Guidelines for monitoring the availability and use of obstetric servicesTool Name: Guidelines for monitoring the availability and use of obstetric services Origin/Source: UNICEF, WHO, UNFPA (Authors: Deborah Maine, Tessa Wardlaw, Victoria Ward, James McCarthy, Amanda Birnbaum, Murat Akalin, Jennifer Brown). Technical area: Maternal health Basic Description: The "Guidelines for monitoring the availability and use of obstetric services," is designed to assist program managers and policy-makers assess the capacity of local health facilities to provide life saving essential obstetric services. The guidelines contain standard survey forms and detailed survey instructions. Country Applications: The tool has been used in a large number of countries, including Cameroon, Mozambique, Tanzania, Ethiopia, Rwanda, Morocco, Mali, Mauritania, Benin, Senegal, Ivory Coast, Pakistan, Bangladesh, Bhutan, Sri Lanka, the states of Rajasthan and Maharashtra in India, Nepal, Vietnam, Tajikistan, Peru and Nicaragua. Language(s) Available: English, French, Spanish Purpose: Needs Assessment, monitoring & evaluation Technical Scope/Purpose: Facility assessment Design: The survey is based on a retrospective review of facility records. Data are collected from a cross sectional sample of health facilities and health system personnel. Method: Quantitative Frequency of Administration: The frequency of administration should be decided locally, depending on need and the survey objective. The tool was originally designed to serve as a needs assessment tool and as such would be used once. It may also serve as a monitoring and evaluation tool with the idea that the indicators would be calculated periodically to measure change. Key Users of the Information: Safe motherhood program planners, managers and policy makers at the district, regional and national levels. The results of the analysis might also be of interest to potential program donors, multilateral and bilateral donor agencies, NGOs and other interested parties. Facility personnel who routinely collect the data should also be able to see, understand and, when appropriate, use the results. Objectives and Scope of the Tool: As the title denotes, the "Guidelines" provide information on the availability, quality and use of essential obstetric care services. Structured survey forms are used to collect information on key indicators that assess the capacity of facilities to provide a number of life saving essential obstetric functions (EOF). These life saving functions are those used to treat the most common direct or major obstetric complications including hemorrhage: antepartum, intrapartum or postpartum; prolonged/obstructed labor; postpartum sepsis; complications of abortion; pre-eclampsia/eclampsia; ectopic pregnancy; and ruptured uterus. The EOF listed below is a short list of the main services that can save the lives of the majority of women with obstetric complications. The list has been compiled for the purposes of facilitating program monitoring and is not by definition comprehensive. Two levels of care are defined: Basic Essential Obstetric Care (BEOC) and Comprehensive Essential Obstetric Care (CEOC). The main difference is the provision of caesarian sections and blood transfusions in comprehensive facilities.
One important aim of the tool is to assess how facilities are actually functioning and not only how they are supposed to function. Many facilities with designated BEOC or CEOC capacity are supposed to be able to provide EOF, but in practice do not for a variety of reasons that may include a lack of equipment, supplies, medicines or staff, inadequately trained staff and many others. Key Indicators: The survey is designed to collect a number of standard indicators each of which has a suggested minimum acceptable standard, see below
Tool Design: The sampling frame and sample size will be determined by local needs and program objectives. A "core team", including national or district planners and programmers, should participate in the design, implementation, survey reporting and follow up. Implementation and Training: The materials have been developed to enable program mangers to carry out the analysis with relatively little technical assistance. 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 program manager, a survey coordinator and a local statistician/epidemiologist. Local surveyors are required for a training workshop and for the duration of the fieldwork. Midwives, nurses and other health workers can make effective surveyors. Manuals and Guidelines: The guidelines contain 4 main chapters on
Reporting and Dissemination of Results: Survey information is used to support local or national safe motherhood program development and strengthening. The main users of the information should therefore be included in the team that carries out the work. The information can be further disseminated at national and district level workshops, etc. Costing: This tool can be used at very low cost if facility staff are collecting, processing and analyzing the data but if the data are going to be aggregated for regional or national purposes, costs will increase. In general, costs will increase as the number of facilities to be surveyed increases. Lessons from Experience: Facility records can be incomplete and/or inconsistent. Rarely is all of the information needed found in only one register. Sometimes many registers or forms must be examined and inconsistencies resolved. Standardization of the major obstetric complications for indicator calculation among facility staff can be both time-consuming and it may be difficult to achieve consensus. Some countries do not train their professionals to perform some of the procedures that are considered essential obstetric functions. This has a major impact on the indicators since few if any of facility will qualify as providing the full range of BEOC or CEOC services. Not always are the indicators shared with facility staff or they are not well known or understood. Their participation in the process tends to enhance the quality of the data and staff morale and should be considered their right. Contact Person: For more information about the Guidelines contact Website: http://cpmcnet.columbia.edu/dept/sph/popfam/amdd/ For more information, contact: Silvia Alayón, MEASURE Evaluation | |||||||||||||||||||||||||||||||||||||||||||||