Background
Methods
Assessment of the current status of global indicators
Defining indicators and data points
WHO and UNAIDS indicators | Other indicators |
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• The World Health Statistics 2011 Indicator Code Book [28] • WHO indicator registry (http://www.who.int/gho/indicator_registry/en/index.html) • WHO Global Health Observatory (http://apps.who.int/gho/data/##) • Indicator registries relevant to monitoring and evaluation for specific Essential Interventions (e.g. UNAIDS Indicator Registry: http://www.indicatorregistry.org/) • The World Health Organization’s near-miss approach for maternal health [29] • Monitoring emergency obstetric care: a handbook [30] • Inter-agency Field Manual on Reproductive Health in Humanitarian Settings [31] • Countdown to 2015 - Building a Future for Women and Children report [32] • Indicators obtained from relevant reports on monitoring and evaluation of the specific intervention (e.g., the ‘WHO World Malaria Report’) found from general search of the WHO website (http://www.who.int/en/) | • The official list of MDG Indicators (mdgs.un.org) • NICE menu of indicators: (www.nice.org.uk/standards-and-indicators) • New Zealand Guidelines Group website: (www.health.govt.nz/about-ministry/ministry-health-websites/new-zealand-guidelines-group) • National Center for Health Statistics Heath indicators warehouse (www.healthindicators.gov/Indicators/) • AHRQ National guidelines clearinghouse (guideline.gov/index.aspx) • Royal College of Obstetricians and Gynaecologists Guidelines (www.rcog.org.uk/guidelines/) |
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process indicator/s for screening/risk identification (the proportion of patients for whom screening tests/risk identification measures were performed);
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outcome indicator/s for screening/risk identification (the proportion of patients screening positive/identified as ‘at-risk’);
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process indicator/s for treatment/management (the proportion of patients treated); and
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outcome indicator/s for treatment/management (the proportion of patients with adverse outcomes in the population).
Evaluation and refinement of indicators
Expert panel evaluation
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Action focused: “It is clear what needs to be done to improve outcomes associated with this indicator (e.g., immunised with tetanus toxoid to reduce neonatal tetanus)”
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Important: “The indicator and the data generated will make a relevant and significant contribution to determining how to effectively respond to the problem”
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Operational: "The indicator is quantifiable; definitions are precise and reference standards are developed and tested or it is feasible to do so"
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Feasible: “It is feasible to collect data required for indicator in the relevant setting”
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Simple and valued: “The people involved in the service can understand and value indicator”
Response to feedback and refinement within the eRegistries technical team
Graphical display of potential utilisation of the eRegistries indicators
Results
Assessment of the current status of global indicators
Intervention | Population data (Percent of the population) | Facility data (Number of survey instruments) | ||||||
---|---|---|---|---|---|---|---|---|
Screening process indicator | Screening outcome indicator | COVERAGE/Management process indicator | Management outcome indicator | Availability of supplies | Staff ever trained | Ever performed at this facility | ||
Preconception/ Periconception and Pregnancy | Folic acid supplementation or fortification | NA | NA | – | – | 5 of 7i
| 4 of 7 | 3 of 7 |
Family planninga
| – | 22 % | 31 % | 4 % | 5 of 7 | 4 of 7 | 3 of 7 | |
Prevention and management of STIs and HIV | – | – | – | – | 1 of 7 | 2 of 7 | 2 of 7 | |
Safe abortion services | – | – | 26 % | – | 4 of 7 | 2 of 7 | 4 of 7 | |
Post-abortion care | – | – | – | – | 2 of 7 | 2 of 7 | 2 of7 | |
Antenatal care visit (1+) (contact) | NA | NA | 84 % | – | NA | NA | NA | |
Antenatal care visit (4+) (contact) | NA | NA | 57 % | – | NA | NA | NA | |
Essential packageb
| NA | NA | – | – | 4 of 7 | 4 of 7 | 3 of 7 | |
Iron and folic acid supplementationc
| NA | NA | 26 % | – | 4 of 7 | 2 of 7 | 3 of 7 | |
Tetanus toxoid vaccinationd
| NA | NA | 81 % | – | 4 of 7 | 0 of 7 | 3 of 7 | |
Prevention of malaria with prophylactic antimalarials | NA | NA | 27 % | – | 4 of 7 | 4 of 7 | 4 of 7 | |
Prevention of malaria with ITN | NA | NA | 37 % | – | ||||
Smoking cessation during pregnancy | – | – | – | – | 0 of 7 | 0 of 7 | 0 of 7 | |
Detection and management of syphilise
| 44 % | 2 % | 37 % | – | 5 of 7 | 5 of 7 | 5 of 7 | |
Detection and management of HIV (including PMTCT)f
| – | 3 % | 67 % |
17 %
| 6 of 7 | 4 of 7 | 6 of 7 | |
Calcium supplementation for deficient women in pregnancy | – | – | – | – | 1 of 7 | 0 of 7 | 0 of 7 | |
Aspirin for pre-eclampsia prevention | – | – | 1 of 7 | 0 of 7 | 0 of 7 | |||
Antihypertensive drugs for hypertension in pregnancy | – | – | 3 of 7 | 0 of 7 | 1 of 7 | |||
Anticonvulsants (i.e., MgSO4) | – | – | – | – | 7 of 7 | 2 of 7 | 3 of 7 | |
External cephalic version | – | – | – | – | 0 of 7 | 0 of 7 | 0 of 7 | |
Induction of labor after pPRoM | – | – | – | – | 0 of 7 | 0 of 7 | 1 of 7 | |
Antibiotics for pPRoM | – | – | – | – | 6 of 7 | 0 of 7 | 3 of 7 | |
Antenatal corticosteroids | – | – | – | – | 4 of 7 | 0 of 7 | 1 of 7 | |
Childbirth and postpartum care | Skilled attendant at birth (contact) | NA | NA | 66 % | – | NA | NA | NA |
Facility delivery (contact) | NA | NA | 63 % | – | NA | NA | NA | |
Social support during childbirth | NA | NA | – | – | 0 of 7 | 0 of 7 | 0 of 7 | |
Prophylactic antibiotics for cesarean section | – | – | – | – | 5 of 7 | 1 of 7 | 3 of 7 | |
Cesarean section | – | – | 10 % | – | 3 of 7 | 2 of 7 | 4 of 7 | |
Uterotonics for prevention of hemorrhage | NA | NA | – | – | 8 of 8 | 5 of 8 | 6 of 8 | |
Active management of the 3rd stage of labor | NA | NA | – | – | 8 of 8 | 5 of 8 | 4 of 8 | |
Induction at ≥ 41 weeks of gestation | – | – | – | – | 0 of 7 | 0 of 7 | 1 of 7 | |
Uterotonics for treatment of hemorrhage | – | – | – | – | 8 of 8 | 2 of 8 | 5 of 8 | |
Manual removal of the placenta | – | – | – | – | 4 of 7 | 2 of 7 | 3 of 7 | |
Initiation or continuation of HIV therapy for HIV positive women
f
(see above)
α
| – | 3 % | 67 % | 17 % | 6 of 7 | 4 of 7 | 6 of 7 | |
Family planning and advice for contraceptives
a
(See above)
α
| – | 22 % | 31 % | 4.00 % | 5 of 7 | 4 of 7 | 3 of 7 | |
Screen for and initiate or continue antiretroviral therapy for HIV
f
(see above)
α
| – | 3 % | 67 % | 17 % | 6 of 7 | 4 of 7 | 6 of 7 | |
Treat maternal anemiag
| – | 40 % | – | – | 0 of 7 | 0 of 7 | 0 of 7 | |
Detect and manage postpartum sepsis | – | – | – | – | 0 of 7 | 1 of 7 | 1 of 7 | |
Newborns and small and ill babies | Immediate thermal care | – | – | – | – | 4 of 7 | 3 of 7 | 2 of 7 |
Promotion and support for early Initiation of breastfeeding | NA | NA | 50 % | – | 1 of 7 | 4 of 7 | 3 of 7 | |
Promotion and provision of hygienic cord and skin care | NA | NA | – | – | 1 of 7 | 2 of 7 | 2 of 7 | |
Neonatal resuscitation | – | – | – | – | 6 of 7 | 3 of 7 | 6 of 7 | |
Newborn Immunizationh
| NA | NA | 91 %/37 % | – | 2 of 7 | 0 of 7 | 1 of 7 | |
Presumptive antibiotic therapy for newborns at risk of bacterial infection | – | – | – | – | 2 of 7 | 1 of 7 | 2 of 7 | |
Case management of neonatal sepsis, meningitis, and pneumonia | – | – | – | – | 2 of 7 | 1 of 7 | 2 of 7 | |
Initiation of ART in babies born to HIV infected mother
f
(see above)
α
| – | 3 % | 67 % | 17 % | 6 of 7 | 4 of 7 | 6 of 7 | |
Kangaroo mother care for preterm and for <2000 g babies | – | – | – | – | 1 of 7 | 1 of 7 | 1 of 7 | |
Extra support for feeding the small and preterm baby | – | – | – | – | 0 of 7 | 0 of 7 | 1 of 7 | |
Prophylactic and therapeutic use of surfactant | – | – | – | – | 0 of 7 | 0 of 7 | 1 of 7 | |
Continuous positive airway pressure (CPAP) for RDS | – | – | – | – | 0 of 7 | 0 of 7 | 1 of 7 | |
Management of newborns with Jaundice | – | – | – | – | 1 of 7 | 0 of 7 | 1 of 7 |