Table 2.

Quality assessment checklist for EmOC assessment

Quality criteria for indicators

Indicator 1: Availability of EmOC

Compared (total or representative) number of functioning facilities with the most recent population size (or projected population if recent population size is older than 5 years).

Included all facilities within the relevant geographical level (national, district, subdistrict): Public and private.

Direct inspection to collect data.

Indicator 2: Geographical distribution of EmOC facilities

Geo-referenced EmOC facilities and identified catchment population for the facility.

Identified underserved areas using disaggregated data.

Included public and private.

Indicator 3: Proportion of all births in EmOC facilities

Triangulated with parallel indicator – proportion of institutional deliveries.

Used most recent population size (or projected population if recent population size is older than 5 years).

Used disaggregated data to relevant geographical level (national, district, subdistrict).

Indicator 4: Met need for EmOC

Triangulated with parallel indicator – proportion of institutional deliveries.

Adhered to operational definition of direct obstetric complications.

Defined period for which data on women treated for direct obstetric complications were collected.

Used most recent population size (or projected population if recent population size is older than 5 years).

Used disaggregated data to relevant geographical level (national, district, subdistrict).

Indicator 5: Caesarean sections as a proportion of all births

Triangulated with parallel indicator – proportion of institutional deliveries.

Used denominator as expected number of live births (in the whole catchment area, not just in institutions).

Used disaggregated data to relevant geographical level (national, district, subdistrict).

Indicator 6: Direct obstetric case fatality rate

Triangulated with parallel indicator – proportion of institutional deliveries.

Used as numerator data of women who developed direct obstetric complications after admission, and die before discharge.

Used as denominator number of women who were treated in the same facility and over the same period as numerator.

Calculated cause-specific fatality rates for each of the major causes of maternal death.

Indicator 7: Intrapartum and very early neonatal death rate

Used fresh stillbirths (intrapartum and very early neonatal deaths within the first 24 h) as numerator.

Denominator used was all women who gave birth in the facility during the same period.

Newborns under 2.5 kg were excluded from the numerator and the denominator.

Indicator 8: Proportion of deaths due to indirect causes in EmOC facilities

Used data on ‘previous existing disease or disease that developed during pregnancy and which was not due to direct obstetric causes, but which was aggravated by the physiologic effects of pregnancy.

Used as denominator all maternal deaths in the same facilities during the same period.

Used disaggregated data to relevant geographical level (national, district, subdistrict).