| Indicator ID | H6 |
|---|---|
| Indicator full statement | # of mothers who receive postnatal care by skilled healthcare workers within 48 hours of childbirth. |
Purpose
| Importance | This indicator assesses the extent to which mothers 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, while also offering opportunities for education on birth spacing and newborn care. Household surveys capture a broader range of deliveries, including those outside health facilities, while routine data often reflects the quality of facility-based care. Comparing these sources can reveal if mothers delivering in facilities are more likely to receive timely postnatal care. |
|---|---|
| ToC pathway | This indicator helps evaluate the accessibility and use of postnatal services, essential for reducing maternal and neonatal mortality, and aligns with Tdh's Theory of Change, contributing to local health systems, communities, and families. |
| Related services | This indicator can be linked to the use of Tdh’s SIMSONE project and IeDA Maternity. |
Definition
The number of mothers who received postnatal care from a skilled provider within 48 hours of childbirth, regardless of the place of delivery.
How to collect & analyse the data
| 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 mothers 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 mothers 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 | 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. Where data on the number of live births are unavailable, rough approximations can be made using census data for the total population and crude birth rates in a specified area as follows: Total expected births = population x crude birth rate. In settings where the crude birth rate is unknown the following formula can be used Total expected births = female of reproductive age x General fertility rate It is important to note that the two indicators (population-level and facility-level) are not comparable. Frequency and timing
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Limitations and precautions
This indicator is responsive to short-term changes as it reflects immediate actions after birth, with annual monitoring feasible through routine data sources. For international comparisons, longer periods of data collection are recommended.
In the absence of surveys, facility data may be used but could over or underestimate the number of mothers receiving postpartum care within two days, as home births by unskilled attendants may not be captured. Incomplete health systems or vital records also require triangulation with household surveys, which can introduce recall bias if respondents forget or misclassify the timing or qualifications of attendants.
Reliable facility data requires consistent entry, management, and standardized definitions to ensure accurate data collection and decision-making. A key challenge is the variation in defining "skilled health personnel" across countries, due to differences in training, practice scope, and resources, which can affect care quality, especially in emergencies. Skilled personnel's ability to manage postpartum care (PNC) depends heavily on their working environment, including access to equipment and infrastructure. Additionally, issues like staff burnout and substandard practices can reduce care quality within facilities.
Disparities in training, skill levels, and infrastructure make international comparisons of this indicator challenging. It does not assess the quality or completeness of postnatal care, only whether care was provided.
Rural areas and marginalized groups often face barriers to care, which this indicator may not capture, masking inequalities in access. Systemic barriers, such as poor governance and funding, further limit health system capacity to train, deploy, and support skilled personnel.
What further analysis are we interested in?
Cross-analysis of this indicator with data on the availability of services, such as the number of health facilities, skilled personnel, and their geographic distribution (using GIS), alongside factors of accessibility and acceptability (e.g., geographic distance, costs, cultural factors, and gender-sensitive service provisions), provides a more complete understanding of maternal postnatal care within a region.
Timely postnatal care (PNC) coverage by skilled personnel measures health care utilization and shows the actual population receiving care. When combined with other indicators of obstetric and neonatal care availability, it offers a fuller picture of the relationship between service provision and utilization.
Sociocultural norms and traditional beliefs should also be analysed, as they can impact access to and the quality of care. Exploring cultural practices (e.g., postnatal confinement or herbal remedies) and gender roles in health-seeking behaviours supports the interpretation of this indicator.
Comparing PNC coverage across regions or over time allows for trend and equity analysis, highlighting areas with varying access to qualified care. Additionally, this indicator helps measure the impact of interventions aimed at improving maternal health coverage.
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 postnatal care service delivery.
Indicator global monitor and strategies:
Who recommendations on maternal and newborn care for a positive postnatal experience, World Health Organization. Available at: https://www.who.int/publications/i/item/9789240045989 (Accessed: 10 September 2024).
Indicator metadata registry details, World Health Organization. Available at: https://www.who.int/data/gho/indicator-metadata-registry/imr-details/4734 (Accessed: 10 September 2024).
Further readings:
Say L, Chou D, Gemmill A et al. Global Causes of Maternal Death: A WHO Systematic Analysis. Lancet Global Health. 2014;2(6): e323-e333.
Samuel O, Zewotir T, North D. Decomposing the urban–rural inequalities in the utilisation of maternal health care services: evidence from 27 selected countries in sub-Saharan Africa. Reprod Health 18, 216 (2021).