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Validating indicators for monitoring availability and geographic distribution of emergency obstetric and newborn care (EmoNC) facilities: A study triangulating health system, facility, and geospatial data

Availability of emergency obstetric and newborn care (EmONC) is a strong supply side measure of essential health system capacity that is closely and causally linked to maternal mortality reduction and fundamentally to achieving universal health coverage. The World Health Organization’s indicator “Av...

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Autores principales: Gausman, Jewel, Pingray, Verónica, Adanu, Richard, Bandoh, Delia A. B., Berrueta, Mabel, Blossom, Jeff, Chakraborty, Suchandrima, Dotse-Gborgbortsi, Winfred, Kenu, Ernest, Khan, Nizamuddin, Langer, Ana, Nigri, Carolina, Odikro, Magdalene A., Ramesh, Sowmya, Saggurti, Niranjan, Vázquez, Paula, Williams, Caitlin R., Jolivet, R. Rima
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10501555/
https://www.ncbi.nlm.nih.gov/pubmed/37708180
http://dx.doi.org/10.1371/journal.pone.0287904
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author Gausman, Jewel
Pingray, Verónica
Adanu, Richard
Bandoh, Delia A. B.
Berrueta, Mabel
Blossom, Jeff
Chakraborty, Suchandrima
Dotse-Gborgbortsi, Winfred
Kenu, Ernest
Khan, Nizamuddin
Langer, Ana
Nigri, Carolina
Odikro, Magdalene A.
Ramesh, Sowmya
Saggurti, Niranjan
Vázquez, Paula
Williams, Caitlin R.
Jolivet, R. Rima
author_facet Gausman, Jewel
Pingray, Verónica
Adanu, Richard
Bandoh, Delia A. B.
Berrueta, Mabel
Blossom, Jeff
Chakraborty, Suchandrima
Dotse-Gborgbortsi, Winfred
Kenu, Ernest
Khan, Nizamuddin
Langer, Ana
Nigri, Carolina
Odikro, Magdalene A.
Ramesh, Sowmya
Saggurti, Niranjan
Vázquez, Paula
Williams, Caitlin R.
Jolivet, R. Rima
author_sort Gausman, Jewel
collection PubMed
description Availability of emergency obstetric and newborn care (EmONC) is a strong supply side measure of essential health system capacity that is closely and causally linked to maternal mortality reduction and fundamentally to achieving universal health coverage. The World Health Organization’s indicator “Availability of EmONC facilities” was prioritized as a core indicator to prevent maternal death. The indicator focuses on whether there are sufficient emergency care facilities to meet the population need, but not all facilities designated as providing EmONC function as such. This study seeks to validate “Availability of EmONC” by comparing the value of the indicator after accounting for key aspects of facility functionality and an alternative measure of geographic distribution. This study takes place in four subnational geographic areas in Argentina, Ghana, and India using a census of all birthing facilities. Performance of EmONC in the 90 days prior to data collection was assessed by examining facility records. Data were collected on facility operating hours, staffing, and availability of essential medications. Population estimates were generated using ArcGIS software using WorldPop to estimate the total population, and the number of women of reproductive age (WRA), pregnancies and births in the study areas. In addition, we estimated the population within two-hours travel time of an EmONC facility by incorporating data on terrain from Open Street Map. Using these data sources, we calculated and compared the value of the indicator after incorporating data on facility performance and functionality while varying the reference population used. Further, we compared its value to the proportion of the population within two-hours travel time of an EmONC facility. Included in our study were 34 birthing facilities in Argentina, 51 in Ghana, and 282 in India. Facility performance of basic EmONC (BEmONC) and comprehensive EmONC (CEmONC) signal functions varied considerably. One facility (4.8%) in Ghana and no facility in India designated as BEmONC had performed all seven BEmONC signal functions. In Argentina, three (8.8%) CEmONC-designated facilities performed all nine CEmONC signal functions, all located in Buenos Aires Region V. Four CEmONC-designated facilities in Ghana (57.1%) and the three CEmONC-designated facilities in India (23.1%) evidenced full CEmONC performance. No sub-national study area in Argentina or India reached the target of 5 BEmONC-level facilities per 20,000 births after incorporating facility functionality yet 100% did in Argentina and 50% did in India when considering only facility designation. Demographic differences also accounted for important variation in the indicator’s value. In Ghana, the total population in Tolon within 2 hours travel time of a designated EmONC facility was estimated at 99.6%; however, only 91.1% of women of reproductive age were within 2 hours travel time. Comparing the value of the indicator when calculated using different definitions reveals important inconsistencies, resulting in conflicting information about whether the threshold for sufficient coverage is met. This raises important questions related to the indicator’s validity. To provide a valid measure of effective coverage of EmONC, the construct for measurement should extend beyond the most narrow definition of availability and account for functionality and geographic accessibility.
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spelling pubmed-105015552023-09-15 Validating indicators for monitoring availability and geographic distribution of emergency obstetric and newborn care (EmoNC) facilities: A study triangulating health system, facility, and geospatial data Gausman, Jewel Pingray, Verónica Adanu, Richard Bandoh, Delia A. B. Berrueta, Mabel Blossom, Jeff Chakraborty, Suchandrima Dotse-Gborgbortsi, Winfred Kenu, Ernest Khan, Nizamuddin Langer, Ana Nigri, Carolina Odikro, Magdalene A. Ramesh, Sowmya Saggurti, Niranjan Vázquez, Paula Williams, Caitlin R. Jolivet, R. Rima PLoS One Research Article Availability of emergency obstetric and newborn care (EmONC) is a strong supply side measure of essential health system capacity that is closely and causally linked to maternal mortality reduction and fundamentally to achieving universal health coverage. The World Health Organization’s indicator “Availability of EmONC facilities” was prioritized as a core indicator to prevent maternal death. The indicator focuses on whether there are sufficient emergency care facilities to meet the population need, but not all facilities designated as providing EmONC function as such. This study seeks to validate “Availability of EmONC” by comparing the value of the indicator after accounting for key aspects of facility functionality and an alternative measure of geographic distribution. This study takes place in four subnational geographic areas in Argentina, Ghana, and India using a census of all birthing facilities. Performance of EmONC in the 90 days prior to data collection was assessed by examining facility records. Data were collected on facility operating hours, staffing, and availability of essential medications. Population estimates were generated using ArcGIS software using WorldPop to estimate the total population, and the number of women of reproductive age (WRA), pregnancies and births in the study areas. In addition, we estimated the population within two-hours travel time of an EmONC facility by incorporating data on terrain from Open Street Map. Using these data sources, we calculated and compared the value of the indicator after incorporating data on facility performance and functionality while varying the reference population used. Further, we compared its value to the proportion of the population within two-hours travel time of an EmONC facility. Included in our study were 34 birthing facilities in Argentina, 51 in Ghana, and 282 in India. Facility performance of basic EmONC (BEmONC) and comprehensive EmONC (CEmONC) signal functions varied considerably. One facility (4.8%) in Ghana and no facility in India designated as BEmONC had performed all seven BEmONC signal functions. In Argentina, three (8.8%) CEmONC-designated facilities performed all nine CEmONC signal functions, all located in Buenos Aires Region V. Four CEmONC-designated facilities in Ghana (57.1%) and the three CEmONC-designated facilities in India (23.1%) evidenced full CEmONC performance. No sub-national study area in Argentina or India reached the target of 5 BEmONC-level facilities per 20,000 births after incorporating facility functionality yet 100% did in Argentina and 50% did in India when considering only facility designation. Demographic differences also accounted for important variation in the indicator’s value. In Ghana, the total population in Tolon within 2 hours travel time of a designated EmONC facility was estimated at 99.6%; however, only 91.1% of women of reproductive age were within 2 hours travel time. Comparing the value of the indicator when calculated using different definitions reveals important inconsistencies, resulting in conflicting information about whether the threshold for sufficient coverage is met. This raises important questions related to the indicator’s validity. To provide a valid measure of effective coverage of EmONC, the construct for measurement should extend beyond the most narrow definition of availability and account for functionality and geographic accessibility. Public Library of Science 2023-09-14 /pmc/articles/PMC10501555/ /pubmed/37708180 http://dx.doi.org/10.1371/journal.pone.0287904 Text en © 2023 Gausman et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Gausman, Jewel
Pingray, Verónica
Adanu, Richard
Bandoh, Delia A. B.
Berrueta, Mabel
Blossom, Jeff
Chakraborty, Suchandrima
Dotse-Gborgbortsi, Winfred
Kenu, Ernest
Khan, Nizamuddin
Langer, Ana
Nigri, Carolina
Odikro, Magdalene A.
Ramesh, Sowmya
Saggurti, Niranjan
Vázquez, Paula
Williams, Caitlin R.
Jolivet, R. Rima
Validating indicators for monitoring availability and geographic distribution of emergency obstetric and newborn care (EmoNC) facilities: A study triangulating health system, facility, and geospatial data
title Validating indicators for monitoring availability and geographic distribution of emergency obstetric and newborn care (EmoNC) facilities: A study triangulating health system, facility, and geospatial data
title_full Validating indicators for monitoring availability and geographic distribution of emergency obstetric and newborn care (EmoNC) facilities: A study triangulating health system, facility, and geospatial data
title_fullStr Validating indicators for monitoring availability and geographic distribution of emergency obstetric and newborn care (EmoNC) facilities: A study triangulating health system, facility, and geospatial data
title_full_unstemmed Validating indicators for monitoring availability and geographic distribution of emergency obstetric and newborn care (EmoNC) facilities: A study triangulating health system, facility, and geospatial data
title_short Validating indicators for monitoring availability and geographic distribution of emergency obstetric and newborn care (EmoNC) facilities: A study triangulating health system, facility, and geospatial data
title_sort validating indicators for monitoring availability and geographic distribution of emergency obstetric and newborn care (emonc) facilities: a study triangulating health system, facility, and geospatial data
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10501555/
https://www.ncbi.nlm.nih.gov/pubmed/37708180
http://dx.doi.org/10.1371/journal.pone.0287904
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