Research Design Workshop for Testing for Coverage Metrics of Facility Care

Every Newborn working with Ending Preventable Maternal Mortality

Research Design Workshop for Testing for Coverage Metrics of Facility Care

20th-21st April 2016, Beaumont Estate, Old Windsor, UK

A Workshop was led by the Every Newborn Action Plan (ENAP) Metrics Group co-chaired by the World Health Organisation and London School of Hygiene & Tropical Medicine (LSHTM) in close collaboration with the Ending Preventable Maternal Mortality (EPMM) team.  It took place over two full days on April 20 and 21st 2016 on the lovely Beaumont Estate in Old Windsor in the UK.


The Every Newborn Action Plan was launched in June 2014 with the aim to support countries in reaching the Sustainable Development Goal (SDG) target of fewer than 12 newborn deaths and stillbirths per 1000 births by 2030. ENAP is based on evidence published in The Lancet Every Newborn series and is supported by a World Health Assembly Resolution (WHA A67/21) adopted in May 2014. The Strategies Toward Ending Preventable Maternal Mortality (EPMM), released in February 2015, proposes a human rights-based approach to maternal and newborn healthcare, and expands the focus to address the shifting patterns of causes of maternal death in countries, as well as the systemic social, political, and economic determinants of health and survival that are associated with high rates of maternal mortality. Both the ENAP and EPMM strategies aim to improve the quality of maternal and newborn care, to reach every woman and newborn with universal coverage, and to strengthen measurement capacity and count every death to drive improvement and accountability. Priority indicators have been identified between the two strategies.

ENAP and EPMM identify an urgent need to test and improve programmatic data especially for coverage of high-impact interventions and included specific and ambitious milestones to improve maternal and newborn data by 2020.  The five-year, multi-partner ENAP Measurement Improvement Roadmap details steps to meet the key ENAP milestones and was developed through wide consultation, and is coordinated via the ENAP metrics group in combination with EPMM metrics work. These inputs will contribute to tracking for the Global Strategy for Women’s, Children’s and Adolescent’s health and the wider Measurement and Accountability for Health roadmap.

Contributing towards the attainment of ENAP metrics milestones and as part of the ENAP measurement improvement roadmap, the overall aim of this research is to improve the measurement of core newborn and maternal health coverage indicators for wide-scale use in routine health management information systems (HMIS).  Specifically, it aims to improve routine data for facility-based health interventions for maternal and newborn care with the main activity to observe these interventions and compare with the data recorded by workers.  This facility-based research is supported by a grant from the Children’s Investment Fund Foundation (CIFF) for facility-based testing of five core maternal/ neonatal indicators in Bangladesh and Tanzania.

Who participated?

Over 60 participants, including researchers as well as programmatic and data experts, from over 30 organisations and 15 countries participated in the two-day workshop.

About the workshop

The workshop’s overall aim was to finalise research protocols for initial facility-based testing of selected ENAP and EPMM coverage indicators, ensuring essential learning from other relevant work. Throughout the workshop, the participants actively contributed their knowledge to achieve comparable results from multi-indicator, multi-country testing and wide use in national data platforms.

The initial plenary sessions outlined the ENAP measurement improvement roadmap, links with EPMM, and specific details about the facility-based ENAP metrics testing research, including the use of observers and training required, checklists and the use of films.

A total of 17 working group sessions were conducted divided into the following three areas: Intervention Specific Indicator working group, Methods working group, and Systems and Integration working group.  Specifically, the Intervention Indicator groups aimed to refine the research protocol to test sensitivity and specificity of observations for five interventions compared with routine recording in registers and to develop outputs, such as an observer checklist, regarding numerator and denominator.  The five interventions discussed include Uterotonics, Resuscitation, Kangaroo Mother Care (KMC), Possible Severe Bacterial Infection (PSBI) treatment and Antenatal Corticosteroids (ACS).  These interventions were selected due to lack of indicator definitions or data, especially for denominators i.e. population in need, following collaborative consultation process.

Workshop agenda: ENAP Metrics Design Workshop for Facility-based Testing for Coverage Metrics Timetable

Country sites

Tanzania and Bangladesh will be the lead sites with 5000 births observed in each country.  The Bangladesh country team from research partner International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) provided an essential overview of the country’s context and testing sites during a presentation and throughout the working groups.

The final selection based on the request for applications for the Tanzania research partner was officially announced. Congratulations to IFAKARA. Tanzania’s Ministry of Health Representative Dr. Mary Azayo, WHO representative Dr. Theopista Johns and the new Director of IFAKARA Dr. Honorati Masanja shared an overview of the context in Tanzania.

We look forward to ongoing work with both teams as the protocol and plans continue to be developed.  Also Nepal, led by the UNICEF, office is asking to be a third site.

Next steps …

Thank you to all participants who contributed their valuable time, energy and thoughts to the extensive discussions and recommendations!  The discussions and input will be reflected upon and integrated into the remaining gaps in the final research protocol and related checklists, and further consultations and participatory input will be requested as necessary.  The workshop report and research protocol will be shared and we welcome ongoing multi-partner teamwork.

ENAP core and additional indicators

enap metrics
Click to enlarge

Shaded= Not currently routinely tracked at global level  Bold red= Indicator requiring additional testing to inform consistent measurement

*also SDG core or complementary indicator. Indicators to be disaggregated by equity such as urban/rural, income, and education.

Adapted from WHO and UNICEF, Every Newborn Action Plan (2014), Mason et al. Lancet (2014), Moxon et al., BMC Pregnancy & Childbirth (2015)


Thanks to CIFF and many partners for funding.

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