The Design and Evaluation of Maternal Mortality Programs

Origin / Source:

Deborah Maine, Murat Z. Akalin, Victoria M. Ward, Angela Kamara
Center for Population and Family Health
School of Public Health
Columbia University
June 1997

Manual (pdf document; http://cpmcnet.columbia.edu/dept/sph/popfam/pubs/docs/main.pdf)
Appendix A: Instruments and Materials (pdf; http://cpmcnet.columbia.edu/dept/sph/popfam/pubs/docs/append_a.pdf
Appendix B: National and Subnational Monitoring (pdf; http://cpmcnet.columbia.edu/dept/sph/popfam/pubs/docs/append_b.pdf)

Technical area:

Maternal health

Basic Description:

This manual is intended to assist health care personnel at all levels (i.e. local, state or national) in gathering and analyzing information to design and evaluate programs working to reduce maternal mortality and morbidity among women with obstetric complications. It contains survey forms, checklists and detailed instructions that aid the process of designing and evaluating maternal mortality programs.

Country Applications:

Has been used extensively in West Africa and South Asia.

Language(s) Available:

English, French, Spanish

Purpose:

Needs assessment, program design, monitoring and evaluation

Technical Scope/Purpose:

Operations research; explanation and use of the UNICEF/WHO/UNFPA Process Indicators for Monitoring the Availability and Use of Obstetric Services. Facility assessment and assessment of: program performance (including quality of services), program coverage and program utilization.

Design:

Retrospective review of facility records; both quantitative and qualitative data are collected from a cross-sectional sample of facilities, health care providers and community members.

Method:

Quantitative and qualitative.

Frequency of Administration:

This tool can be used to conduct a needs assessment for program planning and then periodically for program monitoring and evaluation.

Key Users of the Information:

Program planners and managers at the local/district, state/regional and national levels. While this manual generally focuses on gathering and using information for program planning at the local level, one section is meant to be used specifically at the state and national levels.

Objectives and Scope of the Tool:

This manual is intended to assist health care personnel in gathering and analyzing information to design and evaluate programs working to reduce maternal mortality and morbidity among women with obstetric complications. The strategy proposed throughout this manual rests on two main concepts. The first is that in order to reduce maternal mortality and morbidity, women with obstetric complications must have access to quality emergency obstetric care. The second is that the most efficient way to evaluate the success of programs working to reduce maternal mortality is the use of process and output indicators rather than measures of impact.

The objectives of this manual:

Provide user-friendly structured forms with detailed instructions to use when carrying out needs assessments, for monitoring and evaluation, and for guiding program development.
Aid in program design and the establishment of monitoring systems.

Key Indicators:

UNICEF/WHO/UNFPA Process Indicators for Monitoring the Availability and Use of Obstetric Services:

	Indicator	Standard
	The number of facilities that provide basic and/or comprehensive emergency obstetric care^1,2 (EmOC) per 500,000 population.	For every 500,000 population, there should be: At least 4 basic EmOC facilities At least 1 comprehensive EmOC facility
	The geographical distribution of EmOC facilities.	The minimum level for EmOC is met in smaller geographical areas (i.e. districts, states or regions).
	Proportion of all births in EmOC facilities	At least 15% of all births in the population take place in EmOC facilities.
	Met need for EmOC: the proportion of all women with complications³ who are treated in EmOC facilities.	The proportion of all women with obstetric complications that are treated in EmOC facilities is at least 100%.
	Cesarean section rate as a proportion of all births.	As a proportion of all births in the population, cesarean sections should account for not less than 5% nor more than 15%.
	Case fatality rate: the number of maternal deaths among women with obstetric complications in the health facility being studied.	The case fatality rate should not exceed 1%.

¹ Signal functions of basic EmOC facilities: administer parenteral antibiotics, administer parenteral oxytocic drugs, administer parenteral anticonvulsants for pre-eclampsia and eclampsia, perform manual removal of placenta, perform removal of retained products (e.g., manual vacuum aspiration), and perform assisted vaginal delivery.

² Signal functions of comprehensive EmOC facilities: performs all functions that the basic EmOC facilities do plus can perform surgery (cesarean section) and perform blood transfusion.

³ A complicated case is defined as a woman who has any of the following diagnoses: hemorrhage (antepartum and postpartum), prolonged/obstructed labor, postpartum sepsis, complications of induced abortion, pre-eclampsia/eclampsia, ectopic pregnancy, or ruptured uterus.

Tool Design:

The sampling frame and sample size will vary according to program objectives. The guidelines listed in this manual suggest using a random selection of areas and facilities for studies at the national/regional level and demonstrates how to obtain a random sample.

Implementation and Training:

This manual was designed to be extremely user-friendly and includes very clear and instructive guidelines throughout.

Manuals and Guidelines (if applicable):

Not applicable.

Data Processing and Analysis:

Data collected can be easily calculated into the process indicators listed above. While computer software programs like Excel may be helpful, all indicators can be calculated with a hand-held calculator.

Reporting and Dissemination of Results (if applicable):

Included in this manual is a section offering advice on presentation and dissemination of the monitoring and evaluation information generated.

Contact Person:

For more information, please contact:
The Averting Maternal Death and Disability Project (AMDD)
Heilbrunn Department of Population and Family Health
Mailman School of Public Health
Columbia University
60 Haven Avenue, B-3
New York, NY 10032
Fax: 212-544-1933
Email: amdd@columbia.edu
Website: http://www.amdd.hs.columbia.edu