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Table 1 List of indicators across the continuum of care for maternal health in South Africa

From: Improving the validity, relevance and feasibility of the continuum of care framework for maternal health in South Africa: a thematic analysis of experts’ perspectives

 Continuum of careDomainIndicatorsDefinitionSource
1Pre-pregnancy/Family and communityReproductive healthFemale condom distribution coverageNumber of female condoms distributed from a primary distribution site to health facilities or points in the community (e.g. campaigns, non-traditional outlets, etc.)NIDS
2 Male condom distribution coverageNumber of male condoms distributed from a primary distribution site to health facilities or points in the community (e.g. campaigns, non-traditional outlets, etc.)NIDS
3Adolescent/Pre-conception nutritionMills fortification compliance rateOperational flour and maize milling establishments that were compliant with fortification Regulation under the Foodstuffs, Cosmetics and Disinfectant Act (1972) as a proportion of milling establishments that were inspectedNIDS
4Pre-pregnancy/Primary health facilityReproductive healthCouple year protection rateWomen protected against pregnancy by using modern contraceptive methods, including sterilisations, as proportion of female population 15–49 yearsNIDS
5Pre-pregnancy/District hospitalReproductive careRate of termination of pregnancy at 0–12 weeksPregnancies terminated in health facilities in the first 12 weeks of pregnancy as a proportion of total termination of pregnanciesNIDS
6  Rate of termination of pregnancy at 13–20 weeksPregnancies terminated in health facilities at 13–20 weeks of pregnancy as a proportion of total termination of pregnanciesNIDS
7  Rate of termination of pregnancy in women aged under 20 yearsTermination of pregnancy in women aged under 20 years as a proportion of total termination of pregnancies in health facilitiesNIDS
8Pregnancy/Family and communityHealthy behavioursOHH with pregnancy care rateOHH with pregnancy care as proportion of households visited by the Ward-Based Outreach TeamNIDS
 Danger sign recognition and emergency preparedness  
9Pregnancy/Primary health facilityAntenatal care (with PMTCT)Rate of antenatal 1st visit before 20 weeksWomen who have a booking visit (first visit) before they are 20 weeks into their pregnancy as proportion of all antenatal 1st visitsNIDS
10Antenatal 1st visit coverageThe proportion of potential antenatal clients coming for at least one (booking) antenatal visit; the census number of children under 1 year factorised by 1.15 is used as a proxy denominator – the extra 0.15 (15%) is a rough estimate to cater for late miscarriages (~10 to 26 weeks), stillbirths (after 26 weeks gestation) and infant mortality; pregnant women are regarded as potential antenatal clients from around 10 weeks’ gestation, i.e. spontaneous abortions before that as well as termination of pregnancy cases are excludedNIDS
11Antenatal client HIV re-test rate: retesting among positive HIV clientsAntenatal clients re-tested for HIV as proportion of antenatal clients tested negative for 1st HIV tests done during current pregnancyNIDS
12Percentage of antenatal clients starting on ARTAntenatal clients who started on ART as a proportion of the total number of antenatal clients who are HIV positive and not previously on ARTNIDS
13Percentage of syphilis-positive pregnant women receiving Benz-penicillin 1st doseSyphilis-positive pregnant women who received Benz-penicillin 1st dose as a proportion of pregnant women who tested positive for syphilisDHIS
14  Percentage of syphilis-positive pregnant female receiving Benz-penicillin 2nd doseSyphilis-positive pregnant women receive Benz-penicillin 2nd dose as a proportion of pregnant women who tested positive for syphilisDHIS
15  Percentage of syphilis-positive pregnant women receiving Benz-penicillin 3rd doseSyphilis-positive pregnant women receive Benz-penicillin 3rd dose as a proportion of pregnant women who tested positive for syphilisDHIS
 Pregnancy/District hospitalReproductive careEmergency pregnancy care  
16Birth/Primary health facilityCare for normal delivery and PMTCTDelivery in facility rateDeliveries in health facilities as proportion of expected deliveries in the population; expected deliveries are estimated as population under 1 year multiplied by 1.025 to compensate for stillbirths and infant mortalityNIDS
17Birth/District hospitalEmergency childbirth careRate of caesarean section deliveryDelivery by caesarean section as a proportion of total deliveries in health facilitiesNIDS
18Post-natal care/Family and communityRecognition of danger signs and care-seekingRate of OHH with postnatal careOHH with postnatal care provided to a mother and/or neonate within 6 days after delivery as proportion of households visited by the Ward-Based Outreach TeamNIDS
19Post-natal care/Primary health facilityEarly detection and referral of complicationsRate of mother postnatal visit within 6 daysMothers who received postnatal care within 6 days after delivery as proportion of deliveries in health facilitiesNIDS
20Quality of care/Primary health facilityCross-cuttingRate for Ideal Clinic StatusFixed primary healthcare facilities that have obtained Ideal Clinic status; Ideal Clinic status is a score of 70% or more on assessment of the facility readiness to provide good quality of care along the following main dimensions: 1. Administration, 2. Integrated Clinical Services Management, 3. Medicines, Supplies and Laboratory Services, 4. Human Resources for Health, 5. Support Services, 6. Infrastructure, 7. Health Information Management, 8. Communication, 9. District Health System Support, 10. Implementing Partners and StakeholdersNIDS
21Quality of care/District HospitalCross-cuttingPerformance on National Core StandardsHospitals that achieved a performance of 75% or more on National Core Standards self-assessment; National Core Standards measure: 1. Patient Rights, 2. Patient Safety, Clinical Governance and Clinical Care, 3. Clinical Support Services, 4. Public Health, 5. Leadership and Governance, 6. Operational Management, 7. Facilities and InfrastructureNIDS
22Linkages of care/Cross-cuttingCross-cuttingRate of obstetric clients transportedObstetric clients as a proportion of total EMS clients transportedNIDS
23Rate of rural obstetric response under 40 minPrimary obstetric calls responded to under 40 min in a rural area as a proportion of EMS P1 rural obstetric calls totalNIDS
24Rate of urban obstetric response under 15 minPrimary Obstetric calls responded to under 15 min in an urban area as a proportion of EMS P1 urban obstetric calls totalNIDS
25  Rate of obstetric emergency rural inter-facility transfer under 60 minEmergency obstetric inter-facility transfers response times under 60 min as a proportion of EMS obstetric rural inter-facility transfersNIDS
26  Rate of obstetric emergency urban inter-facility transfer under 30 minEmergency obstetric inter-facility transfers response times under 30 min as a proportion of EMS obstetric urban inter-facility transfersNIDS
27Cross-cutting/Community (intersectoral factors)Water and sanitationEnvironmental health: domestic water compliance rateDomestic bacteriological and chemical water samples taken from Water Services Authorities and water service intermediaries at a point of use that conform to the standards set out in South African National Standard 241 for drinking water quality and safety as a proportion of water samples collectedNIDS
28 Water and sanitationPercentage of women aged 15–49 years drinking safe waterProportion of women aged 15–49 years in households that perceive their water to be safeGHS
29Percentage of women aged 15–49 years in households with adequate water infrastructureProportion of women aged 15–49 years in households with adequate water supply infrastructureGHS
30Percentage of women aged 15–49 years with basic sanitation facilityProportion of women aged 15–49 years in households with basic sanitation facilitiesGHS
31HousingPercentage of women aged 15–49 years with access to electricityProportion of women aged 15–49 years in households with access to electricityGHS
32Percentage of women aged 15–49 years living in adequate housingProportion of women aged 15–49 years living in households with ‘good’ or ‘very good’ wall, roof, and floor condition of the dwellingGHS
33Percentage of women aged 15–49 years living in formal housingProportion of women aged 15–49 years in housing classified as formal housing (by Regional Development Plan plan)GHS
34NutritionPercentage of women aged 15–49 years who have adequate food accessThe mean proportion of women aged 15–49 years in households that ‘never’ had insufficient food, run out of money for food, cut the size of meals, skip a meal, or small variety of mealsGHS
35Household Dietary Diversity ScoreThe Household Dietary Diversity Score by consumption of between 0 and 10 food groups, in households with women 15–49 years of ageGHS
36EducationPercentage of women aged 15–49 years who are literateProportion of women aged 15–49 years who achieved grade 8 or moreGHS
37EmpowermentPercentage of women aged 15–49 years with medical aidProportion of women aged 15–49 years who have medical aidGHS
38Percentage of women aged 15–49 years with income sourceProportion of women aged 15–49 years with at least one of social grant, working for wage/commission/salary, or involved in business activitiesGHS
  1. ART antiretroviral therapy, DHIS District Health Information System, EMS Emergency medical services, GHS General Household Survey, NIDS National Indicator Data Set, OHH Outreach to Households, PMTCT prevention of mother-to-child transmission