Monitoring and Evaluation Outcomes Associated With Strategies to Reduce the Third Delay in Zambia, 2011–2016 (N=110 facilities)

%Relative ChangebSig. Levelc
Strategy 1: Ensure facilities have adequate infrastructure to provide EmONC
Total number of EMONC facilities71385.7N/A
Number of CEmONC facilities4525.0N/A
Number of BEmONC facilities38166.7N/A
Deliveries in EmONC facilities26.0%29.1%12.2***
Hospitals that perform blood transfusionsd100.0%83.3%−16.7N/A
Hospitals that have capacity to perform surgery (caesarean section)d83.3%83.3%0.0NS
Facilities with electricity55.5%92.7%67.0***
Facilities with water90.0%97.3%8.1**
Strategy 2: Ensure sufficient medical supplies and medications
Facilities experiencing no stock out of oxytocin in the past 12 monthse75.3%75.0%−0.4NS
Facilities experiencing no stock out of magnesium sulfate in the past 12 monthse20.0%43.0%115.0***
Facilities reporting gentamycin antibiotic currently availablee67.3%48.2%−28.4***
Strategy 3: Ensure sufficient trained health care providers at facilities
Facilities reporting that at least one doctor, nurse, or midwife is on staff90.0%98.8%9.8**
Health centers that are open 24/7f64.8%95.5%47.4***
Facilities reporting EmONC lifesaving interventions performed in the past 3 monthsg
    Parenteral antibiotics79.1%73.6%−7.0NS
    Parenteral oxytocin90.9%95.5%5.1NS
    Parenteral anticonvulsants44.6%40.0%−10.3NS
    Manual removal of placenta39.1%30.0%−23.3NS
    Remove retained products17.3%49.1%183.8***
    Assisted vaginal delivery10.0%15.5%55.0NS
    Newborn resuscitation27.3%74.6%173.3***
Strategy 4: Improve quality of care and ensure care is evidence-based
Facilities that report routine practice of AMTSL71.8%95.5%33.0***
Facilities reporting that obstetric patients never share beds62.7%73.6%17.4NS
Facilities reporting that women never deliver on the floor71.3%83.8%17.5NS
Strategy 5: Ensure referral capacity to support transfers to higher-level care
Facilities with at least 1 method of communication for referralsh44.6%100.0%124.2N/A
Facilities that reported having available transportation (motor vehicle or motorcycle)i55.5%72.7%31.0***
Strategy 6: Support effective maternal and perinatal health surveillance
Facilities with maternal death reviews performed42.5%75.0%76.5**
Hospitals that performed maternal death reviewsd50.0%100.0%100.0N/A
  • a Baseline period was June 2011 to May 2012; endline period was January to December 2016.

  • b Percentage change calculations are based on unrounded numbers.

  • c Asterisks indicate significance levels calculated with a z-statistic using McNemar's as follows: *** = P<.01, ** = P<.05, NS = not significant. In cases where significance testing is not warranted, this is denoted with N/A.

  • d Hospitals (n=6) included in the HFA.

  • e Data were not collected in Kalomo facilities so they were excluded from the analysis.

  • f Health centers (n=88) included in the HFA.

  • g Performance during the previous 3 months preceding the assessment.

  • h Includes two-way radio or mobile phone with service.

  • i Includes motor vehicle, motorcycle, or bicycle.

  • Abbreviations: AMSTL, active management of the third stage of labor; BEmONC, basic emergency obstetric and newborn care; CEmONC, comprehensive emergency obstetric and newborn care; EmONC, emergency obstetric and newborn care; HFA, health facility assessments; N/A, not applicable; NS, not significant; Sig, significance.