Implementation steps for the data collection phase

Once the Ministry of Health has validated the national network of designated EmONC health facilities, it should organize regular data collection (generally on a quarterly basis and then every six months once stakeholders are used to the approach) of the indicators defined in the national monitoring sheet (see Technical Sheet no. 4) drawn up during the national workshop on EmONC (cf. Phase 2). This will allow a close monitoring of the implementation of the EmONC operational plan. The national support team should also mobilize and train the regional support teams and develop, with the consultant team, terms of reference for the regional support teams and an EmONC monitoring user guide, with a definition of each item of the EmONC monitoring sheet. Implementing the data-collection phase should comprise three steps summarized in Figure 28.

Raise awareness among participants on the notions of an EmONC network and on prioritizing health facilities

• Present analysis of the national and regional situation regarding MNH, and in particular the EmONC network

• Show the importance of EmONC facilities in reducing maternal and newborn mortality, present the concept of an EmONC referral facility (particularly BEmONC)

• Present the approach for developing an EmONC network (including the use of GIS and concepts from the field of implementation science) and the key EmONC network development principles (national process, introduction of EmONC monitoring, making staff in health facilities and districts/regions aware of their responsibilities (“bottom-up” approach to quality improvement)

• Present the concept of prioritization and national prioritization criteria in detail

• Establish the regions’ EmONC requirements based on international standards

• Establish an initial list of potential EmONC health facilities for the region (with a number nearing international standards) based on national criteria and the following process:

1. List the health facilities attending more than 20 deliveries per month (limit determined at the national level) and preferably select the health facilities with more than 30 deliveries per month for the EmONC network

2. Analyse these potential EmONC facilities against the defined national criteria (based on the order of priority established)

• Analyse links between BEmONC and CEmONC facilities

• Analyse the health facilities from this initial list using the analysis framework for strengths and weaknesses in EmONC

• Present and discuss this selection of EmONC facilities in a plenary session (including the number of health facilities according to international standards) and finalize the selected EmONC health facilities based on the feedback and discussions

• Produce a workshop technical report to share with the central level of the Ministry of Health and technical and financial partners

• Validate the national map of designated EmONC health facilities (approved at the central level of the Ministry of Health)

• Present the national map of designated (and functioning) EmONC health facilities to national MNH stakeholders and technical and financial partners

Select EmONC health facilities and analyse

• Concept of a BEmONC referral facility (see Technical Sheet no. 1)

• Concept of an EmONC network and referral links (see Data Sheet no. 2)

• National and regional maps of EmONC health facilities

• Analysis and propositions of the regional working groups

• Demographic data for the first subregional level (region/province) and the second subnational level (district) to establish MAX EmONC requirements

• Recent database (e.g. EmONC (rapid) Assessment) of obstetric and newborn activity per health facility (with geographical coordinates and, a unique national identification number), spatial demographic database, administrative boundaries, topographical and infrastructure data to establish the list of EmONC facilities

• AccessMod tool and GIS

• Regional participants in the workshop for designing the regional map of health facilities

• National or international experts in public health and EmONC to lead the workshop

• National or international expert in public health and EmONC to develop the technical EmONC report (in collaboration with technical staff of the MoH)

• Ministry of Health to validate the national

• Ministry of Health for situation analysis

• UNFPA (and/or H6 partner) for the importance of EmONC facilities in reducing maternal and newborn mortality

• National or international (preferably)

Toolsresponsible

Organize regular data collection of MNH indicators in the EmONC network

• Define the budget for data collection

• Mobilize the national and regional/

district support teams to assist with the collection, analysis and response process (and develop their terms of reference)

• Define the national and regional schedules for data collection and the collection routes (in coordination with the visit of the supervision/supportive supervision regional/district teams)

• Train the national support team to:

- support the approach for developing an EmONC network, including on the EmONC referral facility concept

- use the data collection tool (monitoring sheet)

- coordinate and monitor the entire EmONC monitoring process, including: monitoring of data collection implementation in regions/districts (e.g. keeping to schedule, budget provision, etc.) and providing technical support to regional/district support teams for implementing data collection, analysis, and responses/quality improvement (“PDSA”)

- consolidate regional data (verifying the completeness and quality of data submitted by regions: missing data, wrong type of data)

• Train (by the national support team) the regional/district support teams to:

- support the approach for developing an EmONC network and the EmONC referral facility concept

- use the data collection tool (monitoring sheet)

- consolidate health facility data (verifying the completeness and quality of data:

missing data, wrong type of data)

(For regional/district support teams)

• Visit health facilities in the EmONC network (every quarter at the beginning of the data collection, then every 6 months) and complete the monitoring sheet based on:

- registers (family planning, antenatal consultation, maternity facilities, antiretrovirals, post-partum, etc.) - sample of medical files

- stock sheets (e.g. from pharmacy) - staff interviews

- observation of the working environment

• Consolidate data at regional/provincial levels (For the national support team)

• Consolidate data at national level.

• Coordinate and monitor the indicators from the data collection phase:

- proportion of referral health facilities supported by a regional/district support team (according to the data collection schedule)

- proportion of referral health facilities that have a completed monitoring sheet - proportion of referral health facilities that have submitted the monitoring sheet to the national support team

• Provide on request technical support to the regional/district teams for implementing data collection

Train EmONC support teams (for the first EmONC monitoring)

Implement data collection in the EmONC network

StepsMain activitiesToolsEntities responsible

• National map of EmONC health facilities

• National schedule and routes for the regional/district teams to supervise the health facilities

• Terms of Reference of the national and regional/district support teams

• Monitoring sheet (see Technical Sheet no. 4)

• User guide to the monitoring sheet and staff interview sheet

• Key MNH indicators to consider for analysing the situation

• Concept of a BEmONC referral facility (see Technical Sheet no. 1)

• Concept of an EmONC network and referral links (see Technical Sheet no. 2)

• Monitoring sheet (see Technical Sheet no. 4)

• User guide to the monitoring sheet and staff interview sheet

• National or international expert in public health to set up and train the national and support team

• National support team to train the regional/

district support teams

• National and regional/district support teams

• Health facility staff

• Ministry of Health (central and regional level)