Considerations for Maternal Health Program Evaluations
Comprehensive evaluations of rural maternal health programs should address both process and outcomes. Process
data can be used to improve program components and implementation, while outcomes data can demonstrate
achievement of outcomes. Important concepts to consider when planning and conducting an evaluation are:
- Person-centered maternal healthcare
Each of these dimensions can be measured according to three standards: theoretical, best possible, or best
Coverage in maternal health refers to the proportion of eligible women who are participating in
the maternal health program being evaluated. Coverage is also known as the “use” of an intervention or “crude
coverage”. In recent years, public health researchers have measured “effective
coverage”. Effective coverage considers the availability and access to programs (as crude coverage does)
as well as the quality or efficacy of the program received by the population.
Equity means that a health program is delivering healthcare and services without variation in
quality due to personal characteristics. Maternal health disparities are more pronounced in rural settings due
to a range of social determinants of health, which are linked to the same inequities that rural communities
experience in the larger social context. As discussed in Module
1, rural women suffer a disproportionately higher burden of chronic diseases and experience higher rates
of maternal mortality than their urban counterparts.
is defined by the Institute of Medicine (now the
National Academy of Medicine) as
“the degree to which healthcare services for individuals and populations increase the likelihood of desired
health outcomes and are consistent with current professional knowledge.”
Many quality measures in healthcare are binary (Yes/No). Examples of this are maternal mortality and giving
birth at term. However, in maternal health programs, binary measures may not account for multiple
determinants that influence outcomes. The quality of maternal care is sometimes measured to account for the
content of the care (the procedures) that the woman has received as a key factor of her care. For example, a
component of an intervention aiming at preventing iron deficiency in pregnant women might be receiving a blood
test or receiving iron supplements.
maternity care (PCMC) is a concept that extends beyond the clinical aspects of care to
address satisfaction, quality, and human rights in maternal healthcare. PCMC is a new healthcare quality model
for maternal health that focuses on the perspective of the individual seeking and receiving care.
This framework has been recently translated into a validated scale for measuring PCMC. This international PCMC
scale can be used by researchers, government officials, or health facility administrators and health
providers to measure the whole patient experience. While this scale has only been applied in low and middle income
countries, it can likely be adapted to rural maternal health programs in the U.S.
(VfM) is the cost-effectiveness of the programs in which stakeholders and donors are investing.
The components of a VfM assessment include economy, effectiveness, efficiency, and cost-effectiveness. The goal
of a VfM assessment is to see how resources are being used, and ensure they are serving the greater good for the
most people. Due to the complexity of maternal health programs, a VfM assessment can be quite challenging. At
the same time, a successful VfM assessment can secure a maternal health program's sustainability in a market of
limited resources, as funders require increasing assurances that their money is being used appropriately.
Resources to Learn More
Advancing a Conceptual Model to Improve Maternal Health
Quality: The Person-centered Care Framework for Reproductive Health Equity
Proposes a framework for improving the quality of reproductive health, addressing determinants of health equity,
women's health-seeking behaviors, and quality of care.
Author(s): Sudhinaraset, M., Afulani, P., Diamond-Smith, N., et al.
Citation: Gates Open Research, 1(1)