Table 1 List of indicators across the continuum of care for maternal health in South Africa
Continuum of care | Domain | Indicators | Definition | Source | |
|---|---|---|---|---|---|
1 | Pre-pregnancy/Family and community | Reproductive health | Female condom distribution coverage | Number 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 coverage | Number 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 | ||
3 | Adolescent/Pre-conception nutrition | Mills fortification compliance rate | Operational 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 inspected | NIDS | |
4 | Pre-pregnancy/Primary health facility | Reproductive health | Couple year protection rate | Women protected against pregnancy by using modern contraceptive methods, including sterilisations, as proportion of female population 15–49 years | NIDS |
5 | Pre-pregnancy/District hospital | Reproductive care | Rate of termination of pregnancy at 0–12 weeks | Pregnancies terminated in health facilities in the first 12 weeks of pregnancy as a proportion of total termination of pregnancies | NIDS |
6 | Rate of termination of pregnancy at 13–20 weeks | Pregnancies terminated in health facilities at 13–20 weeks of pregnancy as a proportion of total termination of pregnancies | NIDS | ||
7 | Rate of termination of pregnancy in women aged under 20 years | Termination of pregnancy in women aged under 20 years as a proportion of total termination of pregnancies in health facilities | NIDS | ||
8 | Pregnancy/Family and community | Healthy behaviours | OHH with pregnancy care rate | OHH with pregnancy care as proportion of households visited by the Ward-Based Outreach Team | NIDS |
Danger sign recognition and emergency preparedness | |||||
9 | Pregnancy/Primary health facility | Antenatal care (with PMTCT) | Rate of antenatal 1st visit before 20 weeks | Women who have a booking visit (first visit) before they are 20 weeks into their pregnancy as proportion of all antenatal 1st visits | NIDS |
10 | Antenatal 1st visit coverage | The 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 excluded | NIDS | ||
11 | Antenatal client HIV re-test rate: retesting among positive HIV clients | Antenatal clients re-tested for HIV as proportion of antenatal clients tested negative for 1st HIV tests done during current pregnancy | NIDS | ||
12 | Percentage of antenatal clients starting on ART | Antenatal clients who started on ART as a proportion of the total number of antenatal clients who are HIV positive and not previously on ART | NIDS | ||
13 | Percentage of syphilis-positive pregnant women receiving Benz-penicillin 1st dose | Syphilis-positive pregnant women who received Benz-penicillin 1st dose as a proportion of pregnant women who tested positive for syphilis | DHIS | ||
14 | Percentage of syphilis-positive pregnant female receiving Benz-penicillin 2nd dose | Syphilis-positive pregnant women receive Benz-penicillin 2nd dose as a proportion of pregnant women who tested positive for syphilis | DHIS | ||
15 | Percentage of syphilis-positive pregnant women receiving Benz-penicillin 3rd dose | Syphilis-positive pregnant women receive Benz-penicillin 3rd dose as a proportion of pregnant women who tested positive for syphilis | DHIS | ||
Pregnancy/District hospital | Reproductive care | Emergency pregnancy care | |||
16 | Birth/Primary health facility | Care for normal delivery and PMTCT | Delivery in facility rate | Deliveries 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 mortality | NIDS |
17 | Birth/District hospital | Emergency childbirth care | Rate of caesarean section delivery | Delivery by caesarean section as a proportion of total deliveries in health facilities | NIDS |
18 | Post-natal care/Family and community | Recognition of danger signs and care-seeking | Rate of OHH with postnatal care | OHH 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 Team | NIDS |
19 | Post-natal care/Primary health facility | Early detection and referral of complications | Rate of mother postnatal visit within 6 days | Mothers who received postnatal care within 6 days after delivery as proportion of deliveries in health facilities | NIDS |
20 | Quality of care/Primary health facility | Cross-cutting | Rate for Ideal Clinic Status | Fixed 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 Stakeholders | NIDS |
21 | Quality of care/District Hospital | Cross-cutting | Performance on National Core Standards | Hospitals 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 Infrastructure | NIDS |
22 | Linkages of care/Cross-cutting | Cross-cutting | Rate of obstetric clients transported | Obstetric clients as a proportion of total EMS clients transported | NIDS |
23 | Rate of rural obstetric response under 40 min | Primary obstetric calls responded to under 40 min in a rural area as a proportion of EMS P1 rural obstetric calls total | NIDS | ||
24 | Rate of urban obstetric response under 15 min | Primary Obstetric calls responded to under 15 min in an urban area as a proportion of EMS P1 urban obstetric calls total | NIDS | ||
25 | Rate of obstetric emergency rural inter-facility transfer under 60 min | Emergency obstetric inter-facility transfers response times under 60 min as a proportion of EMS obstetric rural inter-facility transfers | NIDS | ||
26 | Rate of obstetric emergency urban inter-facility transfer under 30 min | Emergency obstetric inter-facility transfers response times under 30 min as a proportion of EMS obstetric urban inter-facility transfers | NIDS | ||
27 | Cross-cutting/Community (intersectoral factors) | Water and sanitation | Environmental health: domestic water compliance rate | Domestic 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 collected | NIDS |
28 | Water and sanitation | Percentage of women aged 15–49 years drinking safe water | Proportion of women aged 15–49 years in households that perceive their water to be safe | GHS | |
29 | Percentage of women aged 15–49 years in households with adequate water infrastructure | Proportion of women aged 15–49 years in households with adequate water supply infrastructure | GHS | ||
30 | Percentage of women aged 15–49 years with basic sanitation facility | Proportion of women aged 15–49 years in households with basic sanitation facilities | GHS | ||
31 | Housing | Percentage of women aged 15–49 years with access to electricity | Proportion of women aged 15–49 years in households with access to electricity | GHS | |
32 | Percentage of women aged 15–49 years living in adequate housing | Proportion of women aged 15–49 years living in households with ‘good’ or ‘very good’ wall, roof, and floor condition of the dwelling | GHS | ||
33 | Percentage of women aged 15–49 years living in formal housing | Proportion of women aged 15–49 years in housing classified as formal housing (by Regional Development Plan plan) | GHS | ||
34 | Nutrition | Percentage of women aged 15–49 years who have adequate food access | The 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 meals | GHS | |
35 | Household Dietary Diversity Score | The Household Dietary Diversity Score by consumption of between 0 and 10 food groups, in households with women 15–49 years of age | GHS | ||
36 | Education | Percentage of women aged 15–49 years who are literate | Proportion of women aged 15–49 years who achieved grade 8 or more | GHS | |
37 | Empowerment | Percentage of women aged 15–49 years with medical aid | Proportion of women aged 15–49 years who have medical aid | GHS | |
38 | Percentage of women aged 15–49 years with income source | Proportion of women aged 15–49 years with at least one of social grant, working for wage/commission/salary, or involved in business activities | GHS |