Establishing a baseline to measure change
This paper is part of a series of articles on Evidence for Action (E4A) to be published in the International Journal of Gynecology and Obstetrics (IJGO).
The programme, E4A, that launched the MamaYe campaign, is funded by the UK Government’s Department for International Development.
It aims to improve maternal and neonatal health (MNH) outcomes in six African countries using a combination of evidence and advocacy to generate greater political accountability for maternal and newborn health (MNH).
This paper outlines the methods used to collect baseline data in the six countries that E4A works in: Ethiopia, Ghana, Malawi, Nigeria, Sierra Leone, and Tanzania. These data are used to monitor E4A’s progress and inform program design.
The paper is co-authored by E4A’s Monitoring and Evaluation Lead, Programme Director, Accountability Lead, and Evidence Lead.
Two questionnaire-based tools were developed specifically for E4A to assess the baseline situation for the program:
1) The Politics, Power, and Perceptions (PPP) tool
2) The Data for Decision-Making (DDM) toolThe PPP tool assesses the level of political will to improve MNH outcomes. It collects information on three specific areas, namely social and political perceptions of MNH care, the level of political priority given to MNH, and the accountability and governance structures that support MNH care.
The DDM tool assesses how far key decision-makers make use of MNH data to prioritise, plan, and allocate resources for MNH care. A crucial component of this is timely access to the data they need and in formats that are useful to them. The tool also collects information about why data are not being fully utilised.
Baseline data were collected in 2012-2013 using a purposive sample of 40-60 key informant interviews in each of the six countries. Participants included national, district, and facility-level representatives.
Data will also be collected at E4A’s mid-point (2014) and end-point (2016) allowing for a time trend analysis of changes in political will and the use of data for decision-making. Where possible, the same individuals will be interviewed to maximise comparability.
Key findings and facts
The DDM tool found that most participants who are responsible for generating, analysing, or using MNH data (e.g. government ministers, national statisticians etc.) are able to access data on use of MNH services and MNH outcomes. However, the results of the PPP questionnaire suggested that these data were not accessible to people outside of the MNH care system.
More specifically, respondents in all six countries reported:
- A lack of public access to information on the health and MNH budget, and information on MNH outcomes
- An uneven distribution of MNH resources
- A sense that politicians do not fully understand the priority needs of their constituents
The paper suggests that some of the main challenges underlying these issues include poor data collection and dissemination systems, and insufficient human resource capacity to generate high-quality, useful data.
Conclusions and key recommendations
There is significant room to improve access to and use of existing evidence for decision-making in MNH care, especially at subnational levels.