This sub-section focuses on global Maternal Newborn Health monitoring frameworks, selected indicators guidance, data sources, and tools.
Selected Maternal and Newborn Health Global Monitoring Frameworks & Indicators Guidance
A common monitoring framework for ending preventable maternal mortality was developed in two phases based on a series of multi stakeholder consultations.
- Phase I focused on indicators related to the proximal causes of maternal mortality and includes 12 recommended indicators and four priority areas for further indicator development and testing. Learn more.
- Phase II focused on indicators of the social, political, and economic determinants of maternal health and mortality and recommended 25 indicators. Learn more.
- The Improving Maternal Measurement Capacity and Use (IHMH) project is promoting adoption and use of the EPMM indicators by country decision makers and is further developing, testing and validating indicators focused on maternal health and survival. Learn more.
The Every Newborn Action Plan, published in 2014, recommends a set of ‘core’ and ‘additional’ indicators categorized under impact indicators (Newborn mortality rate, stillbirth rate), coverage for every mother and baby (skilled attendant at birth, exclusive breastfeeding at 6 mos, early PNC), coverage for complications (antenatal corticosteroid use, kangaroo mother care and feeding support, treatment of neonatal sepsis), and inputs (birth registration.)
This WHO resource recommends a core set of indicators for Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH) for collection, aggregation and reporting in routine health management information systems (HMIS). It includes possible analyses and visualizations of the indicators, references on how to assess the quality of the data, and considerations for using the data for decision-making. The document is a working draft published by WHO in 2019.
This report presents the indicator and monitoring framework for the Global Strategy for Women’s, Children’s and Adolescents’ Health, (2016-2030) focusing on its Survive, Thrive and Transform objectives and 17 targets. The report details the selection process for the indicators and implications for monitoring, measurement, investments and reporting.
This framework outlines QoC information needs of key actors across system levels and includes recommended MNH quality of care indicators in appendix 1 and 2 (see also below).
MNH Data Sources and Tools
Health Management Information Systems
For recommended RMNCH indicators for monitoring in routine health information management systems, check out the WHO Facility Analysis Guidance for RMNCH Managers.
Published by the USAID-funded Maternal and Child Survival Program (MCSP) in 2018, the What Data on Maternal and Newborn Health do National Health Management Information Systems Include? reviews the data elements related to maternal and newborn health (MNH) present in the health management and information (HMIS) systems in 24 low- and lower middle-income countries. The review’s purpose is to quantify the extent to which key data elements are available in the antenatal, delivery and postpartum registers and associated summary reporting of the 24 USAID priority countries for MNH.
Health Facility Assessment Tools
The SPA Survey is a health facility assessment that provides a comprehensive overview of a country’s health service delivery. SPA surveys collect information on the overall availability of different facility-based health services in a country and their readiness to provide those services. The SPA questionnaires were last updated in 2012. The SPA indicators and questionnaires are currently being revised to incorporate a greater focus on quality of care and are expected to be available by the end of 2021.
The harmonized health facility assessment (HHFA) represents a resource package for conducting standardized health facility surveys. The HHFA enables a comprehensive, external review of the availability of health facility services, the systems that facilities have in place to deliver services at required standards of quality, and the effectiveness of the services. The HHFA builds upon the USAID/WHO Service Availability and Readiness Assessment (SARA) and incorporates components of other key global health facility surveys and indicator lists. It is based on global service standards and uses standardized indicators, questionnaires and data collection methodologies. Standardization of indicators and data collection promotes alignment of health facility survey approaches and enables comparability of results over time and across geographic areas.
Demographic and Health Surveys (DHS) are nationally-representative household surveys that provide data for a wide range of monitoring and impact evaluation indicators in the areas of population, health, and nutrition.
The DHS Phase 8 (revised in 2020) includes a Women’s Questionnaire that collects information on antenatal and postnatal care, place of delivery, who attended the delivery, birth weight, and the nature of complications during pregnancy for recent births.
The Multiple Indicator Cluster Surveys (MICS) program is a UNICEF‐supported household survey program whose key objective is to monitor the situation of children and women.
The MEASURE Evaluation legacy website includes a compendium of tools including qualitative tools, such as maternal case review tools.
Quality of Care (QoC) Metrics
In 2015 WHO published a vision for maternal and newborn health that includes eight quality domains related to provision of care, experience of care and cross-cutting health system functions. In 2016, 2018 and 2020 respectively, WHO published Standards for improving quality of maternal newborn care (2016), quality of pediatric and adolescent care (2018) and quality of small and sick newborn care (2020) in health care facilities (see below). Each aspirational standard includes several ‘quality statements’ intended to drive actionable improvement to help achieve the standard. In 2017, WHO and partners launched a multi-country Network to improve quality of maternal newborn and child health care, leveraging the MNCH QoC standards, and published a monitoring framework that outlines QoC information needs of improvement leaders at national, subnational and health facility level, and recommends priority quality of care indicators for each quality statement for use by front-line QI teams working to improve care.