Developing and Promoting Monitoring and Evaluation Indicators, Tools and Resources
As part of its global leadership role in monitoring, evaluation and research (MER), MCHIP works with others to identify gaps in the available resources for conducting MNCH MER such as indicator compendia, M&E guidance documents, assessment toolkits, and Monitoring and Evaluation (M&E) training resources. In turn, MCHIP identifies opportunities to work with critical global partners—such as the World Health Organization (WHO) and other USAID implementing agencies—to contribute to the development of new indicators, data collection tools and other resources to address these gaps.
For example, MCHIP has initiated a new effort to work with the WHO and others to identify “benchmark indicators” for maternal health that can be integrated into national health management information systems (HMIS), and MCHIP is represented in the Millennium Development Goal Countdown Coverage Working Group. MCHIP also participates in ongoing efforts of M&E technical working groups to review MNCH indicators used nationally representative household surveys—such as USAID’s Demographic and Health Survey (DHS) and Malaria Indicator Survey (MIS), and the UNICEF-supported Multiple-Indicator Cluster Survey (MICS)—and provides recommendations for improving them and testing new indicators as appropriate.
MCHIP has further supported the development of toolkits and frameworks that address M&E of MNCH interventions and services, including:
Leading the development of the quality of care for prevention and management of common maternal and newborn complications (QoC MNC) facility survey, which has been implemented in five countries;
Contributing to the development of the toolkit for community case management of childhood illness (which includes a major focus on indicators);
Assisting with the Helping Babies Breathe implementation guide (addressing resuscitation for neonatal asphyxia), which has an M&E section; and
Working on the MCHIP prevention of postpartum hemorrhage and pre-eclampsia/eclampsia toolkits, which both have M&E sections.
In addition to toolkits, MCHIP has created new frameworks for analysis of secondary and qualitative data pertaining to malaria in pregnancy (MIP) programming and health systems strengthening intended to generate practical information for use by policy makers and program planners in low resource settings.
MCHIP has also revised and/or supported application of data collection tools developed or maintained by MCHIP partners in collaboration with others, such as the CORE Group and USAID. Examples of these tools are the Knowledge, Practices and Coverage survey (KPC); the Lives Saved Tool (LiST) the Rapid Health Facility Assessment tool (R-HFA); the MAMAN framework questionnaire; the Sustainability Framework; DHS-based quintile analysis (equity measure); GIS; and Participatory Learning and Action (PLA) tools. MCHIP works to ensure that these tools are up-to-date, reflecting state-of-the-art technical content and that they are consistent with the Common Evaluation Framework, the LiST, the MDGs, and information needed by USAID.
MCHIP provides extensive technical assistance for Child Survival and Health Grants Program (CSHGP) grantees to apply these tools across multiple countries. The CSHGP has used LiST to estimate the number of lives saved among children under five in the grantee program intervention areas. An area of innovation for MCHIP is the application of mHealth tools to M&E activities. There are ongoing rapid advances in mobile hardware, software and connectivity, especially in Sub-Saharan Africa, with the potential for greater usability and data quality for different types of future assessments under MCHIP. MCHIP plans to test and utilize Android tablets for mHealth data collection, especially for facility level and observational assessments due to their mobility, larger screens and ability to synchronize from the field with remote servers.
One example of MCHIP ‘s work in this area is the M&E data collection and analysis system for the QoC MNC facility assessments, consisting of a suite of mobile mHealth data collection tools and a web-based system for remote data management and tabulation. Developed by MCHIP and deployed on smart phones are separate survey and observation checklist data-entry tools for assessing the quality of maternal and newborn health services. Other tools are used for assessing health worker knowledge, inventory of supplies and equipment, and record reviews. The mobile entry forms are customized to each country’s facility sample and include range, skip and logic data checks. The smart phone software also has the capability of capturing facility GIS coordinates and transmitting the data back to a web-based central server. Once the data collection is completed, cleaned and finalized, separate tables are made available for each tool, by country, via a password protected MCHIP web site.
Contributing to the Evidence Base on High-Impact MNCH Interventions
MCHIP conducts targeted special research studies and program evaluations that contribute to the evidence base regarding programmatically effective MNCH interventions, how they can best be delivered at scale, and how they can best be monitored and evaluated. MCHIP’s MER efforts provide evidence that contributes to the Program’s global program learning agenda, which has identified programmatic areas that need focused attention across countries. In addition, MCHIP identifies research questions of global interest and seeks out opportunities to explore these through its country programs.
Global research topic areas that MCHIP is investigating include: community kangaroo mother care; quality of MNCH services; community case management (CCM) of childhood illness; scale up of the Helping Babies Breathe program; implementation processes and outcomes of MIP programs; and community-based delivery of integrated MNCH services.
MCHIP further supports the operations research (OR) studies being conducted by private voluntary organizations and nongovernmental organizations (PVOs/NGOs) through the Child Survival and Health Grants Program's “Innovation Category,” which are focused on community-oriented service delivery. In 2008-2010, 17 CSHGP grants to conduct OR were awarded to PVOs/NGOs that are working in Afghanistan, Bangladesh, Benin, Burundi, Cambodia, Ecuador, Honduras, Indonesia, Liberia, Nepal, Nicaragua, Niger, Pakistan, Rwanda, South Sudan and Zambia. The studies are exploring how to inform program design and scale up related to community-oriented MNCH, CCM, community health worker functionality, integration of MNCH into other sectors, equity, and mobile health among other implementation issues.