospitals in northern Cameroon. SSCL utilization during surgeries was documented, noting completion rates for each checklist section. Barriers to use were analyzed using the COM-B model (Capability, Opportunity, Motivation - Behavior), based on staff interviews and observational data. Results: Overall SSCL compliance was low at 38%. When used, sections 1 and 2 were completed in 100% of cases, but the sign-out section was omitted in 39%, resulting in only 61% overall checklist completeness. Barriers included limited staff training (capability), resource constraints and workflow pressures (opportunity), and low perceived value or leadership engagement (motivation). Teaching hospitals demonstrated higher adherence rates. Conclusion: SSCL utilization in northern Cameroon remains suboptimal, particularly in checklist completion fidelity. Addressing gaps requires multifaceted interventions focused on enhancing training, optimizing surgical workflows, and fostering a safety-oriented culture. Applying behavioral frameworks like COM-B can guide targeted strategies to improve SSCL adoption and ultimately patient safety in resource-limited settings.