| Indicator ID | H2 |
|---|---|
| Indicator full statement | # of births assisted by skilled birth attendants. |
Purpose
| Importance | This indicator measures the actual count of births that were attended by skilled health professionals according to the definition in a specific time frame, providing a direct measure of service delivery in maternal health where Tdh is conducting related activities. This indicator is used to track the performance and capacity of health systems in terms of services provided, focusing on service delivery efforts. |
|---|---|
| ToC pathway | This indicator directly refers to the Tdh Theory of Change (ToC) as it aims to contribute to 3the three inter-related pathways of change, namely 1) local health system, 2) communities, and 3) mothers, children, and their families. It is used depending on the service provided by Tdh. |
| Related services | This indicator can be linked to the use of Tdh’s SIMSONE project. |
Definition
The total number of live births attended by skilled birth attendants (midwives, nurses, and doctors with midwifery skills) during a specified period, regardless of whether the delivery occurred in a facility or a non-institutional setting (e.g., home, community) among Tdh’s target population.
Skilled health personnel, as defined by the WHO, possess the training and proficiency to manage uncomplicated pregnancies, childbirth, and the immediate postnatal period; and recognize complications requiring referral or intervention.
Definitions of skilled health personnel vary between countries. Therefore, each delegation should use the current definition as per Ministry of health. This definition usually excludes traditional birth attendants (TBAs), dai, matrons, even if trained.
Live birth is the birth of a foetus after 22 weeks’ gestation or weighting 500 g or more that shows signs of life -breathing, cord pulsation or with audible heartbeat. This cut-off point refers to when the perinatal period commences and aims at confining the definition for pragmatic purposes. See Indicator 1 Births assisted by skilled birth attendants.
How to collect & analyse the data
| What do we count? | Birth |
|---|---|
| How to calculate the indicator's value | Sum - births attended by skilled health personnel in the same geographic area and reference period. |
| Data sources | Household Survey Method: mothers 15 to 49 years old who had a live birth in a given time period preceding the surve. Or secondary data if Facility-based Data Method |
| Data collection methods and tools | Population based (household) survey such as the Demographic Health Surveys (DHS), or the Multiple Indicator Cluster Surveys (MICS) as primary data sources due to their robustness in low-resource settings: This indicator is best calculated from a survey, since vital registration systems are lacking in Tdh priorities countries. Population based survey: a cross-sectional household survey of mothers 15 to 49 years old who had a live birth in a given time period preceding the survey. A multi-stage, stratified sampling design will be used to select mothers from eligible women. Sampling of households will be based on probability proportional to size (PPS) thus ensuring villages with bigger populations had more sampled households. Routine facility information systems are another possible data source where health information systems are more or less comprehensive, administrative data are also an option to obtain health staff information. |
| Example of survey questions | A structured questionnaire (adaptation of demographic health survey questionnaire) will be used to collect data from respondent. |
| Disaggregation | Data should be disaggregated by age, place of delivery (home or facility), where appropriate depending on the data source. |
| Important considerations | Frequency and timing: Population based surveys: project baseline then biennial (every 2 years). More frequent surveys are probably not desirable because the survey periods may overlap, and sampling error makes it difficult to assess changes. Routine data sources: monthly, quarterly, and annual monitoring at delegation level. |
Limitations and precautions
See Indicator 1 Births assisted by skilled birth attendants.
This indicator doesn’t provide a full picture of population coverage, potentially overestimating success in areas with many health centers while missing underserved or displaced populations. Population data is needed to complement and better interpret the indicator.
What further analysis are we interested in?
Analysis of this indicator can help compare skilled birth attendance across regions to identify areas with low utilization and cross-reference this with health facility data on the availability of skilled birth attendants (SBA). Monitoring trends in skilled birth attendance also helps detect emerging challenges in maternal health services.
However, this indicator does not reflect the availability of emergency obstetric services (e.g., C-sections) or postpartum care, both critical for reducing mortality. To gain a fuller understanding, cross-analysis with other indicators like Complete Emergency Obstetric and Newborn Care (CeMOC) referrals, maternal mortality ratio (MMR), neonatal mortality rate (NMR), and postpartum care (PNC) coverage is needed. This can provide a comprehensive view of service efficiency at both health facility and district levels, linking service availability to maternal and neonatal health outcomes.
This indicator also allows for an evaluation of the operational capacity of health facilities. Cross-referencing it with indicators like monthly births attended by SBAs, SBA staffing levels, and the availability of essential resources (e.g., oxytocin stocks, functional cold chain) can reveal gaps in service delivery. See Indicator 1 Births assisted by skilled birth attendants.
Additional guidance
Resources: Under the technical assistance of HQ, Tdh M&E and operational teams in each delegation should work closely with health authorities to collect and interpret the data. Countries with limited resources to conduct household surveys, should consider using a consultant or facility-based estimates, though less reliable can provide interim insights.
Countries with limited health system infrastructure may consider partnerships with international organizations (e.g., WHO, UNICEF) and academic institutions to support capacity-building for data collection and maternal health service delivery.
Indicator global monitor and strategies: See Indicator 1 Births assisted by skilled birth attendants.