Monitoring and Evaluation Outcomes Associated With Strategies to Reduce the Third Delay in Zambia, 2011–2016 (N=110 facilities)
| Indicators | Baselinea Value | Endlinea Value | %Relative Changeb | Sig. Levelc |
|---|---|---|---|---|
| Strategy 1: Ensure facilities have adequate infrastructure to provide EmONC | ||||
| Total number of EMONC facilities | 7 | 13 | 85.7 | N/A |
| Number of CEmONC facilities | 4 | 5 | 25.0 | N/A |
| Number of BEmONC facilities | 3 | 8 | 166.7 | N/A |
| Deliveries in EmONC facilities | 26.0% | 29.1% | 12.2 | *** |
| Hospitals that perform blood transfusionsd | 100.0% | 83.3% | −16.7 | N/A |
| Hospitals that have capacity to perform surgery (caesarean section)d | 83.3% | 83.3% | 0.0 | NS |
| Facilities with electricity | 55.5% | 92.7% | 67.0 | *** |
| Facilities with water | 90.0% | 97.3% | 8.1 | ** |
| Strategy 2: Ensure sufficient medical supplies and medications | ||||
| Facilities experiencing no stock out of oxytocin in the past 12 monthse | 75.3% | 75.0% | −0.4 | NS |
| Facilities experiencing no stock out of magnesium sulfate in the past 12 monthse | 20.0% | 43.0% | 115.0 | *** |
| Facilities reporting gentamycin antibiotic currently availablee | 67.3% | 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 staff | 90.0% | 98.8% | 9.8 | ** |
| Health centers that are open 24/7f | 64.8% | 95.5% | 47.4 | *** |
| Facilities reporting EmONC lifesaving interventions performed in the past 3 monthsg | ||||
| Parenteral antibiotics | 79.1% | 73.6% | −7.0 | NS |
| Parenteral oxytocin | 90.9% | 95.5% | 5.1 | NS |
| Parenteral anticonvulsants | 44.6% | 40.0% | −10.3 | NS |
| Manual removal of placenta | 39.1% | 30.0% | −23.3 | NS |
| Remove retained products | 17.3% | 49.1% | 183.8 | *** |
| Assisted vaginal delivery | 10.0% | 15.5% | 55.0 | NS |
| Newborn resuscitation | 27.3% | 74.6% | 173.3 | *** |
| Strategy 4: Improve quality of care and ensure care is evidence-based | ||||
| Facilities that report routine practice of AMTSL | 71.8% | 95.5% | 33.0 | *** |
| Facilities reporting that obstetric patients never share beds | 62.7% | 73.6% | 17.4 | NS |
| Facilities reporting that women never deliver on the floor | 71.3% | 83.8% | 17.5 | NS |
| Strategy 5: Ensure referral capacity to support transfers to higher-level care | ||||
| Facilities with at least 1 method of communication for referralsh | 44.6% | 100.0% | 124.2 | N/A |
| Facilities that reported having available transportation (motor vehicle or motorcycle)i | 55.5% | 72.7% | 31.0 | *** |
| Strategy 6: Support effective maternal and perinatal health surveillance | ||||
| Facilities with maternal death reviews performed | 42.5% | 75.0% | 76.5 | ** |
| Hospitals that performed maternal death reviewsd | 50.0% | 100.0% | 100.0 | N/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.