Table 3. Definition of MNH care and facility readiness and performance indicators.

Indicators	Definitions
Readiness and performance of the health centers
BEmONC signal functions	EmONC is a set of life-saving interventions that treat the major obstetric and newborn causes of morbidity and mortality. To assess the level of care, these functions are classified as basic (BEmONC) or comprehensive (CEmONC).
	BEmONC services comprise: 1) administration of parenteral antibiotics to prevent puerperal infection or treat abortion complications; 2) administration of parenteral anticonvulsants for treatment of eclampsia and preeclampsia; 3) administration of parenteral uterotonic drugs for postpartum hemorrhage; 4) manual removal of the placenta; 5) assisted vaginal delivery (vacuum extractions); 6) removal of retained products of conception; and 7) newborn resuscitation.
	The following newborn functions were also assessed: 1) antibiotics for preterm or prolonged premature rupture of membrane (PROM) to prevent infection; 2) corticosteroids in preterm labor; 3) kangaroo mother care (KMC) for premature/very small babies; 4) alternative feeding if baby is unable to breastfeed (breast milk expression and cup/spoon-feeding); and 5) injectable antibiotics for newborn sepsis [12]
Readiness to perform signal functions	Health centers’ readiness to provide the BEmONC signal functions was defined as the availability of equipment, commodities, and drugs (yes/no response). The specific items linked to each signal function are shown below.
Administer parenteral antibiotics	Availability of injectable gentamicin, ampicillin, metronidazole, OR ceftriaxone.
Administer uterotonic drugs	Availability of parenteral oxytocin.
Administer parenteral anticonvulsants	Availability of magnesium sulfate or diazepam.
Manually remove the placenta	Availability of round-the-clock manual removal of placenta services and of at least one BEmONC trained provider.
Remove retained products of conception	Availability of manual vacuum aspiration or E&C/D&C set and at least one BEmONC-trained provider.
Perform assisted vaginal delivery	Availability of vacuum extractor and at least one BEmONC-trained provider.
Perform basic neonatal resuscitation	Availability of Ambu-bag and mask (both small for preterm babies and normal masks) and at least one BEmONC-trained provider.
Antibiotics for preterm or prolonged PROM to prevent infection	Availability of oral erythromycin and ampicillin or ceftriaxone.
Corticosteroids in preterm labor	Availability of parenteral corticosteroids (betamethasone/dexamethasone).
KMC for premature/very small babies	Availability of dedicated space for KMC and trained staff.
Alternative feeding if baby is unable to breastfeed (breast milk expression and cup/spoon-feeding)	Availability of utensils for breast milk expression and cup feeding.
Injectable antibiotics for newborn sepsis	Availability of injectable ampicillin and gentamicin.
Partograph use rate	Of deliveries in the health centers in the past one month, proportion whose labor was monitored using partograph.
Uterotonics given for active management of the third stage of labor (AMTSL)	Of deliveries in the health facilities in the past one month, proportion given uterotonics immediately after delivery to prevent postpartum hemorrhage (PPH).
Women’s care-seeking behavior
At least one ANC	% of women who visited a health facility for check-up during her last pregnancy at least once
ANC in 1st trimester	% of women who visited a health facility for check-up during the first trimester of last pregnancy
ANC 4+	% of women who went to a health facility for antenatal care at least 4 times during the last pregnancy
ANC in 1st & last trimester	% of women who went to a health facility for check-up during her first trimester and during her last trimester of the last pregnancy
Skilled birth attendance	% of women who were assisted by a health professional (doctor, nurse, or midwife) during the last childbirth
Providers’ service provision behavior
Complete ANC	% of women who had their blood pressure measured, and blood and urine tested during last pregnancy
ANC consultation experience (perceived ANC)	ANC experience is an index constructed using the following survey items: 1) How respectfully were you treated in the health center (or health post)? Would you say very respectfully, respectfully, disrespectfully, or very disrespectfully (a 4-point Likert-type scale); 2) In your opinion, how knowledgeable was the health professionals in the health center (or health post)? Would you say very knowledgeable, knowledgeable, or not knowledgeable (a 3-point Likert-type scale); 3) Overall, how comfortable are you at the health center (or health post)? Would you say very comfortable, comfortable, uncomfortable, or very uncomfortable (a 4-point Likert-type scale); and 4) how responsive was the health center (or health post) to your needs? Would you say very responsive, responsive, unresponsive, or very unresponsive (a 4-point Likert-type scale)? To account for the difference in the number of points in the Likert-type responses of the items, the mean of each of the items was standardized and then aggregated to obtain the ANC experience index. We reversed the index so that higher score indicated relatively better ANC experience. The index score was recalibrated to range between 0 and 10.
	Cronbach’s alpha (reliability coefficient) for the 4 items was 0.87. However, the distribution is found to be skewed. As such, we categorized into 2 groups; those who have the maximum score and others.
ANC counseling	ANC counseling is an index constructed using binary response items measuring whether a woman received ANC counseling for 1) breastfeeding; 2) postpartum family planning; 3) HIV; 4) maternal nutrition; 5) danger signs of pregnancy; 6) birth preparedness and complication readiness; and 7) newborn care. The yes responses were coded 0 and no coded 1, and the 7 items aggregated to construct the index. The index score was recalibrated to range between 0 and 10, with a higher score indicating better ANC counseling.
	Cronbach’s alpha for the 7 items was 0.86. Then, we categorized into 2 groups; those with the maximum score and others.
Perceived knowledge of providers	This is based on delivery experience at the health facility. Women were asked, “In your opinion, how knowledgeable are the health professionals in the health center? Would you say very knowledgeable, knowledgeable, or not knowledgeable?”
	“Very knowledgeable and knowledgeable” are categorized as knowledgeable.
Satisfaction with delivery care	Women were asked, “If a close friend of yours were pregnant, would you recommend that she deliver at the same facility where you did, at another health facility, or would you recommend that she not deliver at any health facility?” If they recommended going to the same facility, it is categorized as “satisfied;” otherwise categorized as “not satisfied.”
Disrespect and abuse	Disrespect and abuse were defined if a woman experienced any of the following categories of disrespect and abuse during childbirth in a facility: 1) physical abuse; 2) treatment without permission; 3) violate privacy; 4) violate confidentiality; 5) verbal abuse; and 6) left unattended.
PNC within 48 hours for the mother (home)	% of women who received postpartum care at their home within 48 hours of last childbirth
PNC within 48 hours for the baby (home)	% of women who received newborn care at their home within 48 hours of last childbirth
PNC within 48 hours for the mother (both at home and facility)	% of women who received postpartum care at the health facility or at their home within 48 hours of last childbirth
PNC within 48 hours for the baby (at home and facility)	% of women who received newborn care at the health facility or at their home within 48 hours of last childbirth
Stayed in facility for 24 hours or more	% of women who stayed for 24 hours or more in the facility after the delivery
Birth notification (home birth)	% of women who delivered at home and took measures to inform the HEW about childbirth immediately after delivery
Birth notification (institutional birth)	% of women who delivered at facility and took measures to inform the HEW about childbirth immediately after delivery
Used motor vehicle transport	% of women among those who gave birth at facility and used motor vehicle transport to get there