Development of Composite Indicators
To address this gap, the ministries of health of Burkina Faso, Cote d’Ivoire, and Niger formed inclusive technical working groups (TWGs) to develop a set of composite indicators of integrated FP/MNCH/N service provision. First, the TWGs identified services to be integrated at the facility and community level in accordance with local policy, standards, and protocols. Through iterative and consensus-driven discussion, the TWGs finalized the composite indicators of FP/MNCH/N service delivery.
The composite indicators combine several variables to measure provision of services at each of the five entry points of care in the INSPiRE model. The composite indicators show a continuum of care and provide important metrics for health professionals.
Example indicators include:
- % of women seen for postnatal care who adopted a modern contraceptive method and whose infant aged 0-6 months is being exclusively breastfed.
- Number of home visits by community-based health workers that covered FP, N, and vaccination.
Sustainability
Each country team ensured the composite indicators chosen were already included in country health data management systems and adapted existing data tools to include the new composite indicators. This not only eliminated a need to train providers on a new system, but also ensured rapid adoption and use of data collected. The revised data collection tools also serve as a daily reminder to providers to offer integrated services.
As data collection and reporting on the new indicators continues, providers can see constant improvements in FP/MNCH/N service delivery. Not only is this an incredible benefit for women and children in West Africa, the data are also compelling to policy makers as evidence to support FP/MNCH/N service integration. In the first year of implementation of the model ANC visits increased 188% at sites in Niger and visits for healthy infant/growth monitoring increased 300% at sites in Burkina Faso, Cote d’Ivoire, and Niger.
These results show both the importance of integrated service delivery and the need for continued monitoring to assess progress and to sustain implementation of these efforts. The participatory and country-led process of developing the indicators helped enhance service provider understanding and adherence, and rapid uptake in country health information systems. Over the next three years, the project will further refine the indicators and expand their adoption and use throughout West Africa. Read more here about the development and use of the composite indicators. Any additional inquiries about the integration indicators or the INSPiRE project can be directed to Marguerite Ndour, Project Director, at mandour@intrahealth.org.
Many thanks to Amadou Domboe and Marguerite Ndour for writing the first draft of the brief in French.
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