Towards a new method for evaluating large-scale maternal health programmes : measuring implementation strength of focused antenatal care and emergency obstetric care in Tanzania

Abstract

Measuring the strength of public health programmes may reveal whether and how some programmes have an impact on target populations and others do not. Programme implementation strength (also known as programme intensity) refers to quantitative measure reflecting programme inputs, processes, and their duration. Measuring programme strength requires an understanding of how programmes work and involves defining measurable concepts, identifying sources of programme data and close programme follow-up. There are no standardized methods for measuring programme strength. This thesis developed and tested an approach for estimating programme strength for use in evaluating large-scale maternal health programmes in low- and middle-income countries. It used focused antenatal care (FANC) and emergency obstetric care (EmOC) as tracer programmes, with WHO’s health-system-building blocks as programme components. The thesis used mixed methods including: developing a weighting scheme through opinions from maternal health experts, collecting FANC and EmOC data from 23 districts on programme strength, programme coverage, and programme contextual factors, using government official statistics, and using routine data from a central database. The thesis also tested the content and face validity of the approach. Results from experts showed that, even though all six WHO blocks were required in programme implementation, human resources was given relatively higher weights than the other programme components. While the overall programme strength in districts scored an average of 41% (FANC) and 40% (EmOC), the overall programme coverage scored an average of 80% (FANC) and 64% (EmOC). Contextual factors significantly associated with the programmes included: total fertility rate, female literacy, water, sanitation, and famine. The content and face validity were both rated “very good”. This work aims to contribute towards an efficient way of evaluating large-scale maternal health programmes in low- and middle-income countries. The approach could also be of interest especially to district health management authorities for improving health programmes.