# Surgical indicators for obstetrics and family planning in routine health information systems: a landscape analysis

## TL;DR

This study compares surgical indicators for maternal health and family planning across global guidelines and health systems in nine low- and middle-income countries.

## Contribution

The paper identifies gaps and inconsistencies in surgical indicator tracking for maternal and reproductive health in routine health systems.

## Key findings

- Only 48% of multi-stakeholder surgical indicators are captured in country health systems.
- Post-surgical outcome indicators are rarely tracked in RHIS.
- There is significant variation in indicator inclusion across countries and topics.

## Abstract

Strengthening use of high-quality data for surgical obstetrics and family planning is important for improving maternal and perinatal health outcomes. Routine health information systems (RHIS) represent an important data source for indicator tracking. This landscape analysis aims to describe and compare surgical obstetric and family planning indicators put forth by global multi-stakeholder groups and those that are currently captured in RHIS in nine low- and middle-income countries. The analysis focused on five indicator topics: (i) caesarean delivery, (ii) peripartum hysterectomy, (iii) female genital fistula care, (iv) insertion/removal of long-acting reversible contraception and male/female sterilization, and (v) the general surgical context. We examined 12 indicator lists developed by multi-stakeholder groups and RHIS documentation from the Democratic Republic of the Congo, Guinea, India, Madagascar, Mali, Mozambique, Nigeria, Rwanda, and Senegal. 29 multi-stakeholder and 104 country indicators (119 unique indicators) met our inclusion criteria, typically capturing service provision or service readiness. Indicators on post-surgical outcomes or complications were rarer. The reviewed multi-stakeholder lists did not include indicators on peripartum hysterectomy. At the country level, not all RHIS included fistula care or peripartum hysterectomy indicators and there were marked differences with regard to what indicators were included and the relative distribution of indicators across the indicator topics. Only 14 (48%) of the multi-stakeholder indicators were included in countries’ RHIS, with just two being tracked by all nine countries (caesarean deliveries and family planning users by modern method of contraception). There was a lack of standardized indicators for surgical obstetrics and family planning, and we noted typical RHIS challenges such as indicator profusion, duplication, vague indicator definitions, and measurement of composite or difficult-to-quantify concepts. Our findings suggest that there are opportunities to standardize and streamline prioritized measurement of surgical obstetric and family planning data for tracking with the ultimate aim of improving health services.