| Indicator ID | H4 |
|---|---|
| Indicator full statement | Number of birth attendants trained on perinatal health and respectful care according to national and international standards. |
Purpose
| Importance | This indicator measures Tdh’s capacity-building efforts directed towards skill birth attendants (SBAs) in perinatal health and respectful maternity care where Tdh is conducting related activities. Training SBAs according to national and international guidelines, such as those from the World Health Organization (WHO), Ministry of Health (MoH) plans and protocols, and other professional associations (i.e., international confederation of midwives), improves the quality of maternal and newborn care and is a key strategy for reducing maternal and neonatal mortality. By ensuring that SBAs are well-trained in perinatal health, essential obstetric and neonatal interventions, and respectful care practices, health systems can strengthen the quality of childbirth services. This aligns with Sustainable Development Goal (SDG) 3, which aims to ensure healthy lives and promote well-being for all, particularly SDG 3.1 (reducing maternal mortality) and 3.2 (ending preventable newborn deaths). |
|---|---|
| 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 and IeDA maternity. |
Definition
The total number of skilled birth attendants who have completed a training program in perinatal health and respectful care according to national and international standards during a defined period.
Skilled birth attendants (SBAs) 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.
Perinatal health includes the care provided during pregnancy, childbirth, and the postnatal period, with an emphasis on preventing and managing complications for both mother and newborn.
Respectful care refers to maternity care that maintains the dignity, privacy, and autonomy of the woman and her newborn, avoiding any form of mistreatment, abuse, or neglect.
How to collect & analyse the data
| What do we count? | Skilled birth attendants who have completed a training program in perinatal health and respectful care |
|---|---|
| How to calculate the indicator's value | Training attendance records review |
| Data sources | Training program data: Records from institutions or programs conducting perinatal health trainings supported or directly conducted by Tdh’s, such as those from the Ministries of Health (MoH) responsible of the deployment of the trainings (i.e., health district responsible for perinatal health trained as trainer by Tdh), universities, non-governmental organizations (NGOs), private sector (i.e., Tdh partners in the development and diffusion of the perinatal health training) or professional development organizations (if applicable at the program’s stage). Health facility data: Health facility reports on staff participation in perinatal health trainings supported or directly conducted by Tdh, particularly where perinatal health is integrated into routine health services (such as primary and community health care facility level). Digital perinatal health platform reports: Reports from digital tool providers or platforms supported by Tdh showing user registration and training completion by SBAs. |
| Data collection methods and tools | Secondary review (project data, health facility data, reports) |
| Disaggregation | Data should be disaggregated by:
Where appropriate depending on the data source. |
Limitations and precautions
This indicator measures the number of SBAs trained on perinatal health. It illustrates the capacity building efforts deployed by Tdh in a specific period and geographic area, either district, country, regional and/or globally.
This indicator does not measure the quality of the training programs neither the retention and practical use. Please make sure that you do include in your M&E plan complementary assessments of those aspects. Indeed, the quality of training programs might vary, and training may not always translate into sustained good clinical practice. It is important to assess the depth and relevance besides practicality of training content, as well as the ability of SBAs to retain and apply skills after the training period. Follow-up assessments to measure retention and practical use are crucial. Refresher trainings might be to be considered on specific topics and/or tools according to post-training assessments’ and/or technical supervision’s results. An evaluation template should be used to obtain mainstreamed and comparable results.
What further analysis are we interested in?
This indicator allows the analysis of the number of SBAs who have been trained on perinatal health over time directly or indirectly by Tdh, identifying trends in training uptake across different regions and facility types. The number of trained SBAs should be analysed in relation with other indicators such as the number of SBAs attended deliveries, Antenatal Care (ANC) and Postnatal Care (PNC) consultations performed to evaluate the link between training and actual usage of the competencies; as well as with the percentage of deliveries attended by SBAs to assess how training efforts align with an improved community health seeking behaviours across time.
This indicator might support the identification of gaps in perinatal health training coverage between urban and rural areas, as well as between different districts or health regions, to target capacity-building interventions effectively. This indicator could be relevant to compare per area of interventions with the expected number of live births.
Finally, this indicator might be used to explore the corelation between perinatal training uptake and impacts on healthcare service delivery and attendance, including quality of care, patient satisfaction, and effective health outcomes (i.e., other maternal, newborn, and child health indicators such as maternal mortality rate, newborn mortality rate), where this cross-analysis is possible.
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. Collaboration with the health authorities and professional associations is essential ensure that perinatal health training is embedded in broader capacity-building programs, sustainable health workforce development strategies and health system strengthening efforts.
Delegations with limited capacity to implement and evaluate training programs should consider engaging consultants for evaluation and data analysis where needed.If the training content doesn’t cover both topics (but should), the indicator still can be used but a comment should explain the actual content of the training.
Indicator global monitor and strategies:
Standards for improving quality of maternal and newborn care in health facilities, World Health Organization. Available at: https://www.who.int/publications/i/item/9789241511216 (Accessed: 11 September 2024).
Respectful maternity care - UNFPA ESARO. Available at: https://esaro.unfpa.org/sites/default/files/pub-pdf/respectful_maternity_care_final.pdf (Accessed: 11 September 2024).
Guidance for meeting the ICM Global Standards for Midwifery Education: Practical/Clinical Experience (2024) International Confederation of Midwives. Available at: https://internationalmidwives.org/resources/guidance-for-meeting-the-icm-global-standards-for-midwifery-education-practical-clinical-experience/ (Accessed: 11 September 2024).