Guidelines and Instruments for a Situation Analysis of Obstetric ServicesTool Name: Guidelines and Instruments for a Situation Analysis of Obstetric Services Origin / Source: The Population Council in collaboration with the American College of Nurse Midwives and the Pubcomm Group Inc. Technical area: Maternal health To Tool: http://www.popcouncil.org/rhfp/palmtops.html Basic Description: The Guidelines and Instruments for a Situation Analysis of Obstetric Services are designed to assist Safe Motherhood program managers and program supervisors carry out a rapid needs assessment of obstetric services for life threatening conditions in Safe Motherhood program areas. The methodology is based on the situation analysis of family planning services that was also developed by the Population Council. Country Applications: Vietnam, Ghana Language(s) Available: English, Spanish Purpose: Needs assessment Technical Scope/Purpose: Facility assessment Method: Quantitative Frequency of Administration: The frequency of administration needs to be determined locally and will depend on whether the tool is being used for a baseline needs assessment or for program monitoring and evaluation purposes. Key Users of the Information: Program mangers and supervisors. Objectives and Scope of the Tool: The tool is designed to provide managers at the program level with the necessary tools to undertake a rapid survey: (1) to describe the availability, use and quality of emergency obstetric care services (2) to identify gaps in the provision of this care in order to guide program design for improving services and maternity care. In addition the tool may also be adapted and used to monitor and evaluate change in obstetric services before and after program implementation. Data are entered directly into palm top computers as the observations are recorded. Simple computer programs analyze the data providing summary statistics on provider performance and facility capacity. This rapid analysis allows supervisors to give immediate feedback to service providers and administrators on how best to improve their services. Key Indicators: The tool provides a wide range of indicators across the various dimensions of emergency obstetric care. Key indicators include but are not limited to the following; the availability and coverage of comprehensive essential obstetric care (CEOC), the caesarian section rate, facility case fatality rate, time to referral site and referral site readiness for CEOC. Tool Design: The tool is designed as a cross sectional survey of health facilities and health system personnel. There are two main modules; a facility inventory and health worker interview with the most knowledgeable midwife or obstetrician/gynecologist. The facility inventory collects information on the facility infrastructure; the availability of equipment, emergency transport, supplies, medicines and health personnel and on service statistics related to patient volume, treatment of complications and referrals. The information is collected by direct observation, record review and health worker interview. In addition, the health worker interview also collects information on health worker background, knowledge and decision making related to common obstetric emergencies. The assessment tools need to be reviewed, translated, pre-tested, if possible near but not within the program area, and modified before reproduction and use. All primary and secondary health facilities providing MCH care in the program area may be included in the assessment. If the program area is too large to assess all primary and secondary MCH facilities, a representative sample stratified by level of care should be drawn.(An epidemiologist, statistician or other professional with expertise in sampling should be contacted to accomplish this). Implementation and Training: A two or three day training and trial period in data collection should suffice. Teams of two health service staff, possibly from the program area, with a solid foundation in obstetrics should be responsible for the data collection. Inventories of supplies and equipment should be conducted by one member of the data collection team while the remaining member should interview the midwife (or other health care professional) on site considered to be the most adept and active individual in attending deliveries at the site. The skills assessment thus reflects the best level of delivery care one can attain at each site. Manuals and Guidelines: A codebook and databases with valid value checks were developed in EPIINFO to facilitate entry, and EPIINFO data analysis programs were developed to facilitate analysis. The data collection tool and codebook (in Word), databases and analysis programs (in ASCII text files for use in EPIINFO) and skeleton tables in which to report the final results are provided on diskette to facilitate their site specific modification and use. Criteria for evaluating essential management of life-threatening obstetric conditions are also provided (in Word). Data Processing and Analysis: The situation analysis collects data that are entered into three EPIINFO data (REC) files, REC1, REC2, and REC3. The EPIINFO database/data analysis program can be obtained free of charge from the Centers for Disease Control, Epidemiology Program Office, Atlanta, GA 30333 or downloaded from http://www.cdc.gov/epiinfo/. This program should be installed onto a hard drive. Cost: The data are designed to be collected rapidly by supervisors so survey personnel costs will be relatively low. Handheld computers currently cost between $800-$1,000 (with Word and Excel software). EPIINFO is available for free. Contact: New York Headquarters |