Rapid Evaluation Method (REM) for Maternal and Child Health, Family Planning and other Health Services

Name: Rapid Evaluation Method (REM) for Maternal and Child Health, Family Planning and other Health Services

Purpose: The REM guidelines is a generic tool for conducting a rapid needs assessment situation analysis for MCH, FP and other health services.

Type of Design: Descriptive, cross sectional

BASIC INFORMATION

Name: Rapid Evaluation Method (REM) Guidelines for Maternal and Child Health, Family Planning and other Health Services

Origin /Source: Division of Family Health and Division of Epidemiological Surveillance and Health Situation and Trend Assessment -- World Health Organization -- Geneva, 1993

Technical Area: Maternal and newborn health

Basic Description: The REM assesses service performance and gives prime consideration to the quality of care provided and to client satisfaction. It uses selected quantitative and qualitative indicators in various health facilities as well as in the community to measure the impact of services and community's perception of them. The approach is participatory and motivational in which decision makers, program managers, trainers and health service providers from different levels of the health care system work together on a rapid and comprehensive assessment of the health service situation in a given program or in selected components of it. The REM does not replace -- but rather complements -- other methods of collecting epidemiological information such as patterns of mortality and morbidity.

Country Applications: not known

Language(s) available: English

Purpose: evaluation / needs assessment

Technical Scope /Purpose: Facility assessment, knowledge attitudes and behaviors.

Design: Descriptive, cross sectional

Method: Qualitative and Quantitative.

Frequency of Administration: Dependent on country or district planning needs.

Key Users of Information: Ministries of Health; provincial or district health authorities; health services personnel.

Objectives and Scope of the Tool:

The REM has been developed to become a routine tool for service management to improve quality of care, program performance and enhance community involvement. The general objectives of the REM are --

1. To provide reliable information about service performance in order to strengthen the overall management of MCH/FP programs or any other health programs with emphasis on quality of care, staff performance and client satisfaction.
2. To provide countries with an evaluation management tool that can be adapted for use at all levels of the health care delivery system without additional resources and through use of local expertise.
3. To train MCH/FP or other program managers and service providers, through the REM, in the process of evaluation design, implementation, data analysis and use of results for action.

Key Indicators:

Key indicators will depend entirely on how the tool is adapted and implemented in each setting.

For example:

• Antenatal Care Services: Attitude to referral and knowledge of maternal deaths and high risk (community level); coverage with antenatal care services, risks and follow up (planning administration level);
• Delivery Care Services: Number of village midwives registered, quality of village birth attendant supervision (planning and administration level).

Tool Design:

Primary and higher level facilities are included in the sample in order to provide information on the health services as whole. Multi-stage cluster sampling is used for this. Provinces are usually selected at the first stage and districts within these provinces are chosen at the second stage. Within districts, health facilities are randomly selected with probability proportional to size of the population covered by each facility.

For household survey or focus groups interviews, villages within the catchment area of each facility are randomly selected and this selection may be further stratified by distance to the health facility.

The REM is based around a central planning process, the "Issue information matrix"

Using this matrix for each evaluation health mangers identify

1. the services for assessment.
2. the service aspects

For example:

The methods used for data collection are:

• Record review and data extraction, (e.g. obstetric records, family planning records, antenatal records)
• Direct observation of tasks
• Checking equipment, drugs, supplies (availability, condition)
• Health personnel interviews
• Exit interviews with clients (after clinic visits)
• Focus group discussions (e.g. with staff, community target groups, community leaders)
• Household interviews (least recommended)

Implementation and Training:

1. Instruments for data collection: Individual data collection needs to be designed for each REM.
2. Preparation of data collection instruments: Before drafting the questionnaires, the group defines the key areas for assessment and the standards against which an assessment will be made.
3. Preparation of training manual: A manual is produced and is used both during training sessions and as a reference field guide. Training manuals should contain detailed descriptions of each instrument. When needed, a glossary of health terms should be used.
4. Training the data collection teams: Training of the survey teams is a critical activity. The teams are briefed on the objectives of the evaluation and the methods selected for collecting information. The training requires 3 to 4 days. Team members should be made familiar with any clinical records from which information will be collected. When specific equipment or techniques are to be evaluated, there should be a practical demonstration during the training.
5. Field data collection: Team leaders should be familiar with local work situations in their respective areas and with clinic schedules. Team leaders prepare the survey program and review logistics and any possible constraints.

Data Processing and Analysis:

Software requirements include programs for word processing, for data entry and validity checking, and for data tabulation and analysis. Data processing and analysis is greatly facilitated by the use of Epi Info, a software developed by the Centers of Disease Control (CDC) and World Heath Organization (WHO).

Reporting and Dissemination of Results:

After data processing and analysis (please see above), a summary of major findings which correspond to the objectives and central issues, and a list of recommendations are prepared. The core technical group should draft a plan of action based on the major findings and identified service gaps.

Lessons from Experience:

So far the REM has been managed at national level on relatively large scale to provide an assessment of the MCH/FP service in a given country. The first few countries that used REM recommended that it should be built into the health care system as complementary activity to all efforts aimed at strengthening managerial skills and improving service performance. If REM is undertaken within a decentralized health care system based on district management, it can be used on a continuous basis by district staff to evaluate service performance and quality of care and to ensure full community participation.

Editor's comments: The guidelines is a very generic tool and it is unlikely that groups who are not already familiar with needs assessments or situation analyses of this type will find it useful.