STRENGTHENING FACILITY-BASED MEASUREMENT OF MATERNAL AND NEWBORN HEALTH TECHNICAL REPORT OCTOBER 2015

However, the country's ability to assess the progress of policies and strategies to accelerate reductions in mortality is challenged by a lack of reliable, relevant data at all levels of the health system. A health information system does exist, but its utility is challenged by data quality concerns and by the limited amount of information relevant for monitoring maternal or newborn health evidence-based practices or outcomes. A 2013 review concluded that the inadequate health information system in Indonesia is attributable, at least in part, to the limitations of facility-based data sources. Current efforts at the Ministry of Health, including an expanded MNH indicator list and an online reporting system, will bolster health information, but both are still in the early stages of introduction. What is known about maternal and newborn health is primarily based upon survey data versus routine health information. While population-based surveys such as the IDHS or special studies generate meaningful information, results are not as useful at a facility or sub-national level and are not conducted with sufficient frequency to inform decision-making. The five-year USAID-funded Expanding Maternal and Neonatal Survival (EMAS) Program began in 2011 with the aim to support 450 health facilities across 30 districts in Indonesia with the largest proportion of maternal and newborn mortality. EMAS aims to improve the quality of emergency obstetric and newborn care provided in health centers and hospitals. Improving clinical governance is the underlying principle guiding EMAS facility strengthening efforts. Within the context of clinical governance, measurement and accountability are key themes and are operationalized through the analysis, visualization, and use of data for performance monitoring and decision-making. A set of MNH measures was prioritized early in the program as key indicators for both routine and emergency MNH care. The measures would be assessed both within individual facilities and across geographic areas to monitor performance over time, requiring a degree of standardization. The available facility data systems were not able to generate the needed information and served as the impetus for MNH measurement strengthening activities. Routine care measures include the percentage of live births breastfeeding within one hour after delivery and the percentage of women receiving uterotonic in the third stage of labor. Care for complications measures include the percentage of women delivering preterm who receive at least one dose of antenatal corticosteroids and the percentage of severe PE/E cases that receive at least one dose of magnesium sulfate. Health outcomes measures include institutional maternal mortality ratio, hospital-level case fatality rates for direct obstetric complications, and very early newborn mortality rate. Challenges with facility recording and reporting were identified, including the lack of standardized data registers, inadequate data elements tracked, and the majority of facilities not using data from these registers for analysis or decision-making. The EMAS program introduced processes and tools to strengthen health information systems and data use within hospitals and health centers, guided by principles such as complementing and strengthening the existing health information system.