As part of its global leadership role in monitoring, evaluation and research (MER), MCHIP worked with others to identify gaps in the available resources for conducting maternal, newborn and child health (MNCH) MER, such as indicator compendia, M&E guidance documents, assessment toolkits, and M&E training resources. In turn, MCHIP identified opportunities to work with critical global partners, such as the World Health Organization (ICM and FIGO) 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 initiated a new effort to work with the World Health Organization and others to identify “benchmark indicators” for maternal health that could be integrated into Health Management Information Systems (HMIS), and the Program was represented in the Millennium Development Goal Countdown Coverage Working Group. MCHIP also participated in efforts of M&E technical working groups to review MNCH indicators used in nationally representative household surveys such as USAID’s Demographic and Health Survey and Malaria Indicator Survey and the UNICEF-supported Multiple-Indicator Cluster Survey, and helped to provide recommendations for improving them and testing new indicators, as appropriate.
MCHIP 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 seven countries;
- Contributing to the development of the community case management toolkit, which includes a major focus on indicators; the Helping Babies Breathe implementation guide, which has an M&E section; and the MCHIP prevention of postpartum hemorrhage and pre-eclampsia/eclampsia toolkits, which both have M&E sections.
In addition to toolkits, MCHIP created new frameworks for analysis of secondary and qualitative data pertaining to malaria in pregnancy programming and health systems strengthening intended to generate practical information for use by policymakers and program planners in low-resource settings.
MCHIP 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:
- Knowledge, Practices and Coverage survey
- Lives Saved Tool (LiST)
- Rapid Health Facility Assessment tool
- MAMAN framework questionnaire
- Sustainability Framework
- DHS-based quintile analysis (equity measure)
- Geographical Information Systems (GIS); and
- Participatory Learning and Action tools.
MCHIP worked to ensure that these tools were up-to-date, reflecting state-of-the-art technical content, and that they were consistent with the Common Evaluation framework, the LiST, the Millennium Development Goals and information needed by USAID. MCHIP also provided extensive technical assistance for Child Survival and Health Grants Program (CSHGP) grantees to apply these tools across multiple countries. The CSHGP used LiST to estimate the number of lives saved among children under five among the grantee program intervention areas. The Program performed LiST analyses on the potential impact of MNCH interventions, on request from USAID, and for use in country profiles.
An area of innovation for MCHIP was the application of mHealth tools for M&E activities. There are ongoing, rapid advances in mobile technology, 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. One example of MCHIP’s work in this area was 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 were used for assessing health worker knowledge, inventory of supplies and equipment, and record reviews. The mobile entry forms were customized to each country’s facility sample and include range, skip and logic data checks. The smart phone software also had the capability of capturing facility GIS coordinates and transmitting the data back to a web-based central server. Once the data collection was completed, cleaned and finalized, separate tables were made available for each tool, by country, via a password-protected MCHIP web site.
MCHIP further supported the operations research (OR) studies being conducted by PVOs/NGOs through the Child Survival and Health Grants Program “Innovation Category,” which were focused on community-oriented service delivery. From 2008–2010, 17 CSHGP grants to conduct OR were awarded to PVOs/NGOs working in Afghanistan, Bangladesh, Benin, Burundi, Cambodia, Ecuador, Honduras, Indonesia, Liberia, Nepal, Nicaragua, Niger, Pakistan, Rwanda, South Sudan and Zambia. The studies explored how to inform program design and scale-up related to community-oriented MNCH, community case management, community health worker functionality, integration of MNCH with other sectors, and equity and mobile health, among other implementation issues.