Using health-facility data to assess subnational coverage of maternal and child health indicators, Kenya.

Isabella Maina,Benson Droti,Ties Boerma,Pepela Wanjala,Hillary Kipruto,David Soti

doi:10.2471/blt.17.194399

Abstract

ObjectiveTo develop a systematic approach to obtain the best possible national and subnational statistics for maternal and child health coverage indicators from routine health-facility data.MethodsOur approach aimed to obtain improved numerators and denominators for calculating coverage at the subnational level from health-facility data. This involved assessing data quality and determining adjustment factors for incomplete reporting by facilities, then estimating local target populations based on interventions with near-universal coverage (first antenatal visit and first dose of pentavalent vaccine). We applied the method to Kenya at the county level, where routine electronic reporting by facilities is in place via the district health information software system.FindingsReporting completeness for facility data were well above 80% in all 47 counties and the consistency of data over time was good. Coverage of the first dose of pentavalent vaccine, adjusted for facility reporting completeness, was used to obtain estimates of the county target populations for maternal and child health indicators. The country and national statistics for the four-year period 2012/13 to 2015/16 showed good consistency with results of the 2014 Kenya demographic and health survey. Our results indicated a stagnation of immunization coverage in almost all counties, a rapid increase of facility-based deliveries and caesarean sections and limited progress in antenatal care coverage.ConclusionWhile surveys will continue to be necessary to provide population-based data, web-based information systems for health facility reporting provide an opportunity for more frequent, local monitoring of progress, in maternal and child health.

Highlights

Countries are increasingly focused on the assessment of performance of health programmes at the subnational level
Coverage of maternal and child health interventions are among the most commonly used measures to monitor the implementation of health programmes at both national and subnational levels
Health-facility data are another source of populationbased statistics for selected maternal and child health and other indicators

Summary

Introduction

Countries are increasingly focused on the assessment of performance of health programmes at the subnational level. The sustainable development goals further amplify the importance of local data to assess progress and allocate resources to reduce inequalities within countries.[1] Coverage of maternal and child health interventions are among the most commonly used measures to monitor the implementation of health programmes at both national and subnational levels. During the era of the millennium development goals, monitoring the progress of maternal and child health interventions relied heavily on national household surveys. These are conducted about once every five years and provide data on national-level trends and differentials in maternal and child health indicators.[2]. Many countries are using health-facility data to monitor annual progress and sometimes to conduct more advanced analyses.[4,5,6,7] Scorecards ‒ for instance in the African Leaders Malaria Alliance initiative8 ‒ are increasingly popular and often based on local facility data

Methods

Results

Conclusion