The Safe Motherhood Needs AssessmentTool Name: The Safe Motherhood Needs Assessment Origin / Source: Department of Reproductive Health and Research, World Health Organization, CH-1211 Geneva 27 Switzerland Technical area: Maternal and Newborn health Basic Description: The safe motherhood needs assessment is a tool designed to assist managers, policy-makers, and other interested parties in carrying out a rapid assessment of the health system and community response to maternal and newborn mortality and morbidity. The specific objective of the safe motherhood needs assessment is to provide managers, policy-makers, and other interested parties at the national and district level with the necessary tools to undertake a rapid survey: (1) to describe the availability, use and quality of antenatal, delivery and postpartum care provided to women and newborn babies at all levels within the health care system; and (2) to identify gaps in the provision of this care. Particular emphasis is placed on assessing the skills and ability of staff to provide the services identified in the Mother-Baby Package, and on the availability of appropriate drugs, supplies, equipment, facilities and transport. The safe motherhood needs assessment is based on a collection of structured survey forms which are used to collect the data required. The assessment tools include step-by-step instructions for implementation, model survey forms, pre-programmed computerized data entry and analysis routines, and guidelines and dummy tables for interpretation and analysis of the information collected. A key task of the team carrying out an assessment is the local adaptation of the assessment instruments to meet the needs and match the setting in which it is applied. Country Applications: The tool has been used in a large number of countries, including Malawi, India, Philippines, Ethiopia, Laos, Uganda, Rwanda, Lesotho, Swaziland, and many others. WHO actively promotes its use in countries, but is not always involved in the application of the tool, so we are not in a position to know all of the countries and settings in which it has been used. Language(s) Available: English. French translation is underway. Purpose: Needs Assessment Technical Scope/Purpose: The technical scope of any application needs to be determined locally. The tools can be used to collect a wide variety of information, including facility assessment, client interviews, record reviews, and others. Before the assessment materials are used, they must be carefully reviewed, critically assessed, and adapted to address the specific situation in which they are to be applied. They cannot be used "off the shelf". A key task of the team carrying out the assessment is therefore the local adaptation of the assessment to meet the needs and match the setting in which it is applied. Design: Needs assessment using cross sectional data from health facilities, clients, and health system personnel. There are 11 survey instruments. These are: district health team interview (DHT), facility management (FAC), interview with midwife or maternity nurse (NMW), antenatal client exit interview (ANC), postpartum client exit interview (PPC), antenatal record review (ANR), normal delivery record review (NDR), complicated delivery (eclampsia) record review (CDE), complicated delivery (obstructed labor) record review (CDO), surveyor observations (SOV) and the traditional birth attendant interview (TGA). Method: Quantitative and qualitative. Frequency of Administration: The frequency of administration would be decided locally, depending on local needs. It is most likely that the needs assessment would be a one-time ad hoc activity. Key Users of the Information: The analysis that can be carried out using this tool would be targeted at maternal and newborn health and safe motherhood planners, managers and policy makers at the national and district levels. The results of the analysis might also be of interest to potential programme donors, multilateral and bilateral donor agencies, NGOs or other interested parties. Key Indicators: The tool could be used to collect a wide range of indicators of maternal health that are too detailed to be listed in full. These indicators include community knowledge and understanding of safe motherhood, access and coverage of services, availability of essential infrastructure, equipment, medicines and supplies as well as indicators related to the quality and management of safe motherhood services. Tool Design: The research design needs to be determined locally, in consideration of local objectives. A "core team", including both researchers and national planners and programmers, would typically participate in the assessment design, implementation, reporting, and follow-up (see "Lessons from experience" below for more information about the core team). Implementation and Training The materials have been developed in such a way that experienced researchers will be able to carry out the analysis with minimal or no training. The tools include generic materials for training of the data collection teams. Manuals and Guidelines (if applicable): The manual describing the safe motherhood needs assessment has been developed in six parts. Part I, Guidelines, introduces the process and offers a step-by-step guide to conducting an assessment. Part II, Model Survey Forms, provides examples of all the forms needed to collect the information required during an assessment. Part III, Trainer's Manual, brings together the materials needed for a five-day workshop for the training of needs assessment surveyors, and Part IV, Surveyor's Manual gives instructions to surveyors for conducting the field work (data collection). Part V provides dummy tables for analysis and interpretation of the data collected. The manual is accompanied by a diskette, which contains the survey forms, surveyor's manual and dummy tables in both word processing and Epi-Info formats. Users are encouraged to adapt and use these computer files in order to facilitate their application of the safe motherhood needs assessment. Data Processing and Analysis: The tool includes Epi-Info templates to facilitate data processing. "Dummy tables" are also provided in word-processing format in order facilitate the analysis of the data. Reporting and Dissemination of Results (if applicable): Analysis and report writing is typically carried out by the research team, sometimes in a special "retreat" to enable the team members to focus intensively on the report development. The information can be very useful in support of a process of national safe motherhood programme development and/or strengthening. The main users of the information would therefore probably be included in the team that carries out the work. The information can be further disseminated at national and district level workshops, etc. Cost: The resources required to carry out a safe motherhood needs assessment will vary in different settings. In summary Staff. Once the decision has been taken to undertake the assessment, the first step is the formation of an interdisciplinary "core team". As a minimum, this team should consist of the safe motherhood programme manager, a safe motherhood needs assessment coordinator and a local statistician. Local surveyors are required for a training workshop and for the duration of the field work (data collection). Midwives, nurses and other health workers can make effective surveyors. The surveyors are divided into teams of four, one being designated as team leader. A separate team assumes responsibility for the field work in each district. A team of data entry personnel is then required to enter the data collected into computers, using the specified data entry routines. Computers and software. Full time access to at least one standard microcomputer is required for the duration of the assessment. This may be the computer normally used by the statistician. Access to additional microcomputers will facilitate data entry. Data entry and analysis are undertaken using the Epi-Info statistical software. Vehicles. Each field team requires one vehicle, together with the driver, for the duration of the field work (data collection). The type of vehicles required depends on the size of the teams and the terrain in the areas to be assessed. Other local costs. Other local costs incurred in carrying out an assessment include: the costs of a seminar for the training of surveyors; the per diem expenses of surveyors and drivers; petrol and other vehicle expenses for the field work; the costs of a report-writing retreat for the core team members and planning workshops; and stationery and other miscellaneous expenses. Lessons from Experience:
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