Abstract
Aim
Various reproductive health (RH) indicators have been formulated and used to measure RH services and status. Despite their widespread use, the measurement of these indicators has never been explored in a systematic manner. This study aimed to examine methods and methodologies in the measurement of common RH indicators in the Ethiopian context.
Subjects and Methods
A mixed-method design, comprising in-depth expert interviews, the abstraction of information from relevant public documents and an analysis of peer-reviewed literature, was used. Information from these three sources was then organised and synthesised using a thematic approach.
Results
Until now, routine health information system and demographic and health survey have been the primary sources for RH indicators in Ethiopia. A number of improvements have recently been made in data collection and aggregation methods; however, the focus has been more on the coverage of services than the quality of data. We noted that variations were observed in indicator definition between the two data sources and, as a consequence, in their estimates. It was found that many of the inherent limitations in the measurement of RH indicators could be addressed by making small modifications to the data sources and the reporting formats. Data quality concerns mainly occur at the point of data collection although there are also issues with data aggregation, dissemination and use.
Conclusion
There is a gap in the measurement of the quality and continuity of RH services. Many of the limitations and data quality concerns in the measurement of RH indicators could be resolved with minimal improvements to the current health information system.
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Change history
08 July 2017
An erratum to this article has been published.
References
AbouZahr C (2011) New estimates of maternal mortality and how to interpret them: choice or confusion? Reproductive Health Matters 19:117–128. doi:10.1016/S0968-8080(11)37550-7
Abou-Zahr CLW et al. (2003) Antenatal care in developing countries: promises, achievements and missed opportunities. An analysis of trends, levels and differentials, 1990–2001. vol 618.2: 316. Organización Mundial de la Salud
Arur A, Mohammed-Roberts R, Bos E (2011) Setting targets in health, nutrition and population projects
Boerma JT, Sommerfelt AE (1992) Demographic and health surveys (DHS): contributions and limitations. World Health Stat Q 46:222–226
Brende B, Høie B (2015) Towards evidence-based, quantitative sustainable development goals for 2030. Lancet 385:206–208. doi:10.1016/S0140-6736(14)61654-8
Charles Ngwena ED (2014) Strengthening the protection of sexual and reproductive health and rights in the African region through human rights. Pretoria University Law Press, South Africa
Countdown, HMN, Unicef, World Health Organization (2011) Monitoring maternal, newborn and child health: understanding key progress indicators
CSA II (2012) Ethiopia demographic and health survey 2011 Addis Ababa, Ethiopia and Calverton, Maryland, USA: Central Statistical Agency and ICF International
CSA OM (2001) Ethiopia demographic and health survey 2000 Addis Ababa, Ethiopia and Calverton, Maryland, USA: Central Statistical Agency and ORC Macro 41:91
CSA OM (2006) Ethiopia demographic and health survey 2006 Addis Ababa, Ethiopia and Calverton, Maryland, USA: Central Statistical Agency and ORC Macro
Federal Ministry of Health (2007) HMIS / M&E indicator definitions HMIS / M&E redesign: technical standards area 1 version 1.0. Federal Ministry of Health, Addis Ababa
Federal Ministry of Health (2014a) Ethiopia health and health related indicators 2013/2014 version 1. Federal Ministry of Health, Addis Ababa
Federal Ministry of Health (2014b) Ethiopia health management information system: postnatal care register. Federal Ministry of Health, Addis Ababa
Federal Ministry of Health (2014c) Health management information system (HMIS) recording and reporting procedure. Federal Ministry of Health, Addis Ababa
Federal Ministry of Health (2014d) Health management information system: delivery register. Federal Ministry of Health, Addis Ababa
Federal Ministry of Health (2014e) Health management information system: monthly, quarterly and annual service delivery reporting format, 2014. Federal Ministry of Health, Addis Ababa
Federal Ministry of Health (2014f) Health Managment information system: antenatal care register. Federal Ministry of Health, Addis Ababa
Federal Ministry of Health (2014g) HMIS indicator definitions: technical standards: area 1, revised health management information system, indicator definition 2014. Federal Ministry of Health, Addis Ababa
Graham W, Brass W, Snow RW (1989) Estimating maternal mortality: the sisterhood method. Stud Fam Plan 20:125–135
Hill K, Koenig M, Al-Sabir A, Jamil K, Raggers H (2006) How should we measure maternal mortality in the developing world? A comparison of household death and sibling history approaches. Bull World Health Organ 84:173–180
HMN, World Health Organization (2011) Country health information systems: a review of the current situation and trends. World Health Organization, Geneva
Lincetto O, Mothebesoane-Anoh S, Gomez P, Munjanja S (2006) Antenatal care opportunities for Africa’s newborns: practical data, policy and programmatic support for newborn care in Africa
Lippeveld T, Sauerborn R, Bodart C (2000) Design and implementation of health information systems. World Health Organization, Geneva
MEASURE Evaluation (n.d.-a) Family planning program effort index. Family planning and reproductive health indicators database. http://www.cpc.unc.edu/measure/prh/rh_indicators/specific/fp/family-planning-program-effort-index. Accessed Dec 20 2015
MEASURE Evaluation (n.d.-b) Health management information systems. https://www.measureevaluation.org/resources/training/materials/health-management-information-systems-hmis-1. Accessed Feb 17 2017
Rogo KO, Oucho J, Mwalali P (2006) Maternal mortality. In: Jamison DT (ed) Disease and Mortality in Sub-Saharan Africa
Sambo L (2011) Health systems and primary health care in the African region. The African Health Monitor 14:2–3
von Schirnding Y (2002) Health in sustainable development planning: the role of indicators. World Health Organization
Stanton C, Abderrahim N, Hill K, (1997) DHS maternal mortality indicators: an assessment of data quality and implications for data use. DHS analytical reports no. 4. Calverton, Maryland: Macro International Inc.
Trussell J, Rodriguez G (1990) A note on the sisterhood estimator of maternal mortality. Stud Fam Plan 21:344–346
United Nations (2006) The millennium development goals report 2006
United Nations (2015) The millennium development goals report 2015
United Nations (n.d.) Guidelines on reproductive health. United Nations task force on ICPD implementation. http://www.un.org/popin/unfpa/taskforce/guide/iatfreph.gdl.html. Accessed Nov 15 2015
Wagstaff A, Claeson M (2004) The millennium development goals for health: rising to the challenges. World Bank, Customer Service & Fulfillment, Po Box 960, Herndon, VA, 20172–0960
World Health Organization (1997) Selecting reproductive health indicators: a guide for district managers
World Health Organization (2002) WHO Programme to map best reproductive health practice. WHO antenatal care randomized trial: manual for the implementation of the new model. World Health Organization, Geneva
World Health Organization (2006) Reproductive health indicators: guidelines for their generation, interpretation and analysis for global monitoring
World Health Organization (2011) International statistical classification of diseases and related health problems: Tenth revision, edition 2010:201
World Health Organization (2014) WHO recommendations on postnatal care of the mother and newborn. World Health Organization
World Health Organization, UNICEF (2014) Trends in maternal mortality: 1990 to 2013: estimates by WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division: executive summary
Zahr CA, Wardlaw TM (2004) Maternal mortality in 2000: estimates developed by WHO, UNICEF and UNFPA. World Health Organization
Acknowledgements
We extend our gratitude to the Reproductive Health Program and the monitoring and evaluation experts of Ethiopia for their commitment and courage in providing us with detailed and up-to-date information, as well as the most recent public RH focused documents. The authors gratefully acknowledge the Federal Ministry of Health of Ethiopia for providing relevant information to the public in an organised manner. Swinburne University of Technology in Australia provided both technical and financial support for this study. Our special thanks go to Associate Professor Timothy Moore and Hannah Cramond for their editing support.
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The authors declare that they have no conflict of interest.
Funding
This study was funded by Swinburne University of Technology, Australia.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Ethical approval was obtained from Swinburne University of Technology.
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Informed consent was obtained from all individual participants included in the study.
Additional information
The original version of this article was revised: The name of Jahar Bhowmiki is incorrect. It should be Jahar Bhowmik.
Headline of contribution: Do DHS and HMIS measure RH indicators in the same way?
An erratum to this article is available at https://doi.org/10.1007/s10389-017-0820-5.
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Woldegiorgis, M.A., Hiller, J.E., Mekonnen, W. et al. Measurement of reproductive health indicators in Ethiopia: A mixed method study. J Public Health 25, 491–502 (2017). https://doi.org/10.1007/s10389-017-0810-7
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DOI: https://doi.org/10.1007/s10389-017-0810-7