Measuring coverage in MNCH: challenges and opportunities in the selection of coverage indicators for global monitoring

PLoS Med. 2013;10(5):e1001416. doi: 10.1371/journal.pmed.1001416. Epub 2013 May 7.

Abstract

Global monitoring of intervention coverage is a cornerstone of international efforts to improve reproductive, maternal, newborn, and child health. In this review, we examine the process and implications of selecting a core set of coverage indicators for global monitoring, using as examples the processes used by the Countdown to 2015 for Maternal, Newborn and Child Survival and the Commission on Accountability for Women's and Children's Health. We describe how the generation of data for global monitoring involves five iterative steps: development of standard indicator definitions and measurement approaches to ensure comparability across countries; collection of high-quality data at the country level; compilation of country data at the global level; organization of global databases; and rounds of data quality checking. Regular and rigorous technical review processes that involve high-level decision makers and experts familiar with indicator measurement are needed to maximize uptake and to ensure that indicators used for global monitoring are selected on the basis of available evidence of intervention effectiveness, feasibility of measurement, and data availability as well as programmatic relevance. Experience from recent initiatives illustrates the challenges of striking this balance as well as strategies for reducing the tensions inherent in the indicator selection process. We conclude that more attention and continued investment need to be directed to global monitoring, to support both the process of global database development and the selection of sets of coverage indicators to promote accountability. The stakes are high, because these indicators can drive policy and program development at the country and global level, and ultimately impact the health of women and children and the communities where they live.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adult
  • Child
  • Child Health Services / standards*
  • Child, Preschool
  • Consensus
  • Developing Countries*
  • Family Characteristics
  • Female
  • Global Health
  • Guideline Adherence
  • Health Care Surveys / standards*
  • Health Services Accessibility / standards
  • Health Services Research / methods
  • Health Services Research / standards*
  • Healthcare Disparities / standards
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Maternal Health Services / standards*
  • Practice Guidelines as Topic
  • Program Evaluation
  • Quality Indicators, Health Care / standards*
  • Research Design
  • Surveys and Questionnaires

Grant support

This work was conducted under the auspices of the Child Health Epidemiology Reference Group (CHERG) for WHO and UNICEF, with financial support from The Bill & Melinda Gates Foundation through their grant to the US Fund for UNICEF. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.