Facility Analysis Guidance-RMNCAH

WORKING DOCUMENT, OCTOBER 2019
ANALYSIS AND USE OF HEALTH FACILITY DATA
Guidance for RMNCAH

programme managers
© World Health Organization 2019
All rights reserved. This is a working document and should not be quoted, reproduced, translated or adapted, in
part or in whole, in any form or by any means.
ANALYSIS AND USE OF HEALTH FACILITY DATA: Guidance for RMNCAH programme managers
MODULE 7
Guidance for RMNCAH programme managers
LEARNING OBJECTIVES
This module describes a core set of indicators for Reproductive, Maternal, Newborn, Child and Adolescent Health
(RMNCAH) that can be captured through 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. By the end of this module, participants will be able to:
 Describe the core set of HMIS indicators for routine monitoring of RMNCAH programmes;
 Conduct basic analyses and data visualizations of these indicators to help monitor RMNCAH programmes;
 Interpret the indicator values and their implications for RMNCAH programme management.
AUDIENCE
This module is relevant for a range of stakeholders including:
 Ministry of Health staff working on reproductive, maternal, newborn, child and adolescent health programme(s),
monitoring and evaluation activities, and the Health Management Information System at national and sub-national
levels;
 Staff of partner organizations involved with supporting RMNCAH programme(s), monitoring and evaluation, and/or
health system strengthening;
 Consultants and staff working at research institutes involved with the analysis of RMNCAH data and/or efforts to
improve the quality of routine RMNCAH data.
SUGGESTED ADDITIONAL REFERENCES

 Indicator and Monitoring Framework for the Global Strategy for Women’s, Children’s and Adolescents’ Health. Every
Woman Every Child. Geneva; 2016. https://www.who.int/life-course/partners/global-strategy/en/
 Visualizing and Using Routine Reproductive, Maternal, Neonatal, and Child Health Data at Health Facilities: A
Resource Package for Health Providers and District Managers. Maternal and Child Survival Program; Washington,
D.C.; 2018. https://www.mcsprogram.org/resource/visualizing-and-using-routine-rmnch-data-at-health-facilities-a-
resource-package-for-health-providers-and-district-managers/
 Data Quality Review: A toolkit for facility data quality assessment. World Health Organization. Geneva; 2017.
http://apps.who.int/iris/handle/10665/259224
KEY AUTHORS
Allisyn Moran | Elizabeth Katwan | Liliana Carvajal | Tyler Porth | Ann-Beth Moller | Jennifer Requejo
–1–
CONTENTS
1. About the data………………………………………………………………………………………………………………………… 4
2. Data quality....................................................................................................................................... 7
3. Core facility indicators ..................................................................................................................... 8
4. Analysis of core set of indicators ................................................................................................... 14
5. Limitations of facility-based data .................................................................................................. 24
Annex 1. Additional indicators ........................................................................................................... 25
Annex 2. Additional resources ........................................................................................................... 26
–2–
Acknowledgements
This guidance document has been developed by the World Health Organization and UNICEF, with the support of grants from
Bloomberg Philanthropies Data for Health Initiative, Gavi, the Vaccine Alliance, The Global Fund to Fight AIDS, Tuberculosis and
Malaria, Bill & Melinda Gates Foundation, USAID, and The Norwegian Agency for Development Cooperation.
Contributions to the content of this document came from Theresa Diaz, Kathleen Strong, Moise Muzigaba, Doris Chou, and
Lale Say from the World Health Organization and by Debra Jackson and Remy Mwamba from UNICEF. Additional inputs to
earlier versions of this document came from Ben Nemser and Norah Stoops. This document was also reviewed by Brendan
Hayes, Kimberly Boer, and John Borrazzo from the Global Financing Facility.
We would also like to acknowledge the Every Newborn Action Plan and Ending Preventable Maternal Mortality Metrics
Technical Working groups, MoNITOR and CHAT for input and suggestions and Cecilia Silva Venturini for graphic design.
–3–
Note on the document

This document will be reviewed and updated periodically to ensure that it remains aligned with the most recent guidelines and
evidence. Feedback to the document will contribute to its evolution and improvement over time.
1. About the data

Health service delivery for reproductive, maternal, newborn, child and adolescent health (RMNCAH) follows a continuum of
care which spans from pre-pregnancy, pregnancy and birth to the immediate postnatal period for women and newborns
through to childhood and adolescence. The continuum of care approach recognizes that providing preventive, promotive and
treatment interventions throughout the life course is the most effective way to reduce mortality and improve health outcomes
for women, newborns, children and adolescents. Within the scope of the continuum of care are interventions for normal and
complicated pregnancies, and for well and sick children and adolescents.
Figure 1. Continuum of care for RMNCAH
Figure 1 adapted from: Opportunities for Africa’s Newborns: Practical data, policy and programmatic support for newborn care in Africa. The Partnership for
Maternal, Newborn and Child Health. (http://www.who.int/pmnch/media/publications/oanfullreport.pdf)
In September 2015, the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016-2030)1 (GS) was launched to
stimulate action and accountability. It includes a list of ‘Survive, Thrive, and Transform’ targets and a core set of indicators to
track progress towards them. These indicators align with indicators included in the Sustainable Development Goal Framework
(SDG).2
The Indicator and Monitoring Framework for the Global Strategy 3 recognizes routine health facility data as an important
source of information on the readiness of a facility to provide key RMNCAH services (e.g., the ‘inputs’ such as availability of
essential drugs, equipment and staff), utilization of services, and proxy measures for quality of care. However, in many settings,
availability and quality of facility-based data still needs considerable improvement.
An advantage of using routine data is that they are continuously available for programme monitoring and provide more
granular level of information to better understand the performance of health programmes. However, there are limitations to
routine and health facility data, including representativeness and quality concerns. For example, health facility data capture
information on individuals that seek care at the facility, not necessarily everyone who need specific services and are, therefore,
generally not representative of the population. Also, not all data captured in health facilities are recorded in the health
management information system. Other health service data, such as human resources or commodity stock levels, may be
reported in a system with limited interoperability with the HMIS. Improving interoperability of different systems is an
important goal that countries and their partners should consider. As data from health facilities are reported up through the
health information system, they are further aggregated at each step which results in considerable loss of details that are
important for understanding health system performance and equity considerations.
1 Every Woman Every Child. Global strategy for women’s, children’s and adolescents’ health 2016–2030. New York: Every Woman Every Child, 2015.
2 UN. Sustainable development goals. New York: United Nations Department of Economic and Social Affairs, 2015.
https://sustainabledevelopment.un.org/index.html.
3 Every Woman Every Child. Indicator and monitoring framework for the global strategy for women’s, children’s and adolescents’ health (2016–2030). New
York: Every Woman Every Child, 2016.
–4–
Data collected through surveys, such as behavior, knowledge and attitudes, and socioeconomic variables are not typically
integrated into the HMIS. Integration of survey and routine data could provide additional benefits vis-à-vis data use, analysis,
coverage validation, denominator estimation, and more. Similarly, there is growing interest in collecting community level data
and integrating these data into the formal HMIS. Such efforts would help provide a more comprehensive assessment of the
performance of the health system at all levels.
Programme managers must be aware of these advantages and disadvantages when using health facility data to guide
programming or adapting/changing action plans during implementation.
USE OF FACILITY DATA
Each country has a unique process and system for collecting data from health facilities and reporting on health service delivery
indicators. Information can either be recorded in paper-based registers or Electronic Medical Records (EMR) systems. Data are
collected, collated, and reported at all levels of the health system, starting with the community and lowest level facilities, then
aggregated at the next geographic or administrative unit of the country, and then eventually aggregated up to the national
level further for the purpose of annual reviews.
Figure 2 presents an example of how data can be used for decision-making at each level. For example, at district level, district
and health facility managers can review data on a routine basis, while at national level, these data may be reviewed on an
annual basis.
Figure 2. Frequency of data sources and levels of data use
Figure 2 from: Diaz Theresa, Rasanathan Kumanan, Meribole Emmanuel, Maina Isabella, Nsona Humphreys, Aung Kyaw Myint et al. Framework and strategy
for integrated monitoring and evaluation of child health programmes for responsive programming, accountability, and impact. BMJ. 2018;362:k2785.
GUIDING PRINCIPLES OF THIS DOCUMENT
▪ Aggregated facility-based indicators: This document focuses on aggregate data rather than individual patient-based
longitudinal data.
▪ Facility-based denominators: Since this document focuses on information collected from health facilities, denominators
in the core set of indicators are based on data collected from the facilities and will not be representative of the population.
Population-based indicators are collected via nationally representative household surveys, where the denominator is
based on a representative sample of the total population. Relevant RMNCAH population-based indicators are included in
this document for consideration and may be used in conjunction with the recommended core facility indicators.
▪ Indicators are evidence-based: All indicators in the core set are adapted from evidence-based guidelines and
recommendations.
▪ Indicators are relevant across all levels of the health system: Core indicators are relevant for all levels of the health
system, from the lowest level health facility, to sub-national levels (2nd administrative level), national, and global level.
–5–
▪ Applicable to women, children, and adolescents seeking care in health facilities: Indicators in the core list are
applicable to women, children and adolescents who seek care at a health facility. Indicators for those with specific needs
or conditions for which they would be referred to higher level facilities (e.g. maternal complications, low birth weight
babies, newborns in need of resuscitation or kangaroo mother care) are included as additional indicators in Annex 1.
▪ Disaggregations of indicators are recommended: Within the list of indicators are recommended disaggregations (e.g.
age, treatment type, etc.), which may not be feasible for all settings depending on whether data collection tools, registers
and social/political context allow for indicators to be reported or calculated this way. If it is not currently possible to
disaggregate the indicators this way, please consider these recommendations as something to work towards in future
updates of data collection tools.
STANDARD DEFINITIONS OF TERMS USED IN THIS DOCUMENT

Antenatal client 1st visit - First antenatal care contact by a pregnant woman to a health facility can be used as a proxy denominator
for number of pregnant women using health-facility data when estimated number of pregnancies from the total population is not
available. The timing of initiation of the first antenatal care visit is paramount for ensuring optimal care and health outcomes for
women and children. The WHO antenatal care model4 recommends that the first antenatal care visit takes place within the first
trimester (i.e., gestational age of <12 weeks).
Delivery in facility – Delivery in a facility refers to childbirth that has taken place in a health facility5. To reduce maternal and
newborn mortality, the optimal long-term objective is that all births take place in health facilities in which obstetric complications
can be treated when they arise. In this document, deliveries refer to number of women who give birth in the health facility and not
the number of births (live and stillbirths).
Live birth - Live birth refers to the complete expulsion or extraction from its mother of a product of conception, irrespective of the
duration of the pregnancy, which, after such separation, breathes or shows any other evidence of life - e.g. beating of the heart,
pulsation of the umbilical cord or definite movement of voluntary muscles - whether or not the umbilical cord has been cut or the
placenta is attached. Each product of such a birth is considered live born6,7.
Still birth - Still birth is defined as infant born with no signs of life, weighing more than 1,000 g and older than 28 weeks
gestation. An antepartum foetal death (stillbirth – macerated) refers to a foetus that has suffered an intrauterine death after the
28th week of gestation and before labour. An intrapartum foetal death (stillbirth - fresh), refers to a baby that has died after the
onset of labour and before birth. Fresh stillbirths do not show any signs of maceration. Maceration describes the degenerative
changes that occur in stillbirths retained in the utero after death, and the earliest signs are in the form of discolouration and peeling
of the skin, leaving regions of raw tissue7,8.
Health facility – Health facility refers to any facility at which health services are provided, including but not limited to: clinics,
hospitals and other health service points (public/private/community-based).
4 World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience. Geneva: WHO, 2016.
5 World Health Organization. WHO recommendations on intrapartum care for a positive childbirth experience. Geneva: WHO, 2018.
6 World Health Organization. https://www.who.int/healthinfo/statistics/indmaternalmortality/en/
7 World Health Organization. https://www.who.int/classifications/icd/ICD10Volume2_en_2010.pdf
8
World Health Organization. Making Every Baby Count: Audit and review of stillbirths and neonatal deaths. Geneva: WHO, 2016.
–6–
2. Data quality
There are many issues that affect data quality ranging from using the appropriate tools for collecting and reporting on data,
having adequately trained staff for data entry, and the ability of the person handling the data to understand and interpret it.
As for all data sources, in addition to establishing systems and protocols to enhance good data collection and reporting for
health facility data as described in this document, any analysis must consider whether the results are affected by data quality
issues.
Five domains for periodic assessment of data quality are recommended for all core indicators: 1) Completeness, 2) Timeliness,
3) Internal consistency, 4) External consistency with other data sources, and 5) External comparison with population data.
Except for annual comparisons with external sources of data, quality assessments of the HMIS data can be examined monthly
when collated and reviewed before transmission to higher levels, as well as annually.
Domain Data quality metric Frequency

Completeness and timeliness Completeness and timeliness of reporting (reporting form/data Monthly, annually
set completeness)
Completeness of indicator data (data element completeness) Monthly, annually
Internal consistency Presence of outliers Monthly, annually
Consistency over time, i.e. plausibility of reported values Monthly, annually
compared to previous reporting
Consistency between indicators, i.e. negative dropout rates Annually
Consistency between denominators i.e. pregnancies, live births, Annually, or as needed
infants, etc.
External consistency with Consistency between routinely reported data and population- Annually
other data sources based surveys
External comparison of Consistency between the population data used for calculating Annually
population data immunisation coverages and other sources of population
estimates
WHO has developed a toolkit to support both a desk review and field investigations of data quality. This toolkit includes an
Excel-based tool which, when populated with key data from health facilities and other sources, analyses the completeness,
internal consistency and external consistency of the data. For countries using DHIS2 software to manage their routine data,
WHO has also developed the Data Quality Review toolkit, an application which can be installed on the national DHIS2 system
that automatically generates findings from a data desk review at either national or sub-national level.
–7–
3. Core facility indicators

Below is the core set of RMNCAH indicators that are recommended for collection, aggregation, and reporting for routine
health information systems (N=numerator and D= denominator). All indicators shaded in light pink have more detailed
descriptions in the Facility Analysis and Use Toolkits for other programme areas. This core set of indicators were selected
based on the guiding principles of this document (described above) as well as from consultations with various expert groups.
Information on time intervals for data collection for each indicator are not included because this will vary by country. This core
indicator list will be updated as evidence changes and develops.
Computation
Core indicators Definition Disaggregation
(e.g. numerator/denominator, number)
Sexual and reproductive health
Contraception first Clients who accept for the first time in his/her life Number of clients who accept a family planning
time user contraceptive method method for the 1st time • Age (10-14, 15-19,
20+)
• Sex
• Unit of
contraceptive
method
Postpartum family Percentage of postpartum women delivering in N: Number of postpartum women who delivered in
planning acceptor facility initiating a contraceptive method before facility initiating contraceptive method before • Age (10-14, 15-19,
discharge 20+)
discharge
D: Number of deliveries in facility
“Initiated" refers to women who either leave with an
FP method or intend to begin a method that day
(e.g. fertility awareness method). It combines both
those women who “leave with” a method and those
who “accept” a method prior to discharge or leaving
the facility.
Maternal health
Antenatal client 1st Percentage of antenatal clients with 1st visit before N: Number of antenatal clients 1st visit before 12
visit before 12 weeks 12 weeks weeks • Age (10-14, 15-19,
gestation 20+)
D: Number of antenatal clients 1st visit
Antenatal client Percentage of antenatal clients screened for syphilis N: Number of antenatal clients screened for syphilis
syphilis screening D: Number of antenatal clients 1st visit
Antenatal client Percentage of antenatal clients with haemoglobin N: Number of antenatal clients with haemoglobin
haemoglobin level measured level measured
measured D: Number of antenatal clients 1st visit
Antenatal client blood Percentage of antenatal clients with blood pressure N: Number of antenatal clients with blood pressure
pressure measured measured
measurement D: Number of antenatal clients 1st visit
Prevention of mother- See Analysis and use of health facility data - N: Number of pregnant women attending ANC
to-child transmission Guidance for HIV programme managers for more and/or who had a facility-based delivery who were
(PMTCT) - testing details on PMTCT; numerator and denominator tested for HIV during pregnancy or already knew
coverage rate taken from this document. they were HIV-positive
D: Number of ANC attendees or number of facility-
based deliveries
Intermittent See Analysis and use of health facility data - N: Number of pregnant women given at least three
preventive therapy for Guidance for malaria programme managers for doses of sulfadoxine/purimethamine for IPT
malaria during more details on coverage of IPTp; numerator and D: Number of antenatal clients 1st visit
pregnancy (IPTp) denominator taken from this document.
Iron supplementation See Collection, analysis and use of health facility and Nutrition guidance document and indicator
for pregnant women community data – Guidance for nutrition definitions under development
programme managers† for more details.
Caesarean section Percentage of deliveries in health facilities by N: Number of caesarean sections in a facility
caesarean section D: Number of deliveries in facility • Age (10-14,15-19,
20+)
• Facility type
Uterotonic for Percentage of women who gave birth in a facility N: Number of women who gave birth in a facility
prevention of post- who received a prophylactic uterotonic (e.g. who received a prophylactic uterotonic immediately
partum haemorrhage Oxytocin) immediately after birth for prevention of after birth
postpartum hemorrhage D: Number of deliveries in facility
«Immediately» ideally refers to within one minute
–8–
Computation
Postnatal
Notification for birth See Collection, analysis and use of health facility and N: Number of babies/ children for whom • Sex
registration community data: Guidance for health programme notifications are issued for birth registration
managers on vital events data* for more details on within specified number of days after birth
notification for birth registration.
D: Number of live births in facility
Note: In many countries the health system has the
mandate to notify births to the civil registry or to Note: The specified number of days after birth
provide documentation to parents for registration. should be aligned with national policy/guidelines.
Babies with Percentage of babies born in a facility with N: Number of babies born in a facility with
documented documented birthweight before discharge documented birthweight before discharge
birthweight D: Number of live births in facility
Low-birth weight See Collection, analysis and use of health facility and Nutrition guidance document and indicator
community data – Guidance for nutrition definitions under development
programme managers† for more details on low-birth
weight
Newborns breastfed See Collection, analysis and use of health facility and Nutrition guidance document and indicator
within one hour of community data – Guidance for nutrition definitions under development
birth programme managers† for more details on
immediate breastfeeding
Postnatal care for Percentage of women with postnatal care (PNC) N: Number of women with postnatal care
women D: Number of deliveries in facility • Timing of PNC in
Note: The numerator includes both women who accordance with
gave birth in the health facility and those who gave national policy
birth outside the health facility
Postnatal care for Percentage of newborns with postnatal care (PNC) N: Number of newborns with postnatal care • Timing of PNC in
newborns D: Number of live births in facility accordance with
Note: The numerator includes both newborns who national policy
were born in the health facility and those who were
born outside the health facility
Note on timing of postnatal care for women and newborns9
If birth is in a health facility, women and newborns should receive postnatal care in the facility for at least 24 hours after birth. If birth is at home, the first
postnatal contact should be as early as possible within 24 hours of birth. At least three additional postnatal contacts are recommended for all mothers
and newborns, on day 3 (48–72 hours), between days 7–14 after birth, and six weeks after birth.
Childhood
Pneumonia diagnosis Percentage of children with acute respiratory illness N: Number of cases of children diagnosed with • Age (0-4, 5-9)
(ARI) diagnosed as pneumonia pneumonia
D: Number of children presenting with symptoms of
ARI
Amoxicillin treatment Percentage of children with pneumonia treated with N: Number of children with pneumonia who • Age (0-4, 5-9)
for pneumonia amoxicillin received amoxicillin • Treatment type
D: Number of children with pneumonia (dispersed tablet,
oral syrup)
Diarrhoea treatment Percentage of children with diarrhoea treated N: Number of children who received treatment for • Age (0-4, 5-9)
diarrhoea • Treatment type
D: Number of children with diarrhoea (ORS and
Zinc/ORS/ Zinc)
Malaria treatment See Analysis and use of health facility data - N: Number of malaria cases among children treated • Age (0-4, 5-9)
with ACT Guidance for malaria programme managers for with ACT
more details on malaria testing and treatment; D: Number of malaria cases among children
numerator and denominator taken from this diagnosed
document.
Vitamin A coverage See Collection, analysis and use of health facility and Nutrition guidance document and indicator
programme managers† for more details on Vitamin
A coverage.
9 World Health Organization. WHO recommendations on Postnatal care of the mother and newborn. Geneva: WHO, 2013.
–9–
Computation
Tuberculosis See Analysis and use of health facility data - Number of tuberculosis cases among children • Age (0-4, 5-9)
notification Guidance for tuberculosis programme managers for notified in a specified time period, usually one • Treatment history
more details on TB indicators. year (new and relapse
(incident cases) or
previously treated,
excluding relapse)
Malnutrition See Collection, analysis and use of health facility and Nutrition guidance document and indicator
programme managers† for more details on
childhood malnutrition.
Mortality
Maternal deaths in Number of women who die in the health facility Number of maternal deaths in facility
health facility either while pregnant or within the first 42 days of • By cause of death
the end of pregnancy (Classified by ICD-
MM)
Note: This can include women who gave birth • Age (10-14, 15-19,
outside a facility but who died in the health facility. 20+)
• Facility type
Neonatal deaths in Number of newborns who die in the health facility in Number of neonatal deaths in facility
health facility the first 28 days • By cause of death
(Classified by ICD-
Note: This includes any neonatal death in a facility PM)
that occurred in the first 28 days – pre-discharge • Facility type
after birth or upon re-admission for an illness.
Child deaths in health Number of children who die in the health facility Number of child deaths in facility
facility • By cause of death
Note: This includes deaths that occur between the (Classified by
ages of 1 month up to 9 years of age. ICD10 or ICD11 in
accordance with
what is used in the
country)
• Age (1 month to 59
months, 5-9 years)
• Facility type
Adolescent deaths in Number of adolescents who die in the health facility Number of adolescent deaths in facility
health facility • By cause of death
Note: This includes deaths that occur between the (Classified by
ages of 10 to 19 years of age ICD10 or ICD11 in
accordance with
what is used in the
country)
• Age (10-14, 15-19)
• Sex
• Facility type
Stillbirths in health Stillbirth as a percentage of all births in health N: Number of stillbirths in facility
facility facilities D: Number of live births and stillbirths in • Fresh, macerated
facility • Facility type
(Baby born with no sign of life and weighing at least
1000g or after 28 weeks gestation)
Maternal deaths Percentage of maternal deaths reviewed N: Number of maternal deaths in facility that
reviewed were reviewed • Facility type
D: Number of maternal deaths in facility
Perinatal deaths Percentage of perinatal deaths reviewed N: Number of perinatal deaths in facility that
reviewed were reviewed • Facility type
Note: Perinatal deaths include stillbirths and D: Number of perinatal deaths in facility
newborn deaths up to 7 days after birth
†
Collection, analysis and use of health facility and community data – Guidance for nutrition programme managers will be available in 2020.
* Collection, analysis and use of health facility and community data – Guidance for health programme managers on vital events data will be available in 2019
– 10 –
The core indicator list was developed in accordance with the Guiding Principles of this document, focusing on aggregate data
and facility-based denominators. In some settings though, individual patient-based data may be available allowing for
consideration of indicators which require tracking a patient over time, such as women attending multiple antenatal care visits.
Additionally, some indicators can be calculated using estimated population-based denominators. Below are some additional
indicators for consideration based on data availability and analytical capacity in countries.
IF INDIVIDUAL DATA ARE AVAILABLE
In some countries, individual patient-based data are available from electronic medical records or from paper-based forms. If
individual level data are available, you may consider monitoring the indicators listed below.
Indicator Definition Computation Disaggregation

Maternal and Newborn Health
Antenatal care 4th visit Percentage of antenatal clients who N: Number of antenatal clients with 4th ANC visit
had a 4th ANC visit D: Number of antenatal clients 1st visit
Antenatal care 8th visit Percentage of antenatal clients who N: Number of antenatal clients with 8th ANC visit
had a 8th ANC visit D: Number of antenatal clients 1st visit
Blood pressure measurement Percentage of antenatal clients who N: Antenatal client with blood pressure
during third trimester had a blood pressure measurement measurement in third trimester
recorded in third trimester D: Number of antenatal clients 1st visit
Antenatal client treated for Percentage of antenatal clients N: Number of antenatal clients treated for syphilis
syphillis treated for syphillis D: Number of antenatal clients syphilis
seropositive
USING AN ESTIMATED POPULATION-BASED DENOMINATOR

In some countries, you may wish to analyse some indicators using an estimated population-based denominator. Estimated
population-based denominators need to be treated with care. When using these denominators, the following considerations
should be noted:
• Estimates of target denominators (or a suitable proxy indicator) are available and sufficiently accurate for their
intended use;
• Reporting from facilities that serve the target denominator population needs to have very high reporting rates (e.g.
above 90%) and reflect all facilities serving that population;
• The quality of the data reported must be high and consistent over time

Sexual and Reproductive Health
Couple year protection (CYP) The estimated protection provided by family The CYP is calculated by multiplying the
planning (FP) services based upon the volume quantity of each method distributed by a • Type of method by
of all contraceptives distributed among the units
conversion factor, to yield an estimate of the
female population 15-49 years. See notes and duration of contraceptive protection provided
example on CYP in Table 1 per unit of that method. The CYPs for each
method are then summed over all methods to
obtain a total CYP figure
Cervical cancer screening Percentage of women of reproductive age (15 N: Number of women of reproductive age
to 49 years) who were screened for cervical who were screed for cervical cancer
cancer using any of the following methods: D: Estimated number of women of
visual Inspection with acetic acid/vinegar (VIA), reproductive age
pap smear, human papilloma virus (HPV) test.
– 11 –

Antenatal care 4th visit Percentage of antenatal clients who had 4 ANC N: Number of antental clients with 4th ANC
visits visit
D: Estimated number of pregnant women
Antenatal care 8th visit Percentage of antenatal clients who had 8 ANC N: Number of antental clients with 8th ANC
visits visit
Tetanus vaccination in Percentage of antenatal clients who received at N: Number of Tetanus containing vaccine
antenatal client least two doses of a tetanus containing vaccine doses (TT or Td) • TT or Td
Intermittent preventive See Analysis and use of health facility data - N: Number of pregnant women given at
therapy for malaria during Guidance for malaria programme managers least three doses of
pregnancy (IPTp) for more details on coverage of IPTp; sulfadoxine/purimethamine for IPTp
numerator and denominator taken from this D: Estimated pregnancies in areas at risk
document.
Institutional delivery Percentage of women who gave birth in a N: Number of deliveries in facility
health facility D: Estimated number of live births
Caesarean section Percentage of deliveries by caesarean section N: Number of caesarean sections in facility
D: Estimated number of live births
Childhood
Immunization coverage rate See Analysis and use of health facility data - N: Number of children receiving the vaccine
Guidance for immunization programme D: Estimated number of target population
managers for more details on immunization
coverage rates; numerator and denominator
taken from this document.
++ List of methods and factors to be used are available at https://www.measureevaluation.org/prh/rh_indicators/family-planning/fp/cyp
Facility-based vs. population-based denominators
It is important to note that the classification of indicators with facility-based vs. population-based denominators represents
recommended configurations for this document. However, it is acknowledged that the best configuration of these indicators,
and hence matching denominators, depends on different types users and their corresponding needs. For that reason, it is
suggested that to the extent possible, facility-based information systems be designed to allow certain indicators to be
calculated with either facility or population-based denominators, so they can be aligned to users’ needs accordingly.
For example, the antenatal care 8th visit indicator, can be calculated with either a facility or population-based denominator
where, in both cases, the numerator is the number of antenatal clients receiving 8 ANC visits.
Facility-based denominator for ANC 8 visits = Number of clients presenting for antenatal care first visit
Here, the indicator essentially shows retention in receiving ANC from the 1 st visit to the 8th visit. This can be very useful
for programme managers and care providers.
Population-based denominator for ANC 8 visits = Estimated number of pregnant women

Here, the indicator displays a measure of the overall all coverage of eight antenatal care visits within the population. This
can be very useful for programme managers and policy makers.
– 12 –
Table 1. Notes on couple year protection

This table gives the type of method, the factor to be used, the resulting example calculation and the final score
Method Factor to be used Units issued (1 month) Result

Oral contraceptives Divide by 15 260 17.3
Condoms (male and female) Divide by 120 1500 12.5
Depo Provera Injectable Divide by 4 65 16.25
Noristerat Injectable Divide by 6 72 12
Monthly Vaginal Ring/Patch Divide by 15 88 5.8
Vaginal Foaming Tablets Divide by 120 750 6.25
Cyclofem Monthly Injectable Divide by 13 95 7.3
Copper-T 380-A IUCD Multiply by 4.6 42 193.2
3 Year Implant (e.g. Implanon) Multiply by 2.5 38 95
4 Year Implant (e.g. Sino-Implant) Multiply by 3.2 29 92.8
5 Year Implant (e.g. Jadelle) Multiply by 3.8 31 117.8
Emergency Contraceptive Pills Divide by 20 290 14.5
Sterilization (male and female) * Multiply by 10 18 180
Sum of Units with factors used 770.7

Population female 15-49 years = 26,000 35.5%
Divided by 12 to create denominator for 1 month = 2167
CYPR = 770.7 X 100/2167
– 13 –
4. Analysis of core set of indicators

Programme managers and analysts use routine health facility data to measure intervention coverage, monitor trends over
time, and assess geographic (or facility) differences for a range of standard health indicators among women, newborns,
children and adolescents attending health services. This section provides an overview, with examples, of the types of analyses
that can and should be used to measure changes over time in services provided as well as the causes of illness and death seen
in health facilities.
SEXUAL AND REPRODUCTIVE HEALTH
Purpose
Monitoring sexual and reproductive health is important to ensure the health of a population and to achieve universal access to
sexual and reproductive healthcare. The core components of sexual and reproductive health are family planning, preventing
unsafe abortion and sexually transmitted infections as well as preventing harmful practices such as Female Genital Mutilation
(FGM). Some of the indicators are measures of health status (outcome or impact indicators), while others are intended to
capture ‘processes’.
CONTRACEPTION FIRST TIME USE
With growing trends in adolescent pregnancy and variance in fertility, it is important to track the number of new contraceptive
users by age and sex as well as to monitor changes over time.
Analysis
Figure 3: Examine number of new contraceptive users by age and sex for a specified period.
400
Number of new users
300
200
100
0
Male Female Total
10-14 years 15-19 years 20 + years
Figure 4: Examine number of new contraceptive users over time by sex.
150
100
50
0
Q1 Q2 Q3 Q4
Male Female Total
– 14 –
POSTPARTUM FAMILY PLANNING
The postpartum period is a good opportunity to counsel women on family planning. This indicator assesses the proportion of
women who initiated family planning prior to discharge among women who gave birth in a health facility.
Figure 5: Examine coverage of postpartum family planning by contraceptive method and by region
100
90
80 IUD
70
Implant
60
50 Pill
40 Injectable
30
Condom
20
10 Other methods
0
Region 1 Region 2 Region 3 Region 4 Region 5 Region 6
Considerations/issues for interpretation

Figures 3 and 4 display the number of new contraceptive users by age and sex which allows the program manager to track
uptake of contraception over time and by sex and identify gaps that need to be addressed. For example, in Q3 the number of
female new users decreased, and the number of male new users increased, so it would be important to discuss the reasons for
this change. The change may be due to stockouts, change in personnel, change in demand due to holiday travel or other
reasons, or accessing contraceptives at other locations such as schools or in private clinics.
Figure 5 displays postpartum family planning initiation by region which allows managers to identify high performing and low
performing areas and to assess patterns in performance for contraceptive use. For example, some geographic areas may show
high coverage of certain contraceptive methods, such as injectables or pills, while other areas have higher coverage of
different methods. Geographic areas can be arranged by region or by population size to give further insight into areas which
require greater support or supervision.
MATERNAL AND NEWBORN HEALTH
Purpose
Routine facility-based data on maternal and newborn health (MNH) have three principle objectives:
1. To identify geographical locations and population groups with poor MNH outcomes. This permits managers to direct
resources (e.g. training, supplies, supervision, infrastructure, etc.) to populations in greatest need.
2. To assess the effectiveness of interventions and refine policies. Using a framework that links MNH interventions
coverage to MNH impact (MNH morbidity and mortality), programmes can assess the effectiveness of their
interventions and refine their targeting or policies to optimize impact. These assessments can also be useful tools for
advocating for additional resources.
3. To review progress in reducing maternal and newborn mortality among institutional/facility-based deliveries.
– 15 –
SERVICE COVERAGE FOR MOTHERS AND NEWBORNS
Analysis
Figure 6. Bar chart on coverage of antenatal care interventions among pregnant women attending ANC by year
(percentage)
60
50
40
2015
30
2016
20
2017
10
0
First ANC contact in first Syphillis screening Haemoglobin test Blood pressure
trimester measurement
Figure 7. Bar chart on coverage of delivery and newborn care interventions by year (percentage)
100
90
80
70
60
50
40
30
20
10
0
Uterotonic to prevent PPH Documented birthweight Postnatal visits for woman Postnatal visits for
newborns
Q1 Q2 Q3 Q4
– 16 –
Figure 8: Line chart on coverage of first antenatal care during first trimester by age and over time (percentage)
100
80
60
40
20
0
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017 Q4 2017
10 to 14 15 to 19 20+
Figure 9: Bar chart showing annual coverage of key maternal and newborn interventions by region (percentage)
100
First ANC during 1st
80 trimester
Immediate uteronic to
60 prevent PPH
Documented birthweight
40
PNC for woman
20
0 PNC for newborn

Region 1 Region 2 Region 3 Region 4 Region 5 Region 6

The figures above demonstrate different ways to display key maternal and newborn interventions over time, by age, and in
different geographic areas. Figures 6, 7 and 8 show a national overview, which can be replicated at regional, district and health
facility level. At lower geographic levels, key interventions can be tracked over shorter periods of time, e.g. quarterly or
monthly, rather than only annually (see Figure 8). This figure looks at the coverage of first antenatal care visit by age groups
over time and demonstrates a change in Q2 2017, which will signal to managers to review the data for quality and if correct
understand the reasons behind this change in the age pattern.
Figure 9 displays intervention coverage of a limited set of services, comparing performance in different geographic areas. This
figure allows managers to identify high performing and low performing areas and to assess patterns across the continuum of
care. For example, some areas may show strong performance in coverage of maternal health interventions but not neonatal
health interventions, while other areas perform consistently in both areas. Geographic areas can be arranged by region or by
population size to give further insight into areas which require greater support or supervision.
– 17 –
MATERNAL AND NEWBORN HEALTH OUTCOMES
Analysis
Figure 10: Pie chart showing annual percent distribution Figure 11: Bar chart showing annual numbers of
of institutional neonatal mortality by cause stillbirth by type of stillbirth (numbers)
(percentage)
60
Pre-term birth
complications
50
Intrapartum related
7 events
1 33 40
6 2 Sepsis or meningitis
1
Congenital 30
11
Tetanus 20
Pneumonia 10
Diarrhoea 0
15 2015 2016 2017
24
Other
Fresh stillbirth Mascerated stillbirth
Unclassified
Figure 12: Table of maternal mortality and maternal/perinatal death reviews among deaths reported in HMIS,
number of deaths and percentage of deaths audited.
Indicator 2015 2016 2017

Total number of maternal deaths reported in HMIS 1200 1150 1125
Total number of institutional maternal deaths 950 950 945
% of maternal deaths audited 65 70 60

Displaying data such as in Figures 10, 11 and 12 help managers assess progress in critical outcomes of maternal and newborn
health occurring in the context of an institutional delivery. Figure 10 displays the causes of neonatal death, which is essential
to track over time as this information is critical for developing policies and programs. Figure 12 displays the total number of
stillbirths disaggregated by fresh and macerated stillbirths, which is important to track as an outcome of quality of labour and
delivery care.
Figure 12 reviews the total number of maternal deaths reported in the health facility as well as the proportion of those deaths
and perinatal death that were audited. In some countries, data captured in an HMIS may include community-based deaths;
therefore, the number of maternal deaths in HMIS may be higher than the total number of institutional maternal deaths. If
these two numbers are not the same, then they may include reporting of non-institutional deliveries, or maternal and neonatal
deaths related to non-institutional deliveries. The examples shown here provide a national overview on an annual basis,
however all figures and tables can be presented at subnational level, down to the facility level for more granular assessment of
performance.
– 18 –
Figure 12 also captures the proportion of facilities in the geographic area which conduct maternal death audits. These
indicators measure the extent to which facilities attempt to identify preventable factors contributing to deaths which can be
addressed by the health system. Among facilities which conduct maternal and perinatal death audits, the median and range of
numbers of such deaths can be calculated. Over time, the number of deaths should decline or stabilize as a result of
continuous improvements in care stimulated by these audits.
There are a wider range of indicators that can and should be used to ensure quality of care for women and newborns in health
facilities, such as availability of health workers, commodities and drugs and population-based coverage of key interventions.
However, these types of measures are more accurately collected via health facility surveys or population-based surveys.
SERVICE COVERAGE AND HEALTH OUTCOMES FOR CHILDREN
Purpose
To review progress towards coverage of critical interventions that will reduce the burden of disease and prevent avoidable
deaths among infants, children under 5 years old and the older child aged 5 to 9 years
Analysis
The charts below allow examination of trends in and distribution of child health service coverage and outcomes for essential
services and for diagnosis and treatment of the leading causes of childhood disease and death.
Figure 13. Line chart showing coverage of treatment for diarrhea among children 0-9 years of age over time, by
treatment type
100.0
90.0
80.0 % treated with
ORS alone
70.0
60.0
% treated with
50.0 Zinc alone
40.0
30.0 % treated with
20.0 ORS and Zinc
10.0
0.0
Q4 2018 Q1 2019 Q2 2019 Q3 2019 Q4 2019
– 19 –
Figure 14. Number of children 0-9 years diagnosed with pneumonia, per facility and with district total during a
specified period
250
200
150
100
50
0
Facility 1 Facility 2 Facility 3 Facility 4 District total
0-4 years 5-9 years
Figure 15. Percentage of children 0-9 years diagnosed with pneumonia that were treated with amoxicillin in facilities
over time, by facility
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Q4 2018 Q1 2019 Q2 2019 Q3 2019 Q4 2019
Facility 1 Facility 2 Facility 3 Facility 4
Figure 16. Distribution of deaths in children 0-4 years by Figure 17. Distribution of deaths in children aged 5 to 9
cause, (% of under-5 deaths in facilities) years by cause (% of deaths 5 to 9 years in facilities)
– 20 –

The core facility indicators for children in this document represent a minimum set focusing on what can be collected at the
facility level and assume aggregation of data across facilities for analysis. Ideally, the indicators presented here should be
disaggregated by age groups (0 to 4 years and 5 to 9 years) to identify more specific patterns in causes of illness and death in
children. The selected indicators for the example analyses above focus on the age groups under-5 years and 5 to 9 years,
however adolescents aged 10 to 19 years are a key demographic that should be considered where data are available by this
age disaggregation.
There are a wider range of indicators that can and should be used to ensure quality of care for children and adolescents in
health facilities. Many of these are most appropriately captured in health facility surveys or other population-based surveys.
Examples related to the health of children include use of pulse oximetry measurements in children presenting with symptoms
of acute respiratory illness (ARI) and presence of key life-saving diagnostics, medicines and medical devices with information
on shelf-life and availability of these essential health products.
In Figure 13 treatment for diarrhoea among children under nine years of age is tracked over five quarters. From Q2 to Q3,
there is a drop in coverage of children treated with both oral rehydration salts (ORS) and Zinc and a corresponding increase in
children treated using ORS alone. This could be due to a stock out of ORS during this time period.
Figure 14 displays the number of children who were diagnosed with pneumonia in different facilities and in total for the district
during a specific period of time. This chart also shows variation between the diagnosis of pneumonia among children 0 to 4
years of age and children 5 to 9 years of age. Please note that accurate diagnosis pneumonia can be challenging. Depending
on what is recorded in health facilities, children presenting with ARI can be classified as:
• Chest indrawing or fast breathing pneumonia
• Severe pneumonia or very severe diseases
• Cough and cold – no pneumonia
The pneumonia diagnosis indicator as defined in the core facility indicator list above refers to chest indrawing or fast breathing
pneumonia.
Figure 15 display the percentage of children under nine years of age with pneumonia who were treated with amoxicillin. Again,
it is worth noting that accurate measurement of treatment for pneumonia should be handled with caution as it relies on a
correct diagnosis of pneumonia.
Displaying the coverage of treatment over time in a several facilities, such as in Figure 15, allows managers to monitor any
trends in treatment coverage for children diagnosed with pneumonia. If there is a large drop or increase in coverage in a short
period of time, this could be due to the quality or accuracy of the data recorded or due to a stock out in Amoxicillin. This figure
does not denote the type of amoxicillin (syrup or dispersible tablet), however should that information be available, it could
prove helpful in understanding the cause of differences in coverage over time.
In Figures 16 and 17 the leading cause of death in children under-5 and in older children (5 to 9 years) in health facilities during
a given year are summarized. These pie charts should be interpreted along with data on numbers of deaths among these age
groups that occurred in the facilities.
– 21 –
OVERALL CONTINUUM OF RMNCAH CARE
Purpose
To identify the most significant drop offs in coverage along the maternal, newborn, and child under-5 continuum of care in
health facilities.
Analysis
Figure 18. Bar graph showing key interventions along the RMNCAH continuum of care by year (percentage)
100
80
60
40
20
0
First ANC in Uterotonic to Documented PNC woman PNC newborn Treatment for Treatment for
first trimester prevent PPH birthweight pneumonia diarrhea
2015 2016 2017

Figure 18 displays coverage of key RMNCAH interventions. When displayed together, a snapshot of the poorest performing
indicators locations can be identified. In addition to identifying interventions with low coverage that require additional
resources, one can analyse interventions with strong performances from which to draw best practices that could be replicated.
Another option is to use a scorecard, such as the RMNCAH Score Card app in DHIS2 (Figure 19) to display progress on key
RMNCAH indicators by sub-national level. The different colours indicate if an indicator is on track, in process, or not on track in
each sub-national area, which allows for policy makers to quickly assess identify underperforming geographic areas as well as
underperforming interventions in the RMNCAH continuum of care. Arrows to the left of the data values indicate progress in
comparison to the previous reporting period and can help to assess whether indicator performance is improving or worsening
over time
In addition to the Score Card app, there are other data use and analysis apps that are under further development. The
Bottleneck Analysis app allows users to analyse the determinants of coverage (commodities, human resources, geographic
access, initial utilization, continuity and quality/effective coverage) for RMNCAH interventions in order to identify bottlenecks
in the supply, demand and quality of an intervention and the complementary Action Tracker app allows users to identify
corrective actions for identified bottlenecks, specify next steps for addressing those bottlenecks and monitor the reduction of
bottlenecks. The Bottleneck Analysis app has been developed and is available for download in the DHIS2 App Store. The Action
Tracker app is undergoing testing and validation and is expected to be available by early 2020.
– 22 –
Figure 19. RMNCAH scorecard
Figure 19 from: Interactive scorecard implementation guide, Version 0.1. UNICEF, HISP UiO, HISP Uganda & HISP Tanzania.
– 23 –
5. Limitations of facility-based data

A key limitation to analysis of aggregate data on RMNCAH from HMIS is that the data often are representative of only the
services provided through the health facility and/or individuals who seek care. This may lead to under-reported or biased
coverage data. An example of this would be the absence of outcome data on births and deaths which occur in non-institutional
settings. Similarly, pregnant women who do not receive any prenatal care or children who do not receive any child health
services are not captured by HMIS and are more prone to poor maternal and child health outcomes.
A related limitation of health facility data is that they often collect and report only indicators for service utilization, continuity
and quality, but are commonly unable to provide key information on human resources, accessibility, commodity availability,
knowledge, attitudes and practices. For these reasons, periodic triangulation between analysis from HMIS sources and
information from household surveys and health facility assessments can uncover which segments of the population are
missing in routine analysis of HMIS data and it is also recommended to work towards an interoperable health information
system, which can allow the exchange of data between otherwise disparate systems.
Several of the core analyses in this module include mortality data, which also exclude deaths which occur outside of health
facilities and may not be reported to vital registration systems. Different facility types provide different levels of care, so any
analysis of data in terms of service delivery or performance must be based on an understanding of the population served if a
referral facility, or any changes in the population catchment area and other demographic shifts.
There are other indicators that capture important information about the health facilities and the quality of care provided to
women, newborns, children and adolescents. Because these indicators capture the details of care provided, they are best used
as part of health facility assessments and reviews. They can be used in conjunction with the routine data collected by the
health facilities to triangulate results and provide nuanced insight into the cause of successes and failures of the health service
delivery at facility level.
– 24 –
Annex 1. Additional indicators

The core list of indicators represents the tracer indicators recommended for RMNCAH programme monitoring. However,
countries may wish to track additional indicators depending on their priority interventions and programs. Below are other
relevant indicators for consideration. Please note that these indicators are for aggregate data. These additional indicators are
relevant for Health Information Systems that have the capacity and desire to report on a wider range of indicators.
Computation
Additional indicators Definition Disaggregation
Sexual and Reproductive Health
Female genital mutilation Percentage of women with females N: Number of women with FGM (reported or
(FGM)* genital mutilation (FGM) observed) • Age (15-19, 20+)
D: Number of antenatal clients 1st visit
Gynaecology abortion care Percentage of women presenting for N: Number of women presenting for
gynecological indications related to gynecological indications related to abortion • Age (10-14, 15-19, 20+)
abortion D: Number of women presenting for • Inpatient vs Outpatient
gynecological indications
• Induced or
spontaneous versus
complications

Postpartum family planning Percentage of women delivering at N: Number of postpartum women counselled
counselling facility counseled on postpartum on family planning prior to discharge
family planning prior to discharge D: Number of deliveries in facility
Women with pre-eclampsia/ Percentage of women with severe N: Number of woman with severe pre-
eclamspsia treated with pre-eclampsia/eclampsia who receive eclamspia/eclampsia who receive the initial
loading dose of MgSO4 the initial dose of MgSO4 (loading dose of MgSO4 (loading dose) in facility
dose) in health facility D: Number of deliveries in facility
Newborns on kangaroo Percentage of newborns initiated in N: Number of newborns initiated on KMC (or
mother care (KMC) ** KMC (or admitted to KMC unit if admitted to KMC unit if separate unit exists) • Birthweight (<2000
separate unit exists) N: Number of live births in facility g, ≥2000g)
Newborns resuscitated with Percentage of newborns resuscitated N: Number of newborns resuscitated with bag
bag and mask ** with bag and mask and mask
Newborns treated for Percentage of newborns treated for N: Number of newborns treated for neonatal
neonatal infection ** neonatal infection infection
Pre-term birth Percentage of births in health facility N. Number of newborns born under 37 weeks
that are pre-term (less than 37 weeks gestation
gestation) D: Number of live births in facility
*Female genital mutilation (FGM) is a traditional harmful practice that includes procedures that intentionally alter or cause injury to the female genital organs
for non-medical reasons. It has no medical benefits and is associated with increased risk of adverse reproductive, maternal, neonatal, adolescent and child
health outcomes, including physical and mental health complications that can occur at the time that girls are cut or in the long-term. However, women’s FGM
status is often not recorded in medical records nor discussed during consultations. WHO has developed evidence based clinical guidelines and clinical tools as
part of a health sector response to preventing FGM and improving treatment and care. Within these documents, WHO recommends the recording of FGM as
“a fundamental step towards improving the quality of health care, with the additional benefit of strengthening the capacity of monitoring FGM”
(https://www.who.int/reproductivehealth/topics/fgm/management-health-complications-fgm/en/). In addition, the clinical handbook on FGM provides
practical advice on why and how to record FGM status in medical records, including a job aid that shows health care providers how to indicate FGM status
through drawings of female genitalia (https://www.who.int/reproductivehealth/publications/health-care-girls-women-living-with-FGM/en/).
• Chapter 2.7 “Recording FGM in the patient’s medical record” pages 78-79
• Chapter 5.2.4 “Visual recording of FGM” explains how to illustrate FGM status simply in the medical record, pages 166-167
• Job aid 2 shows how to draw in medical record
** NOTE: There is ongoing work to test different denominators for treatment of newborn complications. Additional guidance on appropriate denominators
will be available in the next version of this document. In the meantime, we recommend using all births as the denominator assessing against a benchmark of
expected cases.
– 25 –
Annex 2. Additional resources

Below is a list of additional resources that were consulted in development of this module.
 Every Woman Every Child. Indicator and Monitoring Framework for the Global Strategy for Women’s, Children’s and
Adolescents’ Health. Geneva; 2016.
 World Health Organization 100 Core Indicators. Geneva; 2018.
 Maternal and Child Survival Program. Visualizing and Using Routine Reproductive, Maternal, Neonatal, and Child Health
Data at Health Facilities: A Resource Package for Health Providers and District Managers. Washington, D.C.; 2018.
Retrieved from https://www.mcsprogram.org/resource/visualizing-and-using-routine-rmnch-data-at-health-facilities-a-
resource-package-for-health-providers-and-district-managers/
 Maternal and Child Survival Program. What Data on Maternal and Newborn Health Do National Health Management
Information Systems Include? A review of data elements for 24 low and lower middle-income countries. Washington, D.C.;
2018.
 World Health Organization. Data Quality Review: A toolkit for facility data quality assessment. Geneva; 2017.
 Interactive bottleneck analysis application for DHIS2. HISP Tanzania. Available for download from
https://play.dhis2.org/appstore/app/x7DbGPFXziA
 Interactive scorecard application for DHIS2. HISP Tanzania. Available for download from
https://play.dhis2.org/appstore/app/M3T1BGCjD3y
 UNICEF, HISP UiO, HISP Uganda and HISP Tanzania. Interactive scorecard implementation guide, Version 0.1. 2016-2017.
 World Health Organization. The WHO Application of ICD-10 to deaths during pregnancy, childbirth and the puerperium:
ICD-MM. Geneva; 2012.
 World Health Organization. The WHO application of ICD-10 to deaths during the perinatal period: ICD-PM. Geneva; 2016.
 World Health Organization. Quality, Equity and Dignity, Common Indicators. Geneva; 2018.
 World Health Organization. Maternal Death Surveillance and Response Technical Guidance: Information for Action to
Prevent Maternal Death. Geneva; 2013.
 World Health Organization. Making every baby count: audit and review of stillbirths and neonatal deaths. Geneva; 2016.
– 26 –
– 27 –

Facility Analysis Guidance-RMNCAH

Uploaded by

Copyright:

Available Formats

Facility Analysis Guidance-RMNCAH

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Facility Analysis Guidance-RMNCAH

Uploaded by

Copyright:

Available Formats

WORKING DOCUMENT, OCTOBER 2019

ANALYSIS AND USE OF HEALTH FACILITY DATA

Guidance for RMNCAH

WORKING DOCUMENT, OCTOBER 2019

© World Health Organization 2019

SUGGESTED ADDITIONAL REFERENCES

1. About the data………………………………………………………………………………………………………………………… 4

3. Core facility indicators ..................................................................................................................... 8

4. Analysis of core set of indicators ................................................................................................... 14

5. Limitations of facility-based data .................................................................................................. 24

Annex 1. Additional indicators ........................................................................................................... 25

Annex 2. Additional resources ........................................................................................................... 26

Note on the document

1. About the data

Figure 1. Continuum of care for RMNCAH

York: Every Woman Every Child, 2016.

USE OF FACILITY DATA

Figure 2. Frequency of data sources and levels of data use

GUIDING PRINCIPLES OF THIS DOCUMENT

STANDARD DEFINITIONS OF TERMS USED IN THIS DOCUMENT

Domain Data quality metric Frequency

3. Core facility indicators

• Age (10-14, 15-19)

IF INDIVIDUAL DATA ARE AVAILABLE

Indicator Definition Computation Disaggregation

USING AN ESTIMATED POPULATION-BASED DENOMINATOR

Indicator Definition Computation Disaggregation

Indicator Definition Computation Disaggregation

Facility-based vs. population-based denominators

Population-based denominator for ANC 8 visits = Estimated number of pregnant women

Table 1. Notes on couple year protection

Method Factor to be used Units issued (1 month) Result

Sum of Units with factors used 770.7

4. Analysis of core set of indicators

SEXUAL AND REPRODUCTIVE HEALTH

CONTRACEPTION FIRST TIME USE

10-14 years 15-19 years 20 + years

Figure 4: Examine number of new contraceptive users over time by sex.

Male Female Total

POSTPARTUM FAMILY PLANNING

Considerations/issues for interpretation

MATERNAL AND NEWBORN HEALTH

SERVICE COVERAGE FOR MOTHERS AND NEWBORNS

0 PNC for newborn

Considerations/issues for interpretation

MATERNAL AND NEWBORN HEALTH OUTCOMES

Indicator 2015 2016 2017

Total number of institutional maternal deaths 950 950 945

% of maternal deaths audited 65 70 60

Considerations/issues for interpretation

SERVICE COVERAGE AND HEALTH OUTCOMES FOR CHILDREN

0-4 years 5-9 years

Facility 1 Facility 2 Facility 3 Facility 4

Considerations/issues for interpretation

OVERALL CONTINUUM OF RMNCAH CARE

2015 2016 2017

Considerations/issues for interpretation

Figure 19. RMNCAH scorecard

5. Limitations of facility-based data

Annex 1. Additional indicators