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

Abstract Background: Reliable and rigorously collected sexual, reproductive, maternal, newborn, child, and adolescent health (SRMNCAH) data in humanitarian settings are often sparse and variable in quality across different humanitarian settings. To address this gap in quality data, the World Health Organization (WHO) developed a core set of indicators for monitoring and evaluating SRMNCAH services and outcomes and assessed their feasibility in four countries, including the Democratic Republic of Congo (DRC) with the goal of aggregating information from global consultations and field-level assessments to reach consensus on a set of core SRMNCAH indicators among WHO partners. Methods: The feasibility assessment in DRC focused on the following constructs: relevance/usefulness, feasibility of measurement, systems and resources, and ethical issues. The multi-methods assessment included five components; a desk review, key informant interviews, focus group discussions, facility assessments, and observational sessions. Results: The findings suggest that there is widespread support among stakeholders for developing a standardized core list of SRMNCAH indicators to be collected among all humanitarian actors in DRC. There are numerous resources and data collection systems that could be leveraged, built upon, and improved to ensure the feasibility of collecting this proposed set of indicators. However, the data collection load requested from donors, the national government, international and UN agencies, coordination/cluster systems must be better harmonized, standardized, and less burdensome. Conclusions: Despite stakeholder support in developing a core set of indicators, this would only be useful if it has the buy-in from the international community. Greater harmonization and coordination, alongside increased resource allocation, would improve data collection efforts and allow stakeholders to meet indicators’ reporting requirements.

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Exploring the feasibility of establishing a core set of sexual, reproductive, maternal, newborn, child and adolescent health indicators in humanitarian settings: a multimethods, multicountry qualitative study protocol

BMJ Open ◽

10.1136/bmjopen-2020-041270 ◽

2021 ◽

Vol 11 (12) ◽

pp. e041270

Author(s):

Loulou Hassan Kobeissi ◽

Manizha Ashna ◽

Kassandre Messier ◽

Allisyn C Moran ◽

Lale Say ◽

...

Keyword(s):

Reproductive Health ◽

Qualitative Study ◽

Adolescent Health ◽

Sexual And Reproductive Health ◽

Child And Adolescent ◽

World Health ◽

Humanitarian Settings ◽

Child And Adolescent Health ◽

Core Set ◽

Newborn Child

IntroductionIn 2019, over 70 million people were forcibly displaced worldwide. Women and girls comprise nearly half of this population and are at heightened risk of negative sexual and reproductive health outcomes. With the collapse of health systems, reduced resources and increased vulnerabilities from displacement, there is a need to strengthen current practices and ensure the delivery of comprehensive sexual, reproductive, maternal, newborn, child and adolescent health (SRMNCAH) services. Recognising the need for consistency in data collection, analysis and use, the WHO developed a list of core SRMNCAH monitoring and evaluation indicators for services and outcomes in humanitarian settings. This research will explore the feasibility of collecting this core set of SRMNCAH indicators in displacement contexts.Methods and analysisWe will undertake a multimethods qualitative study in seven humanitarian settings: Afghanistan, Albania, Bangladesh, Cameroon, the Democratic Republic of the Congo, Iraq and Jordan. We selected sites that reflect diversity in geographic region, sociocultural characteristics, primary location(s) of displaced persons and nature and phase of the crisis. Our study consists of four components: key informant interviews, facility assessments, observational sessions at select facilities and focus group discussions with front-line healthcare personnel. We will analyse our data using descriptive statistics and for content and themes. We will begin by analysing data from each setting separately and will then combine these data to explore concordant and discordant results, triangulate findings and develop global recommendations.Ethics and disseminationThe University of Ottawa’s Research Ethics Board and the Research Project Review Panel (RP 2) of the World Health Organization-Department of Sexual and Reproductive Health as well as local IRBs of PIs’ research institutions reviewed and approved this protocol. We intend to disseminate findings through workshops at the WHO country, regional and headquarter levels, as well as through local, national and international conferences, workshops, peer-reviewed publications, and reports.

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Methods to measure effects of social accountability interventions in reproductive, maternal, newborn, child, and adolescent health programs: systematic review and critique

Journal of Health Population and Nutrition ◽

10.1186/s41043-020-00220-z ◽

2020 ◽

Vol 39 (1) ◽

Author(s):

Cicely Marston ◽

Catherine R. McGowan ◽

Victoria Boydell ◽

Petrus Steyn

Keyword(s):

Data Collection ◽

Health Effects ◽

Adolescent Health ◽

Qualitative Data ◽

Child And Adolescent ◽

Social Accountability ◽

Data Collection Methods ◽

Child And Adolescent Health ◽

Newborn Child ◽

Collection Methods

Abstract Background There is no agreed way to measure the effects of social accountability interventions. Studies to examine whether and how social accountability and collective action processes contribute to better health and healthcare services are underway in different areas of health, and health effects are captured using a range of different research designs. Objectives The objective of our review is to help inform evaluation efforts by identifying, summarizing, and critically appraising study designs used to assess and measure social accountability interventions' effects on health, including data collection methods and outcome measures. Specifically, we consider the designs used to assess social accountability interventions for reproductive, maternal, newborn, child, and adolescent health (RMNCAH). Data sources Data were obtained from the Cochrane Library, EMBASE, MEDLINE, SCOPUS, and Social Policy & Practice databases. Eligibility criteria We included papers published on or after 1 January 2009 that described an evaluation of the effects of a social accountability intervention on RMNCAH. Results Twenty-two papers met our inclusion criteria. Methods for assessing or reporting health effects of social accountability interventions varied widely and included longitudinal, ethnographic, and experimental designs. Surprisingly, given the topic area, there were no studies that took an explicit systems-orientated approach. Data collection methods ranged from quantitative scorecard data through to in-depth interviews and observations. Analysis of how interventions achieved their effects relied on qualitative data, whereas quantitative data often raised rather than answered questions, and/or seemed likely to be poor quality. Few studies reported on negative effects or harms; studies did not always draw on any particular theoretical framework. None of the studies where there appeared to be financial dependencies between the evaluators and the intervention implementation teams reflected on whether or how these dependencies might have affected the evaluation. The interventions evaluated in the included studies fell into the following categories: aid chain partnership, social audit, community-based monitoring, community-linked maternal death review, community mobilization for improved health, community reporting hotline, evidence for action, report cards, scorecards, and strengthening health communities. Conclusions A wide range of methods are currently being used to attempt to evaluate effects of social accountability interventions. The wider context of interventions including the historical or social context is important, as shown in the few studies to consider these dimensions. While many studies collect useful qualitative data that help illuminate how and whether interventions work, the data and analysis are often limited in scope with little attention to the wider context. Future studies taking into account broader sociopolitical dimensions are likely to help illuminate processes of accountability and inform questions of transferability of interventions. The review protocol was registered with PROSPERO (registration # CRD42018108252).

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Setting research priorities for sexual, reproductive, maternal, newborn, child and adolescent health in humanitarian settings

Conflict and Health ◽

10.1186/s13031-021-00353-w ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Loulou Kobeissi ◽

◽

Mahalakshmi Nair ◽

Egmond Samir Evers ◽

Mansuk Daniel Han ◽

...

Keyword(s):

Child Health ◽

Adolescent Health ◽

Research Agenda ◽

Research Priorities ◽

Child And Adolescent ◽

Delphi Process ◽

Humanitarian Settings ◽

Child And Adolescent Health ◽

Newborn Child ◽

Research Questions

Abstract Background An estimated 70.8 million people are forcibly displaced worldwide, 75% of whom are women and children. Prioritizing a global research agenda to inform guidance, service delivery, access to and quality of services is essential to improve the survival and health of women, children and adolescents in humanitarian settings. Method A mixed-methods design was adapted from the Child Health and Nutrition Research Initiative (CHNRI) methodology to solicit priority research questions across the sexual, reproductive, maternal, newborn, child and adolescent health (SRMNCAH) domains in humanitarian settings. The first step (CHNRI) involved data collection and scoring of perceived priority questions, using a web-based survey over two rounds (first, to generate the questions and secondly, to score them). Over 1000 stakeholders from across the globe were approached; 177 took part in the first survey and 69 took part in the second. These research questions were prioritized by generating a research prioritization score (RPP) across four dimensions: answerability, program feasibility, public health relevance and equity. A Delphi process of 29 experts followed, where the 50 scored and prioritized CHRNI research questions were shortlisted. The top five questions from the CHNRI scored list for each SRMNCAH domain were voted on, rendering a final list per domain. Results A total of 280 questions were generated. Generated questions covered sexual and reproductive health (SRH) (n = 90, 32.1%), maternal health (n = 75, 26.8%), newborn health (n = 42, 15.0%), child health (n = 43, 15.4%), and non-SRH aspects of adolescent health (n = 31, 11.1%). A shortlist of the top ten prioritized questions for each domain were generated on the basis of the computed RPPs. During the Delphi process, the prioritized questions, based on the CHNRI process, were further refined. Five questions from the shortlist of each of the SRMNCAH domain were formulated, resulting in 25 priority questions across SRMNCAH. For example, one of the prioritized SRH shortlisted and prioritized research question included: “What are effective strategies to implement good quality comprehensive contraceptive services (long-acting, short-acting and EC) for women and girls in humanitarian settings?” Conclusion Data needs, effective intervention strategies and approaches, as well as greater efficiency and quality during delivery of care in humanitarian settings were prioritized. The findings from this research provide guidance for researchers, program implementers, as well as donor agencies on SRMNCAH research priorities in humanitarian settings. A global research agenda could save the lives of those who are at greatest risk and vulnerability as well as increase opportunities for translation and innovation for SRMNCAH in humanitarian settings.

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Mapping the evidence on social, behavioural and community engagement for reproductive, maternal, newborn, child and adolescent health

10.23846/b/egm/20174 ◽

2017 ◽

Cited By ~ 1

Keyword(s):

Community Engagement ◽

Adolescent Health ◽

Child And Adolescent ◽

Child And Adolescent Health ◽

Newborn Child

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Countdown to 2030 for reproductive, maternal, newborn, child, and adolescent health and nutrition

The Lancet Global Health ◽

10.1016/s2214-109x(16)30204-2 ◽

2016 ◽

Vol 4 (11) ◽

pp. e775-e776 ◽

Cited By ~ 20

Author(s):

Cesar Victora ◽

Jennifer Requejo ◽

Ties Boerma ◽

Agbessi Amouzou ◽

Zulfiqar A Bhutta ◽

...

Keyword(s):

Adolescent Health ◽

Child And Adolescent ◽

Child And Adolescent Health ◽

Health And Nutrition ◽

Newborn Child

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Correction: Setting an implementation research agenda for Canadian investments in global maternal, newborn, child and adolescent health: a research prioritization exercise

CMAJ Open ◽

10.9778/cmajo.20180180 ◽

2018 ◽

Vol 6 (4) ◽

pp. E537-E537

Keyword(s):

Adolescent Health ◽

Implementation Research ◽

Research Agenda ◽

Child And Adolescent ◽

Research Prioritization ◽

Child And Adolescent Health ◽

Newborn Child

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Geospatial analysis for reproductive, maternal, newborn, child and adolescent health: gaps and opportunities

BMJ Global Health ◽

10.1136/bmjgh-2019-001702 ◽

2019 ◽

Vol 4 (Suppl 5) ◽

pp. e001702 ◽

Cited By ~ 4

Author(s):

Zoe Matthews ◽

Barbara Rawlins ◽

Jennifer Duong ◽

Yordanos B Molla ◽

Allisyn C Moran ◽

...

Keyword(s):

Adolescent Health ◽

Child And Adolescent ◽

Geospatial Analysis ◽

Child And Adolescent Health ◽

Newborn Child

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Assessment of Inequalities in Coverage of Essential Reproductive, Maternal, Newborn, Child, and Adolescent Health Interventions in Kenya

JAMA Network Open ◽

10.1001/jamanetworkopen.2018.5152 ◽

2018 ◽

Vol 1 (8) ◽

pp. e185152 ◽

Cited By ~ 6

Author(s):

Emily Catherine Keats ◽

Nadia Akseer ◽

Zaid Bhatti ◽

William Macharia ◽

Anthony Ngugi ◽

...

Keyword(s):

Adolescent Health ◽

Child And Adolescent ◽

Health Interventions ◽

Child And Adolescent Health ◽

Newborn Child

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Tracking development assistance for reproductive, maternal, newborn, child and adolescent health in conflict-affected countries

BMJ Global Health ◽

10.1136/bmjgh-2019-001614 ◽

2019 ◽

Vol 4 (4) ◽

pp. e001614 ◽

Cited By ~ 2

Author(s):

Zhihui Li ◽

Linda Richter ◽

Chunling Lu

Keyword(s):

Adolescent Health ◽

Burden Of Disease ◽

Development Assistance ◽

Child And Adolescent ◽

Communicable Diseases ◽

Maternal And Newborn Health ◽

Non Communicable Diseases ◽

Child And Adolescent Health ◽

Life Years ◽

Newborn Child

BackgroundLittle is known about the patterns of development assistance (DA) for each component of reproductive, maternal, newborn, child and adolescent health (RMNCAH) in conflict-affected countries nor about the DA allocation in relation to the burden of disease.MethodsWe tracked DA to RMNCAH in general and to each of its four components: reproductive health (RH), maternal and newborn health (MNH), child health (CH) and adolescent health (AH), in 25 conflict-affected countries between 2003 and 2017. We compared DA and disability-adjusted life years (DALYs) for each component. Using keyword searching and funding allocation methods, we produced two sets of estimates: DA primarily targeting RMNCAH (lower bound) and DA both primarily and partially for RMNCAH or DA not explicitly targeting RMNCAH but benefiting it (upper bound).FindingsBetween 2003 and 2017, we identified 46 833 projects among the 25 countries that targeted RMNCAH. During the study period, DA to RMNCAH increased by seven-fold from $0.5 billion to $3.6 billion, with a slowdown since 2013. Cumulatively, RH received the largest proportion of DA to RMNCAH (50%) with 84% of its funding earmarked for HIV/AIDS, which contributed to less than 6% of the total RMNCAH-related DALYs. AH received 3% of the DA-RMNCAH but contributed 15% to the RMNCAH-related DALYs. Non-communicable diseases caused more than one-third of the DALYs among adolescents, but received only 3% of DA to AH. RMNCAH-inclusive estimates showed consistent results.ConclusionWhile there was a substantial increase in funding to RMNCAH in conflict-affected countries over the period of study, some health issues with high disease burden (eg, AH and non-communicable diseases) received a disproportionately small portion of aid for RMNCAH. We recommend that donors increase investment to RMNCAH in conflict-affected countries, particularly in areas where the burden of disease or the potential benefit of investment is likely to be high.

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