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
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 | |