Maternal neonatal program index (MNPI)
This indicator is a score (ranging from 0-100) that measures the strength of the national maternal and neonatal health program of a given country based on five main areas: policy and support services, facility capacity, access to services, care received, and family planning (FP). The five main areas cover 13 components:
- Capacities of health centers;
- Capacities of district hospitals;
- Percent of women with access;
- Care at antenatal visits;
- Care at delivery;
- Care for newborns;
- FP at health centers;
- FP at district hospitals;
- Policies toward safe pregnancy;
- Information, education;
- Training; and
- Monitoring and evaluation.
Within each component, the researcher averages items to produce a component score, and converts these scores to a 0-100 scale. The index also yields a total score, which is simply the mean for the 13 components with equal weight for each component (Bulatao and Ross, 2000).
Responses to a detailed questionnaire composed of 81 items from selected key informants (experts from Ministries of Health, medical schools and universities, nongovernmental and community organizations, and donors). Besides rating current program adequacy, experts rate each item on the questionnaire as of three years prior to the survey.
The MNPI questionnaire completed by 10-25 individuals per country.
The purpose of the MNPI is to:
- Assess current health care services;
- Identify program strengths and weaknesses;
- Plan strategies to address deficiencies;
- Encourage political and popular support for appropriate action; and
- Track progress over time.
More specifically, the MNPI is intended to measure the effort put into reducing the maternal/ neonatal mortality and morbidity in a given country. The index is designed to assess only the program inputs, processes, and outputs as they relate to the “supply” or program side of the conceptual framework (Ross, Campbell and Bulatao, 1999). Since the data was first collected in 1999 (then again in 2002 and 2005) it has provided a measure by which to make cross-country and regional comparisons. The MNPI is not designed to provide a single measure of the quality of maternal care; rather, it provides many measures that collectively define a broad standard programs should meet (Bulatao and Ross, 2000).
The MNPI instrument relies on expert judgments, replicating an approach used in family planning and HIV/ AIDS. (See Family Planning Program Effort Index and AIDS Program Effort Index (API) under Family Planning and STIs/HIV/AIDS, respectively.) Standards, however, are ultimately subjective, resting on the knowledge and expertise of the raters, who are different in each country. Whereas the data collection protocol calls for using raters with varying backgrounds (at least ten per country), validating their ratings is difficult (Ross, Campbell and Bulatao, 1999).
Another limitation is the difficulty of correlating the index closely to a reduction in maternal mortality, largely because maternal mortality levels are hard to determine accurately (Bulatao and Ross, 2001).
index, newborn (NB), safe motherhood (SM)