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close this bookMother-Baby Package: Implementing Safe Motherhood in Countries (WHO, 1996, 108 p.)
close this folderHOW to operationalize the Mother-Baby Package
View the document(introduction...)
View the documentDefine national policy and guidelines
View the documentAssess needs
View the documentPrepare national plan of action
View the documentEstimate costs
View the documentIdentify sources of financial support
View the documentDevelop detailed implementation plan
Open this folder and view contentsImplement planned activities
View the documentMonitor and evaluate

Monitor and evaluate

Monitoring should be an ongoing process of collecting and analysing information about implementation of the programme; it should involve regular assessment of whether and how activities are being carried out as planned so that problems can be discussed and dealt with. Monitoring should serve to follow the progresses of planned activities, identify problems, give feedback to staff and solve problems before they can cause delays. Data collected should be processed and analysed in a timely fashion. Results of the analysis should be disseminated to people who are in position to act and react.

Implementation should be evaluated at regular intervals to assess the effectiveness and impact of either particular parts of the plan or the plan as a whole. Data from different monitoring and evaluation methods should be collected, the results compiled and the combined information used to get a better picture of progress.

Monitoring and evaluation are not clearly separable, except that monitoring tends to focus on ongoing implementation and evaluation is focused on effectiveness and impact.

It is neither feasible nor desirable to evaluate all the major activities and tasks necessary to carry out interventions at all levels. Managers should select the most important items for monitoring and evaluation based on current priorities.

Whenever possible, existing systems for data collection, analysis, and response, should be utilized and strengthened.

The following minimal list of indicators is suggested for monitoring from national to subdistrict levels. These focus on three sets of indicators - maternal health, family planning and newborn health - and provide structure, process and impact indicators.

Table 18: Selected monitoring indicators

Indicator


Type

Data Source



P

I

1

2

3

18.1 Family Planning

1.

Average birth interval

Months since last live birth

X

X

X

2.

Contraceptive prevalence rate (modern methods)

X

X

X

3.

New contraceptive acceptors annually

Number of women or partners accepting a modern method during the reference year

X

X

4.

Contraceptive acceptance rate

X

X

5.

Annual continuation rate

X

X

6.

Crude birth rate

X

7.

Age-specific fertility rate

X

8.

Average number of children (live births) born in last three years

X

9.

Average age at first birth for women under 25 years

X

X

P = Process indicator I = Impact indicator
1 = Service data 2 = Surveillance/routine reporting 3 = Surveys

1 15-49 years

Indicator


Type

Data Source



P

I

1

2

3

18.2 Maternal

1.

Number of pregnancy-related deaths

Deaths of women during pregnancy or within 42 days of termination of pregnancy irrespective of the cause of death

X

X

X

2.

Number of maternal deaths

Deaths of women during pregnancy or within 42 days of termination of pregnancy from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes

X

X

X

3.

Maternal mortality ratio*

X

X

X









4.

Percentage of women attended at least once during pregnancy by trained personnel*

X

X

X

X

5.

Percentage of births attended by trained health personnel*

X

X

X

6.

Availability of facilities providing essential obstetric care per 500 000 population*

X

X

X

7.

Percentage of population living within 1 hour travel time of health centre/hospital offering essential obstetric care*

X

X

X

8.

Percentage of complicated obstetric cases managed at essential obstetric care health facilities*

X

X

9.

Case fatality rate for obstetric complications**

X

X

X

10.

Caesarean deliveries as % of all births in the population

X

X

11.

Prevalence of anaemia and moderate/severe anaemia by gestation
· 2nd trimester anaemia moderate/severe anaemia
· 3rd trimester anaemia moderate/severe anaemia

X

X

X

12.

Percentage of pregnant women screened for syphilis

X

X

P = Process indicator I = Impact indicator
1 = Service data 2 = Surveillance/routine reporting 3 = Surveys

* See Indicators to Monitor Maternal Health Goals: Report of a Technical Working Group. Geneva, World Health Organization, 1994, WHO/FHE/MSM/94.14.

** This indicator refers to a given facility and should not be aggregated at the national level.

Indicator


Type

Data Source



P

I

1

2

3

18.3 Newborn

1.

Neonatal mortality rate

X

X

2.

Stillbirth rate

X

X

X

3.

Perinatal mortality rate

X

X

4.

Low birth weight rate

X

X

X

5.

Neonatal tetanus death rate

X

X

X

* Total births = all live births + all stillbirths.

Apart from the quantitative data mentioned above, interviews and focus group discussions with mothers (possibly led by local women’s organizations) may complement the findings of the suggested indicators.