| Indicator ID | H5 |
|---|---|
| Indicator full statement | # of newborns who receive postnatal care by skilled healthcare workers within 48 hours of childbirth. |
Purpose
| Importance | This indicator assesses the extent to which newborns receive postnatal care within 48 hours of birth where Tdh is conducting related activities. Early postnatal care improves health outcomes and survival rates for both mother and newborn, and offers opportunities for education on birth spacing and newborn care. Household surveys capture a wider range of deliveries, including those outside health facilities, while routine data may better reflect the quality of facility-based care. Comparing these sources can reveal whether facility-based deliveries are more likely to receive timely postnatal care. |
|---|---|
| ToC pathway | This indicator helps evaluate the accessibility and use of postnatal services, essential for reducing neonatal and maternal mortality, and aligns with Tdh's Theory of Change pathways: local health systems, communities, and families. |
| Related services | This indicator can be linked to the use of Tdh’s project : IeDA maternity. |
Definition
The number of newborns who received postnatal care from a skilled health provider within 48 hours of birth, regardless of the place of delivery.
How to collect & analyse the data
| What do we count? | Newborns who received postnatal care |
|---|---|
| Data sources | Population-Based Surveys: Best calculated from cross-sectional household surveys of mothers from 15 to 49 years old who had a live birth in the given period preceding the survey, due to gaps in vital registration systems in priority countries. Surveys should use a multi-stage, stratified sampling design to ensure representativeness and eligibility. Data collection should be through structured questionnaires adapted from demographic health surveys. Routine Data Sources: Routine facility information systems, where available, and administrative estimates based on the number of births attended by skilled health personnel. Monthly, quarterly, and annual reporting from health facilities, though this may only reflect facility-based care. |
| Data collection methods and tools | Household Survey: Number of new-borns who received postpartum care by skilled health personnel within two days of birth where Tdh is supporting the service. Facility-based Data Method: Number of new-borns who received postpartum care within two days of birth where Tdh is supporting the service. |
| Disaggregation | Data should be stratified by age, place of delivery (home or facility), where appropriate depending on the data source. |
| Important considerations | Frequency and timing Population-Based Surveys: Baseline and endline studies; biennial (every 2 years). More frequent surveys may not be feasible due to overlapping periods and sampling errors. Routine Data Sources: Monthly, quarterly, and annual monitoring. Note on method of estimation: The number of live births is a proxy for the numbers of all women who need postnatal care. Evaluators generally count all births, but usually use only live births to calculate this indicator because of the difficulty in obtaining information about non-live births.
It is important to note that the two indicators (population-level and facility-level) are not comparable. |
Limitations and precautions
This indicator is responsive to short-term changes as it reflects immediate actions after birth. Annual monitoring is feasible with routine data sources, though international comparisons require longer periods of data collection.
Health facility data may overestimate or underestimate the number of newborns receiving postnatal care (PNC) within 48 hours, as it may only include births assisted by skilled personnel, excluding home deliveries. Incomplete health information systems may require triangulation with household surveys, though these can introduce recall bias if respondents forget details about care, especially in complex deliveries.
Reliable facility data depends on consistent, accurate management and standardized definitions to ensure proper data collection. However, challenges arise from varying definitions of "skilled health personnel" across countries due to differences in training, scope, and resources. Even when the number of skilled personnel is similar, disparities in competencies and resources affect care quality. Context—such as available supplies and infrastructure—plays a critical role in a skilled provider's ability to offer proper care.
Within facilities, factors like staff overload or burnout can reduce PNC quality. Differences in training and infrastructure between regions can complicate comparisons, and this indicator only measures whether care was given, not the quality or completeness of that care.
Rural and marginalized groups often face barriers in accessing skilled personnel or quality facilities, leading to underreporting of health outcomes and masking inequalities in care access.
What further analysis are we interested in?
Cross-analysis of this indicator with service availability (e.g., number of health facilities, skilled personnel, spatial distribution) and accessibility barriers (e.g., geographic distance, costs, cultural factors, and gender-sensitive provisions) offers a comprehensive view of newborn care in a region.
Timely newborn PNC by skilled personnel reflects healthcare utilization, showing the proportion of the population that receives care. When analysed alongside indicators measuring the availability of obstetric and neonatal care, it provides a fuller picture of service utilization and availability. Including sociocultural norms and traditional beliefs in the analysis helps understand how cultural factors, like traditional cord care, influence access to quality care. Qualitative research on health-seeking behaviours, including gender influences, can further interpret this indicator.
Comparing skilled PNC coverage across regions or periods reveals trends and equity gaps in care access. Finally, this indicator helps measure the impact of interventions aimed at improving neonatal health coverage.
Additional guidance
Ressource: 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 postnatal care service delivery.
Indicator global monitor and strategies:
Who recommendations on maternal and newborn care for a positive postnatal experience (no date) World Health Organization. Available at: https://www.who.int/publications/i/item/9789240045989 (Accessed: 10 September 2024).
Indicator metadata registry details (no date) World Health Organization. Available at: https://www.who.int/data/gho/indicator-metadata-registry/imr-details/3340 (Accessed: 10 September 2024).
Who recommendations on Newborn Health: Guidelines approved by The Who Guidelines Review Committee (no date) World Health Organization. Available at: https://www.who.int/publications/i/item/WHO-MCA-17.07 (Accessed: 10 September 2024).