Monitoring and Evaluation

“Monitoring and Evaluation (M&E) is an important and essential component of any intervention, project or program. M&E is the process in which data are collected and analyzed in order to provide appropriate information for use in program planning and management. The most effective way to ensure that a monitoring and evaluation plan is relevant to a program is to develop the M&E system at the same time as the project is being designed.” (CSTS+, M&E TRM, 2007. p.1).[i]

To make informed decisions, managers need an M&E system that yields reliable and timely information on factors such as those in the following list:

  • The health needs of the people in their catchment area
  • The health priorities of the country, province, district, and communities they serve
  • The quality and coverage of the health services they offer
  • The resources (e.g., medicine and supplies) they have used and resources still available
  • Progress in the implementation of their activities and toward desired outputs and outcomes[ii]

What is different about M&E of MNC programs compared with M&E of other programs? The answer in many ways is “not much.” The fundamental M&E principles (i.e., frameworks, indicators, and data sources) apply to MNC programs. The impacts—maternal and newborn mortality rates—are difficult to influence over the life of a typical 4- to 5-year project, but programs can use several internationally recognized and commonly reported indicators to assess changes.  There is a long history of data collection on MNC outcomes through global survey programs, such as DHS and Multiple Indicator Cluster Surveys (MICS).

  • Outputs for MNC programs are similar to those used in other programs, such as these examples:
    • Training outputs include measures such as the number of people trained in MNC activities, the cost per person trained, the percentage of training time spent practicing skills learned, and the percentage of trainees who could adequately perform a certain task.
    • Service outputs include measures such as the number of service delivery points that provide MNC services, the quality of MNC services offered at the delivery points, and the cost of increasing access and quality of MNC services.
  • Intermediate outcomes typically include service use and behavior or practice indicators, such as those listed in Table 1. 
  • Long-term impacts typically include maternal and newborn mortality rates.

Tables 1 and 2 come from the CSHGP’s KPC Survey, MNC module.

Table 1. Maternal Health Indicators: Pregnancy




























Indicator

Definition

Key - LiST

Antenatal care

Antenatal care

(1+ visit)

Percentage of mothers of children ages 0–23 months who received one or more antenatal care visits from a skilled health provider

 

Antenatal care

(4+ visits)

Percentage of mothers of children ages 0–23 months who had four or more antenatal visits while pregnant with their youngest child

K-L

Iron tablets (possession)

Percentage of mothers of children ages 0–23 months who received or purchased any iron tablets during the most recent pregnancy while pregnant with their youngest child

 

Iron tablets (consumption)

Percentage of mothers of children ages 0–23 months who took iron tablets for 90 or more days while pregnant with their youngest child

L*

Maternal tetanus toxoid vaccination (Neonatal tetanus protection)

Percentage of children ages 0–23 months protected at birth from neonatal tetanus through maternal tetanus toxoid immunization

L

HIV testing 

Percentage of mothers of children ages 0–23 months who were tested for HIV and received their results while pregnant with their youngest child

 

Syphilis screening 

Percentage of mothers of children ages 0–23 months who were screened for syphilis while pregnant with their youngest child

L**

Tuberculosis testing (in high HIV prevalence areas)

Percentage of mothers of children ages 0-–-23 months were tested for tuberculosis while pregnant with their youngest child

 

Deworming treatment

Percentage of mothers of children ages 0–23 months who took deworming treatment while pregnant with their youngest child

 

Counseling

Percentage of mothers of children ages 0–23 months who were counseled on the following topics while pregnant with their youngest child:

  • Danger signs during pregnancy, delivery, or postnatal (mother and newborn)
  • Nutrition during pregnancy
  • Rest during pregnancy
  • Self-care during pregnancy
  • Birth planning
  • Postpartum family planning
  • Breastfeeding
 

Urine test (for facility ANC)

Percentage of mothers of children ages 0–23 months who received a urine test during an ANC visit while pregnant with their youngest child

 

Blood pressure taken

Percentage of mothers of children ages 0–23 months who had their blood pressure taken during an ANC visit while pregnant with their youngest child

 

Malaria in pregnancy: prevention and care-seeking

Intermittent preventive treatment for malaria during last pregnancy

Percentage of mothers of children ages 0–23 months who received IPT for malaria in the following categories[1]:

  • 1 dose
  • 2 doses
  • 3 doses
  • 4+ doses

K(3+)-

L(2+)***

Long-lasting insecticide-treated nets use by women during pregnancy[2]

Percentage of mothers of children ages 0–23 months who reported they slept under an ITN all of the time or most of the time during their most recent pregnancy

K-L***

Appropriate care-seeking for fever during last pregnancy

Percentage of mothers of children ages 0–23 months that had fever during pregnancy with the youngest child and sought care from an appropriate provider.

L****

Birth preparedness

Birth preparedness (any)

Percentage of mothers of children ages 0–23 months who made birth preparations before the birth of their youngest child

 

Birth preparedness: Money saved

Percentage of mothers of children ages 0–23 months who saved money for the birth of their youngest child

 

Birth preparedness: Transportation plan (including emergency plan) in place

Percentage of mothers of children ages 0–23 months who had a transportation and emergency plan in place for the birth of their youngest child

 

Birth preparedness: Birth companion decided

Percentage of mothers of children ages 0–23 months who decided on a birth companion before the birth of their youngest child

 

Birth preparedness: Place to deliver decided

Percentage of mothers of children ages 0–23 months who decided on a place to deliver before the birth of their youngest child

 

Misoprostol possession

Misoprostol possession

Percentage of mothers of children ages 0–23 months who were given misoprostol to take immediately after they delivered their youngest child to prevent postpartum hemorrhage

 

* Lives Saved Tool (LiST) indicator: Percentage of pregnant women receiving iron folate supplementation.

** LiST indicator: Percentage of pregnant women screened for syphilis with the rapid plasma reagent test and treated with 2.4 miu benzathine penicillin, if needed.

*** LiST is set up to include only one of the two of these indicators in any given projection.

**** LiST indicator: Percentage of pregnant women with malaria who are treated for malaria between contraception and 6 weeks after delivery.

Table 2. Maternal Health Indicators: Labor and Delivery









Indicator

Definition

Key-LiST

Skilled birth attendant

Percentage of last-born children ages 0–23 months whose births were attended by skilled health personnel

K-L

Facility birth

Percentage of last-born children ages 0–23 months who were born in a health facility

K-L*

Caesarian section

Percentage of last-born children ages 0–23 months who were delivered by Caesarian section

K

Augmented delivery

Percentage mothers of children ages 0–23 months who were delivered using augmented delivery (induced or accelerated labor) when giving birth to their youngest child

 

Assisted delivery

Percentage of mothers of children ages 0–23 months who, when giving birth to their youngest child, were delivered with forceps or vacuum or suction

 

Misoprostol use

Percentage of mothers of children ages 0–23 months who took misoprostol immediately after they delivered their youngest child to prevent postpartum hemorrhage

 

* In LiST, if the information is available, facility deliveries can be disaggregated by essential care, basic emergency obstetric care (BEmOC), and comprehensive emergency obstetric care (CEmOC) facilities; and home deliveries can be disaggregated by assisted and unassisted deliveries.

Table 3. Maternal Health Indicators: Respectful Maternal Care







Indicator

Definition

Key -LiST

Birth companion

Percentage of mothers of children ages 0–23 months who had a support person or birth companion during labor and delivery of their youngest child

 

Birth position

Percentage of mothers of children ages 0–23 months who were allowed to choose their birth position when giving birth to their youngest child

 

Disrespectful care (self)

Percentage of mothers of children ages 0–23 months who experienced disrespectful care or abuse during labor and delivery of their youngest child

 

Disrespectful care (others)

Percentage of mothers of children ages 0–23 months who reported awareness that other women experienced disrespectful care or abuse during labor and delivery

 

Facility recommendation

Percentage of mothers of children ages 0–23 months who would recommend the health facility to a friend or family member to give birth

 

 

 

Table 4. Maternal Health Indicators: Post-Delivery Care



Indicator

Definition

Key - LiST

Postnatal care for mothers

Percentage of mothers of children ages 0–23 months who received postnatal care from an appropriately trained health worker within 24 hours of birth of their youngest child

K

Table 5. Maternal Health Indicators: Knowledge





Indicator

Definition

Key-LiST

Knowledge of pregnancy danger signs

Percentage of mothers of children ages 0–23 months who know at least two danger signs during pregnancy

 

Knowledge of delivery danger signs

Percentage of mothers of children ages 0–23 months who know at least two danger signs during delivery

 

Knowledge of maternal postpartum danger signs

Percentage of mothers of children ages 0–23 months who know at least two postpartum danger signs for the mother

 

Table 6. Newborn Health Indicators: Pregnancy





Indicator

Definition

Key -LiST

Antenatal care

(1+ visit)

Percentage of mothers of children ages 0–23 months who received one or more antenatal care visits from a skilled health provider

K

Antenatal care

(4+ visits)

Percentage of mothers of children ages 0–23 months who had four or more antenatal visits while pregnant with their youngest child

K-L

Neonatal tetanus protection (maternal tetanus toxoid vaccination)

Percentage of last-born children ages 0–23 months protected at birth from neonatal tetanus through maternal tetanus toxoid immunization

K-L

Table 7. Newborn Health Indicators: Labor and Delivery







Indicator

Definition

Key- LiST

Skilled attendant at birth

Percentage of last-born children ages 0–23 months whose birth was attended by skilled health personnel

K-L

Facility birth

Percentage of last-born children ages 0–23 months who were born in a health facility

K-L*

Caesarian section

Percentage of last-born children ages 0–23 months who were delivered by caesarian section

K

Birth weight

Percentage of last-born children ages 0–23 months with a reported birth weight

K

* In LiST, if the information is available, facility deliveries can be disaggregated by essential care, BEmOC, and CEmOC facilities, and home deliveries can be disaggregated by assisted and unassisted deliveries.

Table 8. Newborn Health Indicators: Post-Delivery















Indicator

Definition

Key - LiST

Postnatal care for mothers

Percentage of mothers of children ages 0–23 months who received postnatal care from an appropriately trained health worker within 2 days of birth of their youngest child

K

Postnatal care for newborns

Percentage of last-born children ages 0–23 months who received postnatal care from an appropriately trained health worker within 24 hours of birth

K-L

Early initiation of breastfeeding

Percentage of last-born children ages 0–23 months who were put to the breast within the first hour after birth

K

Clean cord cut

Percentage of last-born children ages 0–23 months who had their umbilical cord cut with a clean instrument (non-facility births only)

 

Thermal care: Immediate drying

Percentage of last-born children ages 0–23 months who were dried immediately after birth

 

Thermal care: Skin-to-skin

Percentage of last-born children ages 0–23 months who were placed on the mother’s bare chest immediately after birth

L*

Thermal care: Delayed bathing

Percentage of last-born children ages 0–23 months whose first bath was delayed until at least 6 hours after birth

L*

Cord care[1]

Percentage of last-born children ages 0–23 months who had nothing harmful applied to the umbilical cord stump

 

Feeding colostrum

Percentage of last-born children ages 0–23 months who were fed colostrum

 

Pre-lacteal feeds

Percentage of last-born children ages 0–23 months who did not receive pre-lacteal feeds

 

Prophylactic eye care

Percentage of last-born children ages 0–23 months who received appropriate preventive eye care within the first hour after birth

 

Postnatal care signal functions

Percentage of last-born children ages 0–23 months who had at least two signal functions checked within 2 days of birth

 

* Percentage of neonates whose mother delays the infant’s bath and who practices skin-to-skin contact to maintain thermal control of the infant.

Table 9. Newborn Health Indicators: Maternal Knowledge



INDICATOR

DEFINITION

KEY - LIST

Knowledge of neonatal danger signs

Percentage of mothers of children ages 0–23 months who know at least two neonatal danger signs

 

Key Resources for M&E:

Facility- and community-based assessments can investigate outcome measures; service delivery reviews can investigate elements of health system performance. 

When a maternal, perinatal, or neonatal death occurs, the local health staff can conduct an audit (verbal or social autopsy in the community or perinatal-maternal death audit at the facility level) to help understand why it occurred and how to prevent maternal, perinatal, and neonatal deaths in the future.

Key Resources:

 


[1] Suggested indicator, but needs additional testing.