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Table 2 Summary findings of the feasibility of collecting the following proposed SRMNCAH indicators in the humanitarian context of the Democratic Republic of the Congo

From: Feasibility of establishing a core set of sexual, reproductive, maternal, newborn, child, and adolescent health indicators in humanitarian settings: results from a multi-methods assessment in the Democratic Republic of Congo

No. Indicator name Overall % of agencies reporting Overall % of agencies reporting Overall % of agencies reporting Place of collection Facilitators to routine collection Barriers to routine collection Necessary modifications Resources needed for routine collection Exclude/include
Kasai Kasai Central Kasai Oriental
Contraception
1.1 Number of clients initiating contraception 100% 56% 89%   National System for Health Information paper registers
DHIS2
Low and unreliable availability of commodities Need for different contraception modalities # of clients accepting a new modern contraceptive method, by method
Should be coupled with indicators covering use, discontinuation and trained staff on provision of modern contraceptive methods
Training for all primary care providers on the different modalities of contraception Include
1.2 Number of clients receiving emergency contraception 100% 44% 78%   National System for Health Information paper registers
DHIS2
Low and unreliable availability of commodities Need for different contraception modalities Should be coupled with an indicator tracking the number of resources available in clinic and indicator on number trained staff on provision of modern contraceptive methods Training on the new IAFM guidelines Train primary care providers on the different contraceptive modalities that can be used for EC Include
1.3 Percentage of clients adopting modern contraceptive method after delivery 100% 56% 89%   National System for Health Information paper registers
DHIS2
Low and unreliable availability of commodities Need for different contraception modalities N/A N/A Include
1.4 Percentage of clients adopting modern contraceptive method after abortion 100% 11% 78%   N/A Legal status of abortion in DRC
Service not provided Potential risk for patient and primary care provider
N/A N/A Exclude
Comprehensive abortion care
2.1 Number of clients requesting an abortion 0% 0% 11%   N/A Legal status of abortion in DRC
Potential risk for patient and primary care provider
Insufficient data encryption
N/A N/A Exclude
2.2 Number of clients receiving an abortion referral 38% 0% 44%   N/A Legal status of abortion in DRC
Potential risk for patient and primary care provider
Insufficient data encryption
N/A N/A Exclude
2.3 Number of clients receiving an induced abortion 38% 0% 44%   N/A Potential risk for patient and primary care provider
Induced abortions are illegal in the DRC except in limited situations according to the Maputo Protocol; however, this exception has yet to be written into national law. Though care can be provided to clients presenting with having self-induced an abortion, due to its rarity and potential repercussions, this indicator is not collected
Insufficient data encryption
N/A N/A Exclude
2.4 Number of clients presenting for post-abortion care (PAC) 88% 0% 89%   National System for Health Information paper registers
DHIS2
Only secondary and tertiary health facilities are equipped and trained to provide comprehensive PAC N/A Training on the new IAFM guidelines
DHIS2 create anonymity for this indicator (code)
Service mapping of abortion providers who provide abortion services to the fullest extent of the law
Include
2.5 Number of clients receiving PAC 100% 22% 78%   National System for Health Information paper registers
DHIS2
Only secondary and tertiary health facilities are equipped and trained to provide comprehensive PAC N/A Training on the new IAFM guidelines
DHIS2 create anonymity for this indicator (code)
Service mapping of abortion providers who provide abortion services to the fullest extent of the law
Include
Maternal health
3.1 Number of maternal deaths 100% 44% 78%   National System for Health Information paper registers
DHIS2
Weak infrastructures around national registries Perceived risk of sanctions on health facilities if a maternal death is reported # of maternal deaths in the facility, by cause of death Should be disaggregated by cause and coupled with indicators that capture maternal death in the community Increased transparency in auditing practices surrounding maternal death
Resources will need to be developed and implemented at the community level to capture the indicators for the maternal deaths in the community
Include
3.2 Number of maternal deaths, disaggregated 38% 44% 44%   National System for Health Information paper registers
DHIS2
Weak infrastructures around national registries Perceived risk of sanctions on health facilities if a maternal death is reported # of maternal deaths1, disaggregated by age (less than 15 years; between 15 and 19 and equal or greater than 19 years) Training for data collectors on the different causes of maternal death and how to encode for each
Develop detailed manuals for frontline workers and data collectors
Training and capacity building for community health workers
Increased transparency in auditing practices surrounding maternal deaths
Include
3.3 Percentage of maternal death reviews 75% 11% 89%   National System for Health Information paper registers
DHIS2
Weak infrastructures around national registries Perceived risk of sanctions on health facilities if a maternal death is reported # of maternal deaths in the facility that were audited and reviewed French wording should be changed to “revue” as this is how it is reported in DHIS2 Training and capacity building for staff to review on maternal death cases
Training and capacity building for community health workers
Increased transparency in auditing practices surrounding maternal deaths
Include
3.4 Number of clients receiving antenatal care (ANC) 100% 44% 67%   National System for Health Information paper registers
DHIS2
Weak infrastructures around national registries N/A Accessibility to commodities and supplies Include
3.5 Number of deliveries 100% 44% 89%   National System for Health Information paper registers
DHIS2
Weak infrastructures around national registries # of clients delivering in facility, including both live and stillbirths
Should be coupled with indicators to capture births occurring in the community
Frontline workers will need training on reporting on stillbirths
Leveraging systems to capture stillbirths for community births (UNICEF)
Training and capacity building for community health workers
Include
3.6 Number of deliveries, disaggregated 63% 22% 78%   National System for Health Information paper registers
DHIS2
Weak infrastructures around national registries # of clients delivering in facility, including both live and stillbirths, disaggregated by age (less than 15 years; between 15–19 and equal or greater than 19 years) Frontline workers will need training on reporting on stillbirths
Leveraging systems to capture stillbirths for community births (UNICEF)
Training and capacity building for community health workers
Include
3.7 Number of clients receiving post-natal care (PNC) 88% 22% 78%   National System for Health Information paper registers
DHIS2
Weak infrastructures around national registries N/A N/A Include
3.8 Number of caesarean section deliveries 88% 11% 67%   National System for Health Information paper registers
DHIS2
Weak infrastructures around national registries Coupled with an indicator on the number of referrals for cesareans Might not be useful outside of hospital setting Include
3.9 Availability of PAC 100% 22% 67%   N/A Service mapping exercise at the provincial level N/A N/A Exclude
3.10 Availability of basic emergency obstetric care (BEmOC) 88% 33% 89%   N/A Service mapping exercise N/A N/A Exclude
3.11 Availability of comprehensive emergency obstetric care (CEmOC) 88% 22% 78%   N/A Service mapping exercise N/A N/A Exclude
3.12 Availability of skilled personnel 88% 22% 67%   N/A Service mapping exercise N/A N/A Exclude
3.13 Number of antenatal care clients with tetanus vaccination 100% 33% 89%   National System for Health Information paper registers
DHIS2
Weak infrastructures around national registries N/A N/A Include
3.14 Number of ANC clients receiving preventive therapy for malaria 88% 44% 89%   National System for Health Information paper registers
DHIS2
Weak infrastructures around national registries N/A N/A Include
3.15 Number of ANC clients receiving syphilis screening 50% 22% 33%   National System for Health Information paper registers
DHIS2
Weak infrastructures around national registries
Shortage/absence of diagnostic screening tests for Syphilis
N/A N/A Include
3.16 Number of ANC clients receiving urinary tract infection screening or treatment 88% 33% 67%   National System for Health Information paper registers
DHIS2
Weak infrastructures around national registries N/A N/A Include
3.17 Number of clients with identified maternal morbidities during post-natal care (PNC) 75% 33% 78%   National System for Health Information paper registers
DHIS2
Weak infrastructures around national registries N/A N/A Include
Newborn health
4.1 Number of neonatal deaths 75% 44% 67%   National System for Health Information paper registers
DHIS2
Perceived risk of sanctions on health facilities if a neonatal death is reported # of neonatal deaths (0–28) at the facility level
Should be coupled with an indicator tracking neonatal death within the community
Increased transparency in auditing practices surrounding neonatal death audits
Training and capacity building for community health workers
Include
4.2 Number of stillbirths 75% 44% 67%   National System for Health Information paper registers
DHIS2
Perceived risk of sanctions on health facilities if a neonatal death is reported
Infrastructural barriers; lack of roads, electricity, and reliable internet connection
N/A N/A Include
4.3 Number of babies born low birth weight 75% 44% 78%   National System for Health Information paper registers
DHIS2
Infrastructural barriers; lack of roads, electricity, and reliable internet connection Should be coupled with an indicator tracking malnutrition among pregnant women N/A Include
4.4 Number of small and sick newborns receiving care 50% 22% 78%   National System for Health Information paper registers
DHIS2
Infrastructural barriers; lack of roads, electricity, and reliable internet connection N/A N/A Include
4.5 Number of newborns receiving post-natal care 63% 22% 67%   National System for Health Information paper registers
DHIS2
Infrastructural barriers; lack of roads, electricity, and reliable internet connection # of newborns receiving post-natal care within 7–10 days N/A Include
4.6 Availability of KMC 88% 22% 78%   N/A Service mapping exercise N/A N/A Exclude
4.7 Availability of neonatal resuscitation 75% 33% 78%   N/A Service mapping exercise N/A N/A Exclude
4.8 Number of neonatal deaths, disaggregated 63% 11% 67%   National System for Health Information paper registers
DHIS2
Perceived risk of sanctions on health facilities if a neonatal death is reported N/A When reviewing data and making recommendations for health programs, consider the disaggregated indicator
Leverage systems that capture newborn death and review these cases for cause of death
Training and capacity building for of primary care providers
Include
4.9 Percentage of perinatal death reviews 25% 22% 67%   National System for Health Information paper registers
DHIS2
Perceived risk of sanctions on health facilities if a neonatal death is reported French wording should be changed to “revue” as this is how it is reported in DHIS2 In urban settings, national systems would need to be established to capture newborn death and review these cases for cause of death
Training and capacity building of primary care providers
Will need to be added to the DHIS2
Include
4.10 Number of newborns receiving Hepatitis B vaccine 0% 0% 22%   National System for Health Information paper registers
DHIS2
Absence/shortages of the diagnostic screening test for Hepatitis B N/A Will need to be added to the DHIS2
Extensive training and capacity building will need to be implementing for scale-up at the national level
Include
4.11 Number of newborns initiating breastfeeding early 75% 33% 56%   National System for Health Information paper registers
DHIS2
Infrastructural barriers; lack of roads, electricity, and reliable internet connection N/A N/A Include
4.12 Number of infants weighed at birth 75% 11% 56%   National System for Health Information paper registers
DHIS2
Infrastructural barriers; lack of roads, electricity, and reliable internet connection # of newborns weighed at delivery N/A Include
4.13 Number of babies registered 63% 22% 67%   National System for Health Information paper registers
DHIS2
Civil registry is unreliable Distinguish between registration at the facility level and at the state level Civil registries to be integrated into hospitals and clinics
Significant training and resources will need be implemented
Include
4.14 Number of newborns receiving treatment for possible severe bacterial infection (PSBI) 63% 0% 56%   National System for Health Information paper registers
DHIS2
Infrastructural barriers; lack of roads, electricity, and reliable internet connection N/A Significant training and resources will need be implemented Include
4.15 Number of newborns admitted 25% 11% 44%   National System for Health Information paper registers
DHIS2
Infrastructural barriers; lack of roads, electricity, and reliable internet connection N/A N/A Include
4.16 Number of newborns with morbidities identified during PNC 38% 0% 44%   National System for Health Information paper registers
DHIS2
Infrastructural barriers; lack of roads, electricity, and reliable internet connection N/A Resources for primary care providers on the definitions for morbidity type
Will need to be added to the DHIS2
Extensive training and capacity building of primary care providers
Include
Child health
5.1 Number of deaths of children under 5 88% 0% 44%   National System for Health Information paper registers
DHIS2
Lack of integration of child health into routine service delivery as a category of its own N/A Training and outreach programs will need to be implemented at the health facility and community level
Child health indicators to be integrated into routine service delivery as a specific area of its own, including for data collection
Include
5.2 Under 5 mortality rate 25% 0% 33%   N/A Population-level indicator with impractical denominator N/A N/A Exclude
5.3 Percentage of children under 5 with suspected pneumonia taken to appropriate health facility 50% 14% 33%   N/A Population-level indicator with impractical denominator N/A N/A Exclude
5.4 Coverage of diarrhea treatment 50% 14% 44%   National System for Health Information paper registers
DHIS2
Lack of integration of child health into routine service delivery as a category of its own N/A Child health indicators to be integrated into routine service delivery as a specific area of its own, including for data collection Include
5.5 Percentage of children under 5 who are wasted 38% 0% 44%   N/A Low burden of disease, population-level indicator with impractical denominator N/A N/A Exclude
5.6 Percentage of children under 5 who are registered 25% 0% 56%   N/A The denominator of this indicator is not feasible since population level metrics are often unreliable in the DRC N/A N/A Exclude
5.7 Number of children presenting with fever tested for malaria in endemic settings 50% 14% 56%   National System for Health Information paper registers
DHIS2
Reported solely for donors; not integrated into national HIS # of children under 5 who have been administered outpatient malaria tests, by age Child health indicators to be integrated into routine service delivery as a specific area of its own, including for data collection Include
5.8 Number of confirmed cases of malaria in endemic settings 50% 14% 56%   National System for Health Information paper registers
DHIS2
Reported solely for donors; not integrated into national HIS N/A Child health indicators to be integrated into routine service delivery as a specific area of its own, including for data collection Include
5.9 Percentage of confirmed malaria cases treated 50% 14% 56%   National System for Health Information paper registers
DHIS2
Reported solely for donors; not integrated into national HIS N/A Child health indicators to be integrated into routine service delivery as a specific area of its own, including for data collection Include
5.10 Coverage of DP3 50% 14% 56%   National System for Health Information paper registers
DHIS2
Lack of integration of child health into routine service delivery as a category of its own N/A Child health indicators to be integrated into routine service delivery as a specific area of its own, including for data collection Include
Adolescent health
6.1 Adolescent birth rate 25% 14% 33%   N/A Population-level indicator with impractical denominator N/A N/A Exclude
6.2 Sexual violence against children 63% 25% 33%   N/A Lack of integration of adolescent health services tailored to this population’s unique needs N/A N/A Exclude
6.3 Adolescent mortality rate 0% 0% 11%   N/A Population-level indicator with impractical denominator N/A N/A Exclude
6.4 Percentage of adolescents living with HIV who are currently receiving antiretroviral therapy, disaggregated Could be collected   Organizations in the DRC do not actively collect disaggregated data yet the information could be extracted from the HIS Lack of integration of adolescent health services tailored to this population's unique needs # of adolescents living with HIV who are currently receiving antiretroviral therapy, disaggregated by age (less than 15 years; between 15 and 19 and equal or greater than 19 years)
Removal of the denominator
Significant training and capacity development for frontline staff on adolescent health indicator reporting
Will need to be added to the DHIS2
Include
6.5 Immunization coverage rate Could be collected   Organizations in the DRC do not actively collect disaggregated data yet the information could be extracted from the HIS Lack of integration of adolescent health services tailored to this population's unique needs # of adolescents receiving the nationally mandated immunization, disaggregated by age (less than 15 years; between 15–19 and equal or greater than 19 years)
Removal of the denominator
Significant training and capacity development for frontline staff on adolescent health indicator reporting
Will need to be added to the DHIS2
Include
6.6 Suicide rate, disaggregated 0% 0% 22%   N/A Population-level indicator with impractical denominator
Low burden of disease
N/A N/A Exclude
Sexual and gender-based violence
7.1 Number of rape survivors 88% 50% 78%   National System for Health Information paper registers
DHIS2
Current indicators do not capture the cultural and community interventions surrounding SGBV N/A An anonymous code should be assigned to each survivor to avoid duplication of data Include
7.2 Percentage of health facilities with clinical management of rape services 63% 43% 67%   N/A Service mapping exercise N/A N/A Exclude
7.3 Percentage of rape survivors receiving HIV post-exposure prophylaxis 63% 29% 67%   National System for Health Information paper registers
DHIS2
Current indicators do not capture the cultural and community interventions surrounding SGBV Should be coupled with indicators capturing referrals and availability of supplies Significant training for the entire health care team
Training on the new IAFM
Inclusion of community leaders
Inclusion of judicial system
Training and outreach for community leaders
Changes in the DHIS2 will need to be made to avoid duplicity in the data reporting
Training in clinical management of HIV
Increased availability/supply of PEP kits
Coordination with the Justice System
Include
7.4 Percentage of rape survivors receiving emergency contraception 88% 38% 67%   National System for Health Information paper registers
DHIS2
Current indicators do not capture the cultural and community interventions surrounding SGBV Should be coupled with indicators capturing referrals and availability of supplies Significant training for the entire health care team
Training on the new IAFM
Training and outreach for community leaders
Inclusion of judicial system
Changes in the DHIS2 will need to be made to avoid duplicity in the data reporting
Coordination with the Justice System
Include
7.5 Number of rape survivors requesting abortion 13% 0% 11%   N/A Though it is technically legal to receive an abortion due to rape according to the Maputo Protocol, this exception has yet to be written into national law. As such, this indicator is not collected N/A N/A Exclude
7.6 Number of rape survivors receiving induced abortion care or referral 25% 0% 44%   N/A Though it is technically legal to receive an abortion due to rape according to the Maputo Protocol, this exception has yet to be written into national law. Though care will be provided to clients presenting with abortion, due to its rarity and potential repercussions, this indicator is not collected N/A N/A Exclude
7.7 Availability of intimate partner violence front line support (LIVES) 25% 13% 44%   N/A Service is not routinely provided N/A N/A Exclude
HIV
8.1 Antiretroviral therapy coverage among people living with HIV, disaggregated 38% 38% 56%   National System for Health Information paper registers
DHIS2
Supply and training shortages N/A Training in clinical management of HIV Include
8.2 Percentage of exposed individuals receiving post-exposure prophylaxis 38% 38% 56%   National System for Health Information paper registers
DHIS2
Supply and training shortages N/A Training in clinical management of HIV Include
8.3 Percentage of donated blood units screened for HIV in quality assured manner 38% 13% 56%   National System for Health Information paper registers
DHIS2
Supply and training shortages N/A Training in clinical management of HIV
Might not be useful outside of hospital setting
Include
Prevention of mother-to-child transmission
9.1 Percentage of antenatal care clients receiving syphilis screening and treatment 50% 25% 44%   National System for Health Information paper registers
DHIS2
Shortage/absence of diagnostic screening tests for Syphilis N/A Training in clinical management of HIV
Might not be useful outside of hospital setting
Include
9.2 Percentage of antenatal care clients offered testing for HIV 50% 25% 56%   National System for Health Information paper registers
DHIS2
Supply and training shortages # of first-time antenatal care clients who received pre-testing counselling for HIV Training in clinical management of HIV Include
9.3 Percentage of HIV-positive pregnant people receiving antiretroviral therapy 63% 25% 44%   National System for Health Information paper registers
DHIS2
Supply and training shortages N/A Training in clinical management of HIV Include
9.4 Percentage of all deliveries to HIV-positive mothers receiving antiretrovirals 50% 25% 44%   National System for Health Information paper registers
DHIS2
Supply and training shortages #of HIV-positive mothers who receive ART according to national protocol
Should be coupled with an indicator for the infant also receiving ART
Training in clinical management of HIV Include
Sexually transmitted infections (STIs) and reproductive tract infections (RTIs)
10.1 Percentage of STI/RTI cases managed 75% 15% 78%   National System for Health Information paper registers
DHIS2
Infrastructural barriers; lack of roads, electricity, and reliable internet connection # of patients with STI/RTI accessing services who are diagnosed symptomatically, and counselled according to protocol
Distinguish between the number of cases and the number of cases “managed”
STI and RTI cases need to be formulated as separate indicators
Training on how to identify and report on STI/RTIs
Training on the clinical management of STI/RTI cases
Include
  1. Italicized text refers to current description of indicator