SM2015 is an ambitious project with the Ministry of Health and local support. This presentation outlines the design and activities around the data collection and analysis of the evaluation, as well as the results, conclusions, and future activities.

1. 1
Salud Mesoamérica Initiative: Data for
Better Health
November 11, 2014
Ali H. Mokdad, Ph.D.
Director, Middle Eastern Initiatives
Professor, Global Health

2. 2
Outline
Introduction
Design and activities
Results
Conclusions and future activities

3. 3
Outline
Introduction
Design and activities
Results
Conclusions and future activities

4. 4
Introduction
• SMI is an ambitious project with MOH and local
support
• Baseline and 18-month follow-up completed
• Indicators developed by the MOH and IDB
• IHME serves as an independent evaluator

5. 5
Outline
Introduction
Design and activities
Results
Conclusions and future activities

6. 6
Activity flowchart
Study and survey design (IHME)
• Fact-finding visits
• Instrument design
• CAPI (Real-time data collection)
• Training and pilots
• Sampling
• Quality checks
Data collection (in-country agencies)
• Community census
• Household survey
• Health facility survey
• Supervision by IHME
Analysis (IHME)

7. 7
Household survey
• Household characteristics
• Expenditure and health expenditure
• Health services utilization (women and children)
• Family planning, reproductive history
• Child health, breastfeeding and immunization
Physical measures
Dried blood spots (DBS)
Water quality (Panama)

8. 8
Facility survey
• Questionnaire administered to facility
manager
• Physical observation
─ Equipment and inputs
─ Review of registries to detect stock-outs
• Medical record review
─ Record quota according to the characteristics of the
unit
» Antenatal care
» Deliveries
» Maternal and neonatal complications
• Selection of medical records from MoH records
when possible

9. 9
Effective coverage of measles immunization
• Immunization history from health card and
caregiver recall for 6,204 children under five
in Mexico and Nicaragua
• DBS samples from 1,134 children, 12-23
months
• ELISA test of DBS samples for presence of
measles antibodies
•Comparison of survey-based
and biomarker-based
estimates of measles
immunization coverage
•Validation study in Chiapas to
adjust cut-off point

10. 10
SMI evaluation innovations
• Integrated surveillance approach:
data collected from different
sources on the same variable
• Ability to link information
• Identification of health facilities
visited by households
• Large samples in high-risk
populations
• Census for denominator
• Electronic data capture on
Netbooks
• Rapid, automated quality check
process with prompt feedback
• Detailed health facility observation
and medical record review
• Dried blood spot analysis
Medical record review and electronic data
capture

11. 11
Outline
Introduction
Design and activities
Results
Conclusions and future activities

12. 12
Sample
Households Women Children
Belize * 351 311
Costa Rica 41 schools
El Salvador 3,625 4,730 3,328
Guatemala 4,420 5,899 5,282
Honduras 2,971 3,342 3,144
Mexico 5,428 6,988 6,462
Nicaragua 2,071 2,823 2,225
Panama 1,710 2,453 2,253
*LQAS

13. 13
Reasons for non-use of contraception

14. 14

15. 15

16. 16
Costa Rica
SMI Intervention Regions

17. 17
Costa Rica Indicators
Indicator N Prevalence 95% CI
Knowledge of contraception
availability at EBAIS facilities
881 30.5% (21.5 - 39.5%)
Receipt of sexual and reproductive
health counseling
560 24.5% (19.2 - 29.8%)
Correct identification of STI symptoms 912 12.2% (8.2 - 16.1%)
Correct identification of methods to
reduce the risk of STIs
909 22.4% (16.3 - 28.4%)

18. 18
Sexually active students
Grade Gender Percent sexually active (95% CI)
7th grade All 4.5% (1.0 -8.1%)
Male 3.0% (0.0 -6.2%)
Female 5.7% (0.0 - 11.3%)
8th grade All 11.9% (3.7 - 20.1%)
Male 8.0% (0.0 - 16.8%)
Female 16.0% (3.6 - 28.3%)
9th grade All 27.3% (14.0 - 40.7%)
Male 26.4% (8.2 - 44.6%)
Female 27.6% (6.8 - 48.4%)
10th grade All 21.3% (12.5 - 30.0%)
Male 19.9% (5.2 - 34.7%)
Female 21.9% (9.1 - 34.6%)
11th grade All 40.6% (23.2 - 58.0%)
Male 70.5% (27.3 - 100%)
Female 9.3% (0.0 - 26.5%)

19. 19
Mexico

20. 20
Denominator is Equally Important

21. 21
Comparison of SMI and ENSANUT 2012
Indicator Prevalence SMI
Prevalence
ENSANUT 2012,
rural Chiapas
Prevalence
ENSANUT 2012,
national
Institutional deliveries* 47% (N=4538)
Segments: 0.0%-100%
Municipalities: 1.6%-99.2%
45% (N=139) 94% (N=5738)
Anemia in children, age
12-59 months
25% (N=4474)
Segments: 0.0%-100%
Municipalities: 3.0-51.5%
31% (N=207) 23% (N=7570)
MMR immunization
coverage, age 0-59
mos**
79% (N=6003)
Segments: 32.7%-100%
Municipalities: 33.7%-100%
90% (N=344) 92% (N=13160)
Wasting (<-2SD weight for
height), age 0-59 mos
1.4% (N=5771)
Segments: 0.0%-11.1%
Municipalities: 0.0%-5.4%
2.6% (N=326) 1.6% (N=10658)
*For most recent birth in the past 5 years ; **Based on recall and vaccination card

22. 22
Challenging Environment
• Lots of disparities
• Remote areas
• Logisitical challenges
• Indigenous population
• Culture and expectations

23. 23
DBS Results

24. 24
Mexico: measles immunization coverage

25. 25
Where are the gaps?
Proportion of card-positive children lacking antibodies

26. 26
Odds of lacking antibodies by facility characteristics
Characteristic
Odds
Ratio
95% CI
lower
95% CI
upper
Basic facility 0.35 0.07 1.77
Complete facility 1.16 0.09 15.09
Facility has doctor 0.78 0.06 9.98
Electricity at all hours 2.72 0.28 26.91
Internet access 0.23 0.04 1.37
Routine staff meetings on
medical topics
1.22 0.12 12.81
Any fridges with out-of-range
temperature on day of survey
**10.79 1.55 74.99
N = 101 This is a survey-weighed logistic regression
* p <0.10 ** p <0.05 *** p <0.01 **** p <0.001

27. 27
Nicaragua: crude and effective coverage of measles
immunization
*Figure restricted to 299 children with all three
sources, excluding children with DBS collection
within 28 days of vaccination. Lines indicate 95%
confidence intervals. Estimates are survey
weighted.

28. 28
Crude and effective coverage of measles immunization
*The number in each municipality indicates sample size. Estimates are survey weighted.

29. 29
Crude and adjusted odds ratios of likelihood that card-
positive children lack antibodies
Characteristic
Odds
Ratio
95% CI
lower
95% CI
upper
Anemic 1.36 0.79 2.34
Underweight 7.99 1.66 38.51
Asset score 0.05 0.00 0.82
Urban area 0.27** 0.11 0.69
Matagalpa* 0.54 0.12 2.45
RAAN* 16.59** 2.21 124.53
Madriz* 4.73 0.90 24.80
1+ broken cold storage observed 7.82 0.68 90.14
N = 237. Survey weighted logistic regression
* Jinotega reference category; * *p <0.05

30. 30
Sample sizes for HF surveys (intervention areas)
Country Baseline 18-m follow-up
Facilities Medical
records
Facilities Medical
records
Mexico 60 1,744 60 1,985
Guatemala 64 1,175 60 2,304
Belize 39 792 38 1,191
El Salvador 65 n/a 60 1,591
Honduras 59 1,293 60 1,519
Nicaragua 40 850 60 1,698
Panama 38 498 39 863
Total 365 6,352 377 11,151

31. 31
Mexico- Chiapas

32. 32
Mexico HF Performance Indicator Matrix
Baseline 18-month 18-month target
# Indicator description Percent (95% CI) Percent (95% CI) % One-sided Z-
test p value*
7020** Health facilities with permanent availability
of inputs and equipment necessary for
prenatal and postpartum care
3.6% (0.4 – 12.5%) 45.8% (32.7 – 59.2%) 80% < 0.00001
7040 Health facilities with permanent availability
of inputs and equipment necessary for
delivery and newborn care
0% (0 – 19.5%) 21.4% (4.7 – 50.8%) 80% < 0.00001
7030 Health facilities with permanent availability
of inputs and equipment necessary for
emergency obstetric and neonatal care
0% (0 - 24.7%) 14.3% (1.8 – 42.8%) 80% < 0.00001
7010 Health facilities with permanent availability
of inputs and equipment necessary for
pediatric, vaccination and nutrition care
3.6% (0.4 – 12.5%) 13.6% (6.0 – 25%) 80% < 0.00001
7050 Health facilities with modern family planning
supplies (oral, injectable, barrier, IUD),
according to the schedule (population
under responsibility, time of year, rotation)
55.1% (40.2 – 69.3%) 62.7% (49.1 – 75.0%) 80% 0.0001
7000 Health facilities with cold chain that meets
the standards
70.8% (48.9 – 87.4%) 77.8% (57.8 – 91.4%) 80% 0.3864
**The requirements for lab inputs at hospitals changed from the baseline to the 18-month evaluation, becoming more flexible with the
allowance of rapid tests as an alternative to lab equipment.
*One sided test of proportions comparing if the estimate is lower than the target

33. 33
7020: Health facilities with availability of inputs and
equipment necessary for prenatal and postpartum care
Baseline(%) 18-Month(%)
Indicator 7020 3.6 45.8
Standing scales 70.9 98.3
Stadiometer/ tallimeter 72.7 100
Gynecological exam table
1
82 100
CLAP obstetric tape 29.1 100
Lamp gooseneck/ hand lamp 67.3 95.0
Sphygmomanometer 85.5 95.0
Stethoscope 85.5 100
Perinatal maternal medical history 90.9 91.7
Perinatal maternal card 90.9 88.3
IUD insertion kit2
62.0 84.3
All necessary equipment observed and functional 12.7 68.3
(Iron + Folic acid)/ Multivitamin 71.7 98.3
Erythromycin/Ampicillin/ Penicillin benzathine3
81.3 100
Tetanus vaccine2,4
28.6 85.7
Ayre palletes
2
28.6 78.4
Microscope slides2
49.0 86.3
Nitrofurantoin2
63.3 98.0
All pharmacy inputs observed on the day of survey 11.3 69.5
Continuous availability in previous three months 9.4 59.3
Rapid syphilis test kit / dark field microscope/ equipment for
enzyme immunoassay 60 85.7
Rapid HIV/AIDS test kit / fluorescence microscope 53.3 100
Urine strips / urinalysis equipment 73.3 92.9
Blood glucose strips / glucose meter 80 100
Hemocue / automated cell counter 66.7 78.6
Pregnancy test5
100 100
Lab reagents (blood type + RH factor antibody) 93.3 92.9
All lab equipment observed on day of survey 13.3 35.7
Indicator 7020: Health facilities with availability of inputs and equipment necessary for
prenatal and postpartum care
Equipment
Pharmacy inputs
Laboratory inputs
1
Not applicable to mobile units
2
Not applicable to ambulatory without doctor
3
Only applies to Ambulatory facilities with doctor
4
Only applicable if facility stores vaccine
5
Only applicable to Basic facilities

34. 34
7020: Health facilities with availability of equipment
necessary for prenatal and postpartum care
Baseline
18-month follow-up
*Gynecological exam tables not measured at mobile units
Overall
Standing scale
Stadiometer
Gyn. exam table/stretcher1
Gooseneck lamp
CLAP obstetrical tape
Blood pressure apparatus
Perinatal maternal medical history
Stethoscope
Overall
Standing scale
Stadiometer
Gyn. exam table/stretcher1
Gooseneck lamp
CLAP obstetrical tape
Blood pressure apparatus
Perinatal maternal medical history
Stethoscope

35. 35
7040: Health facilities with availability of inputs and
equipment necessary for delivery and newborn care
* Drug requirements dependent on facility EONC classification
Baseline(%) 18-Month(%)
Indicator 7040 0 21.4
Intravenous catheter sterile N ° 18 88.2 100
Metallic/Plastic Clamp or umbilical tape 100 100
Equipment p / serum c / macrogotero and microgotero 94.1 92.9
Nasogastric tube1
41.2 78.6
Sterile fields or sheltering for a baby 94.1 92.9
All necessary equipment observed and functoinal 35.3 71.4
Hyoscine bromide / Butilioscina 53.3 85.7
Ergonovine maleate / Ergometrine / Oxytocin 46.7 100
Drops of chloramphenicol ophatlmology / 1% silver nitrate
/oxytetracycline ophthalmic 46.7 92.9
Iodopovidona 20 92.9
Ringer lactate / Hartman solution / saline solution 33.3 100
S lidocaine /S epinephrine 40 100
C / mounted needle syringe (syringe insulin) 40 85.7
Vitamin K 40 100
All pharmacy inputs observed on the day of the survey 0 64.3
Continuous availability in previous three months 0 28.6
Indicator 7040: Health facilities with availability of inputs and equipment necessary for
delivery and newborn care
Equipment
Pharmacy inputs
1
Nasogastric tube K 33 measured at baseline, but any nasogastric tube accepted at 18-months

36. 36
7040: Health facilities with permanent availability of
pharmacy inputs necessary for delivery and newborn care
*Uterotonics = Ergonovine maleate/Egometrine/Oxytocin
• Stock-outs are an issue at 18-month evaluation, but consistently better
in most recent months
• 60% of basic and complete EONC had all drugs available on the day
of survey, but only 27% also had continuous availability in previous
three months of uterotonics and vitamin K

37. 37
7030: Availability of inputs and equipment necessary for
emergency obstetric and neonatal care
Baseline(%) 18-Month(%)
Indicator 7030 0 14.3
Anesthesia equipment1
100.0 85.7
Autoclave (or dry heat sterilizer) 46.2 85.7
Blood pressure apparatus 38.5 85.7
Kit for C-sections1
100.0 85.7
Laryngoscope 61.5 85.7
MVA kit 30.8 42.9
Neonatal/ pediatric stethoscope1
75 71.4
Oxygen tank 61.5 92.9
Portable doppler (or Pinard stethoscope) 61.5 85.7
Reanimation resuscitation bag for adult 53.8 78.6
Neonatal resuscitation bag 69.2 78.6
Stethoscope 69.2 78.6
All necessary equipment observed and functional 0 35.7
Amikacin /Amikacin sulfate1
25 100
Penicillin crystals /IV ampicillin /Amoxicillin 66.7 100
Ceftriaxone1
25 100
Cloramphenicol/ Metronidazole1
25 100
Dexamethasone / Betamethasone 25 100
Diazepam / Midazolam Chlorhydrate1
25 100
Furosemide1
50 100
Hidralazine / Hidrazaline chloral hidrate1
25 100
Magnesium sulfate 41.7 85.7
Nifedipine1
50 100
Oxytocin / Ergometrine 58.3 100
Sevoflurane
1
100 100
Succinylcholine chloride1
25 71.4
Gentamicin2
0 100
All pharmacy inputs observed on the day of survey 0 71.4
Continuous availability in previous three months 0 28.6
2
Only applies to Basic facilities
Indicator 7030: Health facilities with availability of inputs and equipment necessary
for emergency obstetric and neonatal care
Equipment
Pharmacy inputs
1
Only applies to Complete facilities

38. 38
7010: Health facilities with availability of inputs and equipment
necessary for pediatric, vaccination and nutrition care
Baseline(%) 18-Month(%)
Indicator 7010 3.6 13.6
Pediatric balance or scale 70.9 81.7
Standing balance or scale for children 52.7 98.3
Tallimeter or stadiometer 69.1 100.0
Stethoscope 60 100.0
Oral/axillary thermometer1
97.3 95.6
Growth card 89.1 96.7
Pediatric tensiometer2
16.7 50.0
Pediatric stethoscope
2
33.3 50.0
Packets/ Envelopes of ORS 75 100
Ferrous sulfate drops 57.7 90
Albendazol/Mebendazol 76.9 100
Antibiotics3
76.6 98.0
Ringer lactate/ Hartman solution/ Saline solution
2
31.3 100
Pentavalent 74.1 57.1
MMR 81.5 85.7
Rotavirus 74.1 78.6
Pneumococcal conjugate 37.0 42.9
BCG 70.4 50
1
Only applicable at Ambulatory facilities
2
Only applicable at Basic & Complete facilities
3
Not applicable to Ambulatory facilities without doctor
4
Only applies to facilities that store vaccines
Indicator 7010: Health facilities with availability of inputs and equipment necessary
for pediatric, vaccination and nutrition care
Equipment
Pharmacy inputs
Vaccines
4

39. 39
7010: Health facilities with availability of equipment necessary
for pediatric, vaccination and nutrition care
Overall 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 83 83 83 83 83 83 83 83 83 83 80 80 67 60
Infant scale 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 1 0 0 0 0 0 0 0 1 0 1 0
Child scale 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0
Tallimeter 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
Stethoscope 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
Card 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 0 1
Baseline
18-month follow-up
Overall 100 100 100 100 100 100 100 100 100 100 100 100 100 83 83 83 83 83 83 83 83 80 80 80 80 80 80 80 67 67 67 67 67 67 67 67 67 67 60 60 60 50 50 50 40 40 40 40 33 33 33 33 33 20 20
Infant scale 1
Child scale 1
Tallimeter 1
Stethoscope 1
Card 1

40. 40
7050: Availability of modern contraceptive methods on the
day of the survey
*Only applies to Basic and Complete facilities
**Only applies to Complete facilities
0
10
20
30
40
50
60
70
80
90
100
Male Condom Any pill Any injectable IUD* IUD insertion kit* Doctor trained
to perform
tubal ligation &
vasectomy**
Baseline
18-Month

41. 41
7000: Cold chain according to the standards*
*Among facilities that had at least one observed refrigerator for storing vaccines
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
Temperature was 2-8 C
on the day of the survey
Temperature monitoring
chart observed for each
fridge
Temperature was
recorded twice daily
during the last 30 days
Temperature range was
2-8C for each fridge in
the last 30 days or if
temperature wasn’t 2-8
C, there is a record of
action
Baseline
18-Month

42. 42
Nicaragua

43. 43
Nicaragua HF Performance Indicator Matrix
Baseline 18-month 18-month target
# Indicator description Percent (95% CI) Percent (95% CI) % One-sided Z-
test p value*
7000 Health facilities with cold chain according to
standards
28.6% (13.2-48.7%) 88.9% (70.8-97.6%) 85% 0.7143
7010 Health facilities that have the necessary
inputs to provide child health care according
to the norms
0% (0 – 9.5%) 71.7% (57.7-83.2%) 85% 0.0033
7020 Health facilities that have the necessary
inputs for providing pre- and post natal care
according to the norms
10.8% (3.0-25.4%) 76.8% (63.6-87.0%) 85% 0.0426
7030 Health facilities that have the necessary
inputs for providing emergency obstetric and
neonatal care according to the norms
60% (14.7-94.7%) 90.9% (58.7-99.8%) 85% 0.7084
7050 Health facilities that have continuous supplies
of modern family planning methods
59.5% (42.1 – 75.2%) 87.5% (75.9-94.8%) 85% 0.6998
*One sided test of proportions comparing if the estimate is lower than the target

44. 44
Nicaragua HF Performance Indicator Matrix
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
7000 7010 7020 7030 7050
Baseline 18-Month

45. 45
7000: Health facilities with cold chain according to standards
Baseline(%) 18-Month(%)
Indicator 7000 28.6 88.9
A temperature monitoring chart on each
functioning refrigerator 57.1 92.6
Monitoring chart filled out twice each
working day in the last 30 days1
28.6 88.9
Requirements
1At baseline, every day in previous all 30 days was considered

46. 46
7010: Health facilities that have necessary inputs to provide
child health care according to the norms
• 86.8% of facilities met
equipment component
• 88.8% of facilities met
pharmacy component
• 84.9% of facilities met
vaccine component
• 71.7% of facilities met all
three components of the
indicator.
• Facilities doing well and
missing very few
requirements
1
Health posts not required to have pediatric stethoscopes
2
Data missing for pediatric scale & growth and development card in 4 units at 18 months
3
Not applicable in health posts
4
Hib not evaluated due to survey programming

47. 47
7020: Health facilities that have necessary inputs to provide
prenatal and post-natal care according to the norms
Baseline(%) 18-Month(%)
Indicator 7020 10.8 76.8
Scale and tallimeter 86.5 98.2
Gynecological exam table 91.9 98.2
CLAP or metric tape 75.7 100
Gooseneck lamp or hand lamp 54.1 83.9
Blood pressure apparatus 89.2 98.2
Stethoscope 86.5 98.2
Gestogram 73.0 96.4
IUD insertion kit1
0 100
HIV rapid test n/a 100
Serological mixer/Syphilis rapid test/R.P.R.(syphilis)/Rapid
plasma reagent n/a 90.9
Qualitative urinalysis strip n/a 100
Glucose strips/glucometer n/a 100
Standard hemoglobin TED/spectrophotometer/Diagnostico
500/Stax Fax/ Climar Junior/Microhematocrit centrifuge n/a 100
Microscope n/a 100
Cell counter n/a 100
Blood glucose strips/ glucose meter 100 n/a
Hemocue/ automated cell counter 100 n/a
Rapid HIV/AIDS test/ flourescence microscope 60 n/a
Rapid syphilis test/ dark field microscope/ equipment for
enzyme immunoassay 60 n/a
Urine protein strips/ urinalysis equipment 100 n/a
1
Not applicable in health posts
2
Only applies to Basic facilities
Indicator 7020: Health facilities that have necessary inputs to provide prenatal and post-natal
care according to the norms
Equipment
Laoratory inputs
2

48. 48
7050: Health facilities with availability of modern contraceptive
methods on the day of the survey
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
Condoms Contraceptive pills Injectables Intrauterine device
Baseline
18-Month

49. 49
Belize
SMI Intervention Regions

50. 50
Belize HF Performance Indicator Matrix
Baseline 18-month 18-month target
# Indicator description Percent (95% CI) Percent (95% CI) % One-sided Z-
test p value*
7030 Health facilities that have the necessary inputs for
providing emergency obstetric and neonatal
care according to the norms
0% (0 - 60.2%) 0%(0-60.2%) 75% 0.0003
7020 Health facilities that have the necessary inputs for
providing pre- and post natal care according to
the norms
2.9% (0.0 - 14.9%) 17.2% (5.8-35.8%) 85% <0.00001
7010 Health facilities that have the necessary inputs to
provide child health care according to the norms
0% (0 - 9.5%) 0% (0-9.5%) 85% <0.00001
7050 Health facilities that have permanent availability
of modern family planning methods
73.7%(48.8 - 90.9%) 90%(68.3-98.8%) 85% 0.7344
7460 Health facilities with a mechanism in place for
carrying out patient satisfaction surveys
0%** 55.3% (38.3-71.4%) 85% <0.00001
7410 Health facilities that have implemented Quality of
Care job aid tools for reproductive health
0%** 55.3% (38.3-71.4%) 85% <0.00001
7465 Health facilities that can submit and receive data
from the Belize Health Information System (BHIS)
0%** 30% (6.7-65.2%) 85% <0.00001
7420 Health facilities that have sexual and
reproductive health (SRH) educational materials
specifically targeted at adolescents
0%** 62.2% (44.8-77.5%) 85% 0.0001
**New intervention: baseline assumed to be 0%
* One-side test of proportions comparing if the estimate is lower than the target

51. 51
7020: Health facilities with availability of equipment necessary
for prenatal and postpartum care
1Missing data for 1 ambulatory facility
2Not required for ambulatory facilities
3Only facilities that stored vaccines reported on Tetanus availability at follow-up
4Rapid test not asked at baseline
5Only required in basic facilities
Baseline (%) 18-Month (%)
Indicator 7020 2.9% 17.2%
Pharmacy inputs
(Iron + Folic acid)/ Multivitamin 65.2 93.3
Nitrofurantoin 30.4 53.3
Cephalexin 43.5 53.3
Tetanus vaccine3
70 100
Ayre palettes/swabs 26.1 73.3
Pap smear slides n/a 76.7
Laboratory inputs
Rapid Syphillis test/dark field microscope/
equipment for enzyme immunoassay
4
75 100
Rapid HIV/AIDS test/fluorescence microscope4
50 100
Urine protein strips/urinalysis equipment 100 100
Blood glucose strips/glucose meter 0 75
Hemocue/automated cell counter 50 100
Microcuvettes
5
100 50
Pregnancy test kit5
100 100
Baseline (%) 18-Month (%)
Indicator 7020 2.9% 17.2%
Equipment
Scale with measuring rod 60.0 79.3
Gynecological exam table 60.0 100
CLAP obstetric tape 54.3 96.6
Gestogram 34.3 100
Lamp 48.6 96.6
Sphygmomanometer1
48.6 100
Stethoscope 57.1 100
Fetoscope 22.9 93.1
Thermometer 31.4 100
Reflex Hammer 8.6 65.5
Perinatal maternal medical history 60 96.6
Perinatal maternal card 60 96.6
Referral forms 34.3 96.6
Robes or sheets for patients 40 89.7
Set for IUD Insertion2
25 100
Equipment cart
2
0 100

52. 52
7020: Health facilities with availability of inputs and equipment
necessary for prenatal and postpartum care
• Heat map detailing
equipment and drugs
by facility
• Facilities doing well and
missing very few
requirements
Indicator
value 17%
Reflex
hammer
Nitrofurantoin,
Cephalexin

53. 53
7020: Health facilities with availability of equipment necessary
for prenatal and postpartum care
• Indicator value
increases to 41% when
excluding just these
three issue inputs
• Facilities are generally
missing just one or two
of the requirements
Indicator increases
by 24%

54. 54
7020: Health facilities with availability of pharmacy inputs and
vaccines necessary for prenatal and postpartum care
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
Baseline
18-Month

55. 55
7010: Health facilities with availability of inputs and equipment
necessary for pediatric, vaccination and nutrition care
Interviewers commented that physicians
generally own personal stethoscope &
ophthalmoscopes
Adult stethoscopes and blood pressure
apparatus can be used for children as well
Seasonal vaccine
Baseline 18-Month
Indicator 7010 0 0
Pediatric scales or salter scales 62.2 100
Measuring Tape 59.5 97.2
Height rod 56.8 100
Stethoscope 57.6 100
Pediatric stethoscope 13.5 13.9
Pantascope/oto-ophthalmoscope 5.4 8.3
Hand Lamp 16.2 81
Examination table or stretcher 62.2 89
Pediatric blood pressure apparatus 25 100
Neonatal tensiometer 0 0
Binaural stethoscope for newborns 25 0
Reflex hammer 25 75
Negatoscope 0 100
Packets/envelopes of oral rehydration salt 52 94.6
Ferrous sulfate drops/multivitamins 60 83.8
Albendazole/Mebendazole 64 94.6
Zinc sulfate/zinc gluconate 28 83.8
Antibiotics 100 88.9
Saline solutions 100 100
IV Set 50 100
Pentavalent 100 100
MMR 100 100
Polio 100 100
Influenza 90 52.9
BCG 100 100
Indicator 7010: Health facilities with availability of inputs and
equipment necessary for pediatric, vaccination and nutrition care
Equipment
Pharmacy inputs
Vaccines

56. 56
7010: Health facilities with availability of inputs and equipment
necessary for pediatric, vaccination and nutrition care
The picture looks different if we
consider the following:
• Pediatric and neonatal
stethoscopes can be substituted
with a normal stethoscope
• Pediatricians often own personal
ophthalmoscopes & pediatric
stethoscopes
• Influenza vaccine may not be
stored during all times of the year
Excluding these requirements, the
indicator value increases almost 38%
Baseline 18-Month
Indicator 7010 0 0
Pediatric scales or salter scales 62.2 100
Measuring Tape 59.5 97.2
Height rod 56.8 100
Stethoscope 57.6 100
Hand Lamp 16.2 81
Examination table or stretcher 62.2 89
Binaural stethoscope for newborns 25 0
Reflex hammer 25 75
Negatoscope 0 100
Packets/envelopes of oral rehydration salt 52 94.6
Ferrous sulfate drops/multivitamins 60 83.8
Albendazole/Mebendazole 64 94.6
Zinc sulfate/zinc gluconate 28 83.8
Antibiotics 100 88.9
Saline solutions 100 100
IV Set 50 100
Pentavalent 100 100
MMR 100 100
Polio 100 100
BCG 100 100
Indicator 7010: Health facilities with availability of inputs and
equipment necessary for pediatric, vaccination and nutrition care
Equipment
Pharmacy inputs
Vaccines

57. 57
7010: Health facilities with availability of inputs and equipment
necessary for pediatric, vaccination and nutrition care
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
Baseline
18-Month

58. 58
7050: Health facilities with availability of modern contraceptive
methods on the day of the survey
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
Male Condom Any pill Any injectable IUD Training for doctors
to perform tubal
ligation &
vasectomy
Baseline
18-Month

59. 59
El Salvador
SMI Intervention Regions

60. 60
El Salvador 18-M HF Performance Indicators
Baseline 18-month 18-month target
# Indicator description Percent (95% CI) Percent (95% CI) % One-sided
Z-test p
value*
7001 Health facilities with availability of
refrigerator
42.6% (29.2 – 56.8%) 78.4% (64.7 – 88.7%) 84.4% 0.119
7010 Health facilities with availability of
supplies and equipment needed for
child
36.2% (24 – 49.9%) 92.2% (81.1 – 97.8%) 75.3% 0.997
7020 Health facilities with continuous
availability of supplies and equipment
needed for prenatal care
48.3% (35 – 61.8%) 98% (89.6 – 100%) 88.3% 0.985
7050 Health facilities have supplies of
modern family planning methods (oral
pill, injectable, barrier, IUD)
19% (9.9 – 31.4%) 92.2% (81.1 – 97.8%) 84.4% 0.936
7193 Health facilities with availability of staff 69.8% (55.7 – 81.7%) 76.8% (63.6 – 87%) 83.3% 0.004
3041 First prenatal care visit within 12 weeks
of gestation, with doctor or nurse
n/a 64.9% (58.8 – 70.6%) 77% <0.00001
4106 Enrollment of children in ECOS
Familiares within 8 days of birth
n/a 90.1% (86.6 – 92.9%) 61% 1
* One-side test of proportions comparing if the estimate is lower than the target

61. 61
El Salvador HF Performance Indicator Matrix
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
7001 7010 7020 7050 7193
Baseline
18-month

62. 62
7010: Health facilities with availability of supplies and
equipment needed for child care
1Baseline only captures Albendazole, while 18-month includes Albendazole or Mebendazole.
Baseline (%) 18-Month (%)
Indicator 7010 36.2 92.2
Equipment
Infant scale 87.9 96.1
Child scale 86.2 100
Thermometer 96.6 100
Pharmacy inputs
Oral rehydration salts 89.7 98.0
Zinc 86.2 98.0
Antihelmentics1
48.3 100

63. 63
7010: Health facilities with availability of supplies and
equipment needed for child care
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
Baseline
18-Month
1Baseline only captures Albendazole, while 18-month includes Albendazole or Mebendazole.

64. 64
Guatemala
SMI Intervention and Control Regions

65. 65
Guatemala HF Performance Indicator Matrix
Baseline 18-month 18-month target
# Indicator description Percent (95% CI) Percent (95% CI) % One-sided Z-
test p value*
7020** Health facilities with permanent availability
of inputs and equipment necessary for
prenatal and postpartum care
14.1% (6.6 – 25.0%) 10.7% (4.0 – 21.9%) 50% < 0.00001
7030 Health facilities with permanent availability
of inputs and equipment necessary for
emergency obstetric and neonatal care
0% (0-19.5%) 8.3% (0.2 – 38.5%) 50% 0.0019
7010 Health facilities with permanent availability
of inputs and equipment necessary for
pediatric, vaccination and nutrition care
3.2% (0.4 – 11.0%) 3.6% (0.4 – 12.5%) 50% < 0.00001
7050 Health facilities with stock-out of modern
family planning supplies (oral, injectable,
barrier, IUD),
40.3% (28.1 – 53.6%) 33.9% (21.8 – 47.8%) 30% 0.2606
7160 Municipal Health Districts that can access
data and generate regular reports in
immunization, maternal, newborn, and child
care
n/a 92.9% (66.1 – 99.8%) 70% 0.969
8610 Children aged 0-23 months who received
growth monitoring according to their age in
their most recent visit
n/a 81.3% (77.9 – 84.5%) 6% 1
**The requirements for lab inputs at hospitals changed from the baseline to the 18-month evaluation, becoming more flexible with the
allowance of rapid tests as an alternative to lab equipment.
* One-side test of proportions comparing if the estimate is lower than the target

66. 66
7010: Ambulatory health facilities with availability of equipment
necessary for pediatric, vaccination and nutrition care
Baseline
18-month follow-up
Overall 100 100 100 100 100 75 75 75 75 75 75 75 75 75 75 75 75 75 75 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 25 25 25 25 25 25 25 20
Child scale
Tallimeter
Stethoscope
Thermometer
Overall 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 75 75
Child scale
Tallimeter
Stethoscope
Thermometer

67. 67
7020: Health facilities with availability of equipment necessary
for antenatal and postpartum care
Baseline
18-month follow-up
Overall 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 86 86 86 86 86 86 86 86 86 86 86 86 86 86 86 86 86 86 86 71 71 71 71 71 71 71 71 57 57 57 57 57 57 57 57 57 57 57 57 57 57 57 43 43 43 43 29
Standing
scale
Gyn table
Lamp
Tape
BP
Stethoscope
Med history
Overall 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 86 86 86 86 86 86 86 86 86 86 86 86 86 86 86 86 86 86 86 86 86 86 83 71 71 71 71 71 71 71 71 67
Standing
scale
Gyn table
Lamp
Tape
BP
Stethoscope
Med history

68. 68
Panama
SMI Intervention Regions

69. 69
Panama HF Performance Indicator Matrix
Baseline 18-month 18-month target
# Indicator description Percent (95% CI) Percent (95% CI) % One-sided Z-
test p value*
7010
Basic attention units (UBAs) with continuous
availability of supplies needed for child care,
immunization and nutrition
11.8% (1.5 - 36.4%) 84.2% (60.4 - 96.6%) 80% 0.6768
7020
Basic attention units (UBAs) with continuous
availability of supplies and equipment needed for
pre and postpartum care
17.6% (3.8 - 43.4%) 100% (82.4 - 100%) 80% 0.9854
7040
Basic EONC facilities with continuous
availability of supplies and equipment needed for
delivery care
7.1% (0.2 - 33.9%) 47.1% (23.0 - 72.2%) 80% < 0.00001
7050
Basic attention units (UBAs) that have supplies
of modern family planning methods (oral,
injectable, barrier, IUD)
7.1% (0.2 - 33.9%) 78.9% (54.4 - 93.9%) 80% 0.4543
7192 Facilities with 24/7 availability of a nurse or
general physician at basic EONC level facilities
60.0% (32.3 - 83.7%) 76.5% (50.1 - 93.2%) 78% 0.4395
7710
UBA facilities that possess monthly AIN-C
registries in which 80% of children under 24
months are registered with weight
n/a 53.3% (26.6 - 78.7%) 80% 0.0049
7730** Population living in communities with a plan for
better community sanitation and water quality
n/a 100% (79.4 - 100%) 80% 0.9772
7740**
UBAs with birthing plans for communities
under their responsibility (which have been
approved by the community)
n/a 87.5% (61.7 – 98.4%) 80%
0.7734
**When considering actual observed availability of plans at health facilities, 56.3% of communities had sanitation plans and 37.5% of
communities had birthing plans located at respective health facilities.
* One-side test of proportions comparing if the estimate is lower than the target

70. 70
Panama HF Performance Indicator Matrix
- Indicators 7730 and 7740: This is a new intervention, thus not evaluated at baseline.
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
7010¹ 7020 7040² 7050 7192³ 7710 7730⁴ 7740⁴
Baseline
18 months

71. 71
7040: Availability of inputs and equipment for delivery care
by facility
Baseline facilities (N =14 )
18-month follow-up facilities (N= 17)
Equipment p / serum c / macrogotero and microgotero
Sterile fields or sheltering for a baby
Intravenous catheter sterile N ° 18
Metallic clamp /umbilical tape / plastic clamp*
Infusion equipment
Urinary catheter
Hyoscine bromide / Butylscopolamine
Ergonovine maleate / Ergometrine / Oxytocin
Ringer lactate / Hartmann solution / Saline solution
Drops of chloramphenicol ophthalmic / 1% silver nitrate
Vitamin K
Equipment p / serum c / macrogotero and microgotero
Sterile fields or sheltering for a baby
Intravenous catheter sterile N ° 18
Metallic clamp /umbilical tape / plastic clamp*
Infusion equipment
Urinary catheter
Hyoscine bromide / Butylscopolamine
Ergonovine maleate / Ergometrine / Oxytocin
Ringer lactate / Hartmann solution / Saline solution
Drops of chloramphenicol ophthalmic / 1% silver nitrate
Vitamin K

72. 72
7020: Health facilities with availability of inputs and
equipment necessary for prenatal and postpartum care
*Does not apply to ambulatory UBA facilities
**Stock-out of ferrous sulfate was checked
Baseline(%)
18-
Month(%)
Indicator 7020 17.6 100.0
Equipment
CLAP obstetrical tape 60.0 100
Gynecological exam table* 66.7 100
Gooseneck lamp/hand lamp 40.0 100
Perinatal maternal card 100 100
Perinatal maternal medical history 100 100
Sphygmomanometer 80.0 100
Standing scales 80.0 100
Stethoscope 93.3 100
Tallimeter/stadiometer 53.3 100
All equipment observed on the day of survey 26.7 100
Pharmacy inputs
Ayre palletes/swabs 76.5 100
Ferrous sulfate 100 100
Microscope slides 76.5 100
All inputs observed on day of survey 76.5 100
Continuous availability in previous 3 months** 52.9 100

73. 73
Honduras
SMI Intervention and Control Regions

74. 74
Honduras 18-M HF Performance Indicators
Baseline 18-month 18-month target
# Indicator description Percent (95% CI) Percent (95% CI) % One-sided Z-
test p value*
7030 Health facilities with permanent
availability of inputs necessary for
emergency obstetric and neonatal
care in maternity clinics
62.5% (24.5 – 91.5%) 85.7% (42.1 – 99.6%) 80% 0.6473
7035 Health facilities with permanent
availability of inputs necessary for
emergency obstetric and neonatal
care in hospitals
0% (0.0 – 45.9%) 50% (11.8 – 88.2%) 2
units
0.8068
7050 Health facilities with modern family
planning supplies (oral, injectable,
barrier, IUD), according to the
schedule (population under
responsibility, time of year, rotation)
86.4% (75.0 – 94.0%) 93% (83.0 – 98.1%) 90% 0.7735
7060 Health facilities with permanent
availability of inputs and necessary
for the treatment of pneumonia
and diarrhea
0% (0.0 – 4.6%) 51.1% (35.8 – 66.3%) 80% <0.00001
7070 Continuous availability of
powdered micronutrients
n/a 93.5% (82.1 – 98.6%) 80% 0.9889
* One-side test of proportions comparing if the estimate is lower than the target

75. 75
Honduras HF Performance Indicator Matrix
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
7030 7035 7050 7060 7070*
Baseline
18-month
*This indicator is a new intervention, thus not evaluated at baseline

76. 76
7030: Basic EONC facilities with continuous availability of inputs
for emergency obstetric and neonatal care in maternity clinics
1At baseline, oxytocin and ergometrine are counted. At 18-months, these two and ergobasine are counted.

77. 77
7035: Health facilities with availability of inputs for neonatal
and obstetric emergencies in hospitals
Baseline(%) 18-Month(%)
Indicator 7035 0 50
Resuscitation bag for adults 83.3 100
Neonatal resuscitation bag 100 100
MVA kit 66.7 100
Stethoscope 66.7 100
Sphygmomanometer 83.3 100
Pinard stethoscope/portable doppler 100 100
Oxygen tank 83.3 100
Autoclave/dry heat sterilizer 66.7 83.3
Pediatric/neonatal stethoscope 0 83.3
Laryngoscope 100 83.3
Anesthesia kit 66.7 66.7
Uterotonics1
100 100
Tetracycline eye ointment 16.7 100
Saline wash 66.7 100
Saline solution or Ringer's lactate 83.3 100
Magnesium sulfate 100 100
Anti-hypertensives2
100 100
Naloxone hydrochloride 83.3 100
Furosemide 100 100
Phenobarbital sodium 100 100
Diazepam 100 100
Dextrose 66.7 100
Dexabethasone/ betamethasone3
66.7 100
Sodium bicarbonate 100 100
Antibiotics4
100 100
Adrenaline 100 100
Atropine/epinephrine 100 100
Equipment
Pharmacy inputs 1Baseline measured oxytocin or ergometrine, while 18-
months measured these two or ergobasine
2Hydralazine, hydralazine hydrochloride, alphamethyl
dopa, propanolol, nifedipine
3At baseline, only dexamethasone is measured; at
followup, betamethasone is also measured.
Requirement for one of these two drugs only applies to
follow-up
4Amoxicillin, ampicillin, amikacin sulfate, penicillin G,
clindamycin, cephalexin, dicloxicillin, doxycycline,
gentamicin, metronidazole

78. 78
7050: Availability of modern contraceptive methods on the
day of the survey
0
10
20
30
40
50
60
70
80
90
100
Injectables Contraceptive pills Condoms Intrauterine device
(IUD)
Baseline
18-Month

79. 79
Outline
Introduction
Design and activities
Results
Conclusions and future activities

80. 80
WOW
What a great SUCCESS

81. 81
Conclusions and future activities
• Great support for SMI at all levels
• Great support from the MoHs for the evaluation

82. 82
Future activities
• Some of the requirements have to be reviewed
• Seasionality has to be accounted for
• Further assess facility’s ability to operate vs not
• Comparative assessment and scoring is needed

83. 83
Future activities
• Lessons learned have to be documented
• Success and failure
• A network for sharing information within and
between countries
• Lots to offer to other areas of the country
• Lots to offer globally
• Build upon the success and maintain it
• Continue to engage the local Health officials
• Continue to engage the communities

84. 84
Thank You
For more information:
mokdaa@uw.edu