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Maternal Health Programs: Monitoring and Evaluation
Maternal Health Programs: Monitoring and Evaluation
Infection 14.9%
19.8 24.8
Eclampsia 12.9%
7.9
Obstructed Labor
6.9%
14.9 Unsafe Abortion
12.9 12.9%
6.9 12.9 Other Direct Causes
7.9%
Indirect Causes
19.8%
WHY Do These Women Die?
Three Delays Model
HISTORICAL REVIEW
• Antenatal care
• Traditional birth attendants
• Risk screening
CURRENT APPROACH
• Skilled attendant at delivery
Recommended
Birth Preparedness, Including
Complication Readiness
• Preparing for Normal • Readiness for
Birth Complications
– Skilled attendant – Early detection
– Designated decision
– Place of delivery
maker(s)
– Finance – Emergency funds
– Nutrition – Communication
– Essential items – Transport
– Blood donors
ANC Recommendations (I)
• Detection/management of complications
• Prevention
– All women:
• Tetanus toxoid vaccination
• Iron folate supplementation
– Select populations:
• Malaria intermittent preventive treatment
• Routine hookworm treatment
• Iodine supplementation
• Vitamin A supplementation
Sample Results Framework for
Maternal Health
SO1: Increased use of maternal
health services
• Establishing causality
• Maternal health is multifactorial
• Improvements in overall health status are not
necessarily followed by concomitant changes in
mortality
• Considerable time lag to measure mortality change
M&E Challenges (II)
MMRatio:
Interpretation:
MMRate:
• Misclassification of illness
• Reliability
• Small numbers
Measuring Quality of Maternity
Care
• Campbell, O., Filippi, V., Koblinsky, M., Marshall, T., Mortimer, J.,
Pittrof, R., Ronsmans, C., and Williams, L. 1997. Lessons Learnt:
A decade of measuring the impact of safe motherhood
programmes. London: London School of Hygiene and Tropical
Medicine.
• Stanton, C., Abderrahim, N., and Hill, K. 2000. “An assessment of
DHS maternal mortality indicators.” Studies in Family Planning
31(2): 111-123.
• Thaddeus, S. and Maine, D. 1994. Too far to walk: maternal
mortality in context. Social Science and Medicine 38(8): 1091-
1110.
• UNICEF, WHO, and UNFPA. 1997. Guidelines for Monitoring the
Availability and Use of Obstetric Services. New York: UNICEF
Supplemental Slides I
Measuring Service Utilization by Women With
Complications
• Count number of women with specific complications
in the health facilities
• Derive expected number of complications in a year
– standard guesstimate: 15% of all deliveries have
complications
– estimate from self-reported data by women on the
occurrence of complications in a survey (OVER METHOD)
– Specific prevalence of complications based on literature
Supplemental Slides (II)
OVER METHOD
Problem:
• Example - In a district with an estimated 10,000 deliveries
in a year, 40 breech deliveries were reported by the health
facilities. What is the coverage of breech deliveries by
health facilities?
Answer:
• 10,000 * 31.7/1000 = 317 breech deliveries are
expected; coverage is 40/317 = 13%