CLINIC SUPERVISOR'S MANUAL - Management Sciences for Health

SECTION 5: INFORMATION SYSTEM GUIDELINES
MATERNAL HEALTH INDICATORS - continued
Name ANC visits per client
Targets The National target is that 90% of women should have three at least ANC visits
Definition Average number of antenatal visits by women coming to antenatal care.
Calculation
26 Clinic Supervisor’s Manual
Numerator: All ANC visits (first and repeat visits all included)
Denominator: First ANC visits
Rationale All pregnant women should have at least three visits in each pregnancy. This indicator does NOT
measure visits by each woman, but measures the average number of visits.
Data source Tally sheets, Registers – either Tick register or maternal health registers
Common
problems
Actions to
consider
Other possible
indicators
Women who have started ANC elsewhere, but who come to your facility for follow up should be
counted as subsequent ANC and NOT first ANC.
Low repeat visits means that there may be problems with the acceptability of the services provided
and the attitude of staff needs to be investigated.
% Of antenatal clients having three visits (if data is available)
% Referred to hospital
%WR positive who are treated (important quality measure – should be 100%)
Name Institutional Delivery coverage
Targets The National target is 80%; some provincial targets are much lower but some achieve almost 100%.
This depends largely on delivery infrastructure, access to transport and customs of the population.
Definition The percentage of deliveries from the catchment population taking place in this reporting health
facility under supervision of trained personnel.
Calculation
Numerator: Number of deliveries conducted in this institution in the reporting period
Denominator: Total expected deliveries in this population for the same time period The number of
children under one year is used as a proxy denominator for expected deliveries per
year – divide by 12 for monthly estimate.
Rationale The proportion of deliveries done by the institution is an indicator of accessibility and acceptability of
the health services.
Data source Maternity (delivery) register
Expected deliveries is 2.2 –3.4% of population (discuss with supervisor)
Common
problems
Actions to
consider
Many clinics report deliveries of their clients that occurred in institutions ELSEWHERE. This causes
double reporting for they are reported from the place where they actually deliver as well.
As most deliveries occur in hospitals, this indicator is really only valid at the district level where all
deliveries in all institutions are added together and compared to all expected deliveries in the district
population.
If less than 80% (? 60% in rural areas) of deliveries in the district occur at health facilities, (or with
trained assistance), your maternal health services need to be re-examined. The facilities need to be
assessed for capacity to provide emergency services.