sexual, reproductive, maternal, newborn, child and

SEXUAL, REPRODUCTIVE, MATERNAL, NEWBORN, CHILD AND ADOLESCENT HEALTH POLICY SURVEY 2018–2019: REPORT

Sexual, reproductive, maternal, newborn, child and adolescent health policy survey, 2018–2019: report

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iiiForeword

Foreword

Reducing maternal, newborn, child and adolescent morbidity and mortality, and improving health and well-being, remain key health priorities globally. Under the Sustainable Development Goals (SDGs) and the United Nations Secretary-General’s Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030), all countries have committed to improving health for all, especially for women, children and adolescents, via transformative multisectoral action to accelerate coverage of interventions, reduce gender inequalities and equity gaps, and improve the quality of services. Achieving these goals requires the adoption and implementation of strong rights-based, evidence-informed and equity-focused policies spanning the continuum of care for sexual, reproductive, maternal, newborn, child and adolescent health (SRMNCAH), reaching beyond traditional health system boundaries. Such a life-course approach is essential for ensuring that all people can live healthily throughout their lives into old age.

Within the World Health Organization, the Department of Maternal, Newborn, Child and Adolescent Health and Ageing and the Department of Sexual and Reproductive Health and Research have been tracking policies in SRMNCAH for more than 10 years. This global survey harnesses these efforts and creates a single report on the status of national policies, guidelines and laws on SRMNCAH across the continuum. With responses from more than 150 countries, this survey represents the most comprehensive database on SRMNCAH policies and guidelines currently available. The policy documents collected through the survey, which provide a valuable repository for the health community, are available at: https://www.who.int/data/maternal-newborn-child-adolescent/national-policies?selectedTabName=Documents.

Having the appropriate laws, policies and guidelines in place is a critical first step for countries to achieve universal health coverage for healthier populations through the provision of primary health care. However, only through effective implementation of these laws, policies and guidelines can improvements in the health of women, children and adolescents occur globally. We hope the information generated through this survey will provide an opportunity for countries to initiate the necessary policy dialogues and strategic reviews to achieve the SDGs.

Dr Ian Askew Dr Anshu Banerjee

Director DirectorDepartment of Sexual and Reproductive Health Department of Maternal, Newborn, Child andand Research Adolescent Health and Ageing

https://www.who.int/data/maternal-newborn-child-adolescent/national-policies?selectedTabName=Documents

https://www.who.int/data/maternal-newborn-child-adolescent/national-policies?selectedTabName=Documents

Sexual, reproductive, maternal, newborn, child and adolescent health policy survey 2018–2019: reportiv

Acknowledgements

This report was prepared by the World Health Organization (WHO) Department of Maternal, Newborn, Child and Adolescent Health and Ageing together with the Department of Sexual and Reproductive Health and Research. The work on the SRMNCAH policy survey was coordinated by Theresa Diaz. Elizabeth Katwan was responsible for data management and statistical analysis. Gerard Lopez collaborated in data management. Ashley Sheffel worked on statistical analysis and report writing.

We wish to thank colleagues from WHO headquarters who provided technical guidance, inputs and support for the 2018–2019 SRMNCAH Policy Survey: Bernadette Daelmans, Mario Festin, Regina Guthold, Rajat Kholsa, James Kiarie, Blerta Maliqi, and Marcus Stahlhofer. We also thank additional colleagues from WHO headquarters who provided feedback and inputs to the survey questionnaire, glossary and report: Avni Amin, Valentina, Baltag, Kaia Engesveen, Kid Kohl, Ornella Lincetto, Allisyn Moran, Moise Muzigaba, Annie Portela, Nathalie Roos, David Ross, Kathleen Strong and Wilson Were. We would also like to thank focal points in the WHO regional offices for their generous support and assistance in coordinating the SRMNCAH policy survey during 2018–2019. This includes, but is not limited to: Adjoa Agbodjan-Prince, Nino Berdzuli, Geoffrey Bisoborwa, Betzabe Butron Riveros, Sergei Bychkov, Kwami Dadji, Natalia Fedkina, Anoma Jayathilaka, Dhiraj Kumar, Zhao Li, Ivo Rakovac, Saliyou Sanni, Khalid Siddeeg, Howard Sobel, Martin Weber and Teshome Desta Woldehanna. Additional thanks to staff in numerous WHO country offices who provided invaluable support in implementing the survey.

Colleagues who participated in the Policy Reference Group also provided helpful feedback and support throughout the survey process: David Adamson, Martina Lukong Baye, Victoria Boydell, Joanne Carter, Sarah Dalglish, Cheikh Faye, Patty Garcia Former, Alanna Galati, Asha George, Jody Heymann, Debra Jackson, Benoit Kalasa, Zoe Matthews, Kimberly McArthur, Kristine Nilsen, Annie Portela, Jennifer Requejo, Jim Ricca, Bruno Rivalan, Nathalie Roos, David Ross, Kate Somers, Petra ten Hoope-Bender, Wilson Were, Lisa Witter and Shehla Zaidi.

Thanks also to Jura Editorial Services who supported report editing and Green Ink who helped with the design and final preparation of this report.

This work on the SRMNCAH policy survey was funded through a grant from the Bill and Melinda Gates Foundation.

Finally, we thank all Member States (Annex 7) that took part in the survey, allowing the assessment and completion of this report.

vTable of Contents

Contents

Foreword .............................................................................................................................................. iii

Acknowledgements ............................................................................................................................. iv

List of abbreviations ......................................................................................................................... xiv

Executive summary .............................................................................................................................. 1

1. Introduction .................................................................................................................................. 71.1. Background and rationale 81.2. History of policy surveys in SRMNCAH 81.3. Key objectives of the 2018–2019 global SRMNCAH policy survey 8

2. Methods ......................................................................................................................................... 92.1. SRMNCAH Policy Reference Group 102.2. PRG survey to prioritize SRMNCAH policy survey questions 102.3. Review of existing data sources 102.4. Mapping the MCA Department’s MNCAH questionnaire and new SRMNCAH policy database to frame priority policy areas 102.5. Questionnaire development 102.6. Questionnaire administration 112.7. Data processing 112.8. Data analysis 11

3. Response rate and scope of report .......................................................................................... 133.1. Response rate 143.2. Scope of report 15

4. Sexual and reproductive health ................................................................................................ 174.1. Availability and components of national policy/guideline on reproductive health care 184.2. Availability of national policy/guideline on family planning/contraception 204.3. Availability of national clinical practice guideline on family planning/contraception 204.4. Inclusion in national essential drugs list of drugs indicated for use for family planning 224.5. Availability of national policy/guideline on task-sharing for family planning services 234.6. Availability and components of national policy/guideline on STI diagnosis, treatment and counselling 234.7. Availability and components of national policy/guideline on comprehensive national cervical cancer prevention 26

5. Antenatal care ............................................................................................................................ 295.1. Availability and components of national ANC policy/guideline 30

6. Childbirth..................................................................................................................................... 376.1. Availability and components of national childbirth policy/guideline, including national policy/guideline on the right of every woman to have access to skilled care at childbirth 386.2. Availability of national policy/guideline on facility infrastructure 416.3. Availability of national policy/guideline/law on notification and review of maternal, stillbirth and neonatal deaths 426.4. Availability of national policy/guideline setting forth a competency framework for maternal and/or newborn health care 436.5. Inclusion in national essential drugs list of drugs indicated for use during pregnancy, childbirth and postpartum care 43

Sexual, reproductive, maternal, newborn, child and adolescent health policy survey 2018–2019: reportvi

7. Postnatal care for mothers and newborns .............................................................................. 477.1. Availability of national policy/guideline on postnatal care for mothers and newborns 487.2. Availability and components of national policy/guideline on management of low-birth-weight and preterm newborns 497.3. Availability of national standard on management of newborn infants with severe illness 52

8. Child health ................................................................................................................................. 558.1. Availability of national policy/guideline on child health and development 568.2. Availability of national policy/guideline on competency framework for child health care 578.3. Availability and components of national policy/guideline on management of childhood pneumonia 578.4. Availability and components of national policy/guideline on management of childhood diarrhoea 608.5. Availability and components of national policy/guideline on manage ment of malaria with appropriate recommendations for children 618.6. Availability of national policy/guideline on management of acute malnutrition in children 628.7. Availability of national policy/guideline on routine assessment of children for overweight or obesity in health facilities 648.8. Availability and components of national policy/guideline on paediatric hospital care for sick children 648.9. Availability of national policy/guideline on early childhood development (ECD) 678.10. Availability and components of national policy/guideline on Integrated Management of Childhood Illness (IMCI) 688.11. Availability of national policy/guideline on treatment of young infants with PSBI 698.12. Availability and components of national policy/guideline on management of childhood illness by trained community health workers 708.13. Availability of national policy/guideline on integrated community case management (iCCM) 728.14. Availability and components of national policy/guideline on home-care practices by trained community health workers 73

9. Adolescent health ....................................................................................................................... 779.1. Availability of national policy/guideline on adolescent health 789.2. Availability and components of national standard for delivery of health services to adolescents 789.3. Availability and components of national standard for health-promoting schools 799.4. Availability and components of national adolescent health programme 809.5. Availability of national policy/guideline and system related to health worker competency and training in adolescent health 80

10. Violence against women ............................................................................................................ 8310.1. How many countries have multisectoral plans of actions on violence against women? 8410.2. How many countries report having national guidelines/protocols to address health system response to violence against women? 8510.3. How many countries report having training programmes to strengthen capacity of health-care providers to respond to violence against women/gender-based violence? 87

11. Cross-cutting .............................................................................................................................. 8911.1. Availability of national targets for monitoring key SRMNCAH indicators 9011.2. Availability of national coordinating body for SRMNCAH 9111.3. Availability of national policy ensuring engagement of civil society organization representatives in national-level planning and periodic reviews of SRMNCAH programmes 9111.4. Participation of stakeholders in reviews of national SRMNCAH programmes 9311.5. Areas addressed by national policies/guidelines to improve quality of care in SRMNCAH services 9411.6. Availability of national quality of care steering committee/technical working group for SRMNCAH 9511.7. Most commonly used data sources to compare national maternal, newborn, child and adolescent mortality rates to mortality rates in other countries 9611.8. Comparing policy availability and intervention coverage 96

12. Limitations of the 2018–2019 SRMNCAH policy survey .......................................................... 97

13. Conclusions ................................................................................................................................ 99

References ........................................................................................................................................ 101

viiContents

List of figuresFigure 1. Availability of key SRMNCAH policies, globally 2Figure 2. Availability of 16 key SRMNCAH policies, by WHO region 3Figure 3. Map of WHO Member States that participated in the 2018 global SRMNCAH policy survey 15Figure 4. Map of countries where national policy/guideline on reproductive health care is available 19Figure 5. Components included in national policies/guidelines on reproductive health care, globally 19Figure 6. Average proportion of policy components and proportion of countries with all components included in

national reproductive health-care policy/guideline, by WHO region 20Figure 7. Map of countries where national policy/guideline on family planning/contraception is available 21Figure 8. Availability of national policies/guidelines on family planning/contraception, and policy includes

requirement of contraceptive commodity security plan, by WHO region 21Figure 9. Proportion of countries with national clinical practice guidelines on family planning/contraception

using latest WHO guidelines, by WHO region 22Figure 10. Family planning commodities included in national essential drugs list, globally 22Figure 11. Average proportion of family planning commodities included in national essential drugs list and

proportion of countries with all family planning commodities included, by WHO region 23Figure 12. Availability of national policies/guidelines on task-sharing of family planning services, by WHO region 24Figure 13. Map of countries where national policy/guideline on STIs is available 24Figure 14. Components included in national policy/guideline on STIs, globally 25Figure 15. Average proportion of policy components and proportion of countries with all components included in

national policy/guideline on STIs, by WHO region 25Figure 16. Map of countries where national policy/guideline on comprehensive cervical cancer prevention is available 26Figure 17. Components included in national policy/guideline on comprehensive national cervical cancer prevention,

globally 27Figure 18. Average proportion of policy components and proportion of countries with all components included in

national policy/guideline on comprehensive national cervical cancer prevention, by WHO region 27Figure 19. Map of countries where national policy/guideline on ANC is available 30Figure 20. Availability of national policies/guidelines on ANC, by WHO region 31Figure 21. National policy/guideline on ANC specifies minimum number of ANC contacts during a normal pregnancy,

by WHO region 32Figure 22. National policy/guideline on ANC specifies time of first contact, by WHO region 32Figure 23. National policy/guideline on ANC includes statement on counselling and interventions, by WHO region 33Figure 24. Components included in national ANC policy/guideline, globally 33Figure 25. National policy/guideline on ANC recommends use of ultrasound before 24 weeks of gestation,

by WHO region 34

Annexes

Annex 1: Reproductive, Maternal, Newborn, Child and Adolescent Health Policy Survey 2018–2019 .......................................................................................................................... 105

Annex 2: Tables ................................................................................................................................ 213

Annex 3: Policy Reference Group members ..................................................................................... 259

Annex 4: MCA Policy Tracking Survey Report October 2017 ........................................................... 261

Annex 5: Mapping of data sources and creation of a database for Maternal, Newborn, Child and Adolescent Health Policies ................................................................................ 273

Annex 6: Mapping priority policy areas ............................................................................................ 337

Annex 7: Countries that completed the 2018–2019 SRMNCAH Policy Survey by WHO region ....... 365

Annex 8: Countries that completed the 2018–2019 SRMNCAH Policy Survey by World Bank income group ..................................................................................................................... 367

Sexual, reproductive, maternal, newborn, child and adolescent health policy survey 2018–2019: reportviii

Figure 26. Average proportion of policy components and proportion of countries with all components included in ANC national policy/guideline, by WHO region 35

Figure 27. Map of countries where national policy/guideline on childbirth is available 38Figure 28. Availability of national policies/guidelines on the right of every woman to have access to skilled care at

childbirth, by WHO region 39Figure 29. Components included in national policy/guideline on the right of every woman to have access to skilled

care at childbirth, globally 39Figure 30. Average proportion of policy components and proportion of countries with all components included in

national policy/guideline on the right of every woman to have access to skilled care at childbirth, by WHO region 40

Figure 31. Availability of national policies/guidelines on availability of clean water, sanitation and essential equipment in facilities where births take place, by WHO region 41

Figure 32. Availability of policies/guidelines/laws on maternal, stillbirth and neonatal death notification and review, by WHO region 42

Figure 33. Availability of national policies/guidelines setting forth a competency framework for maternal and/or newborn health care, by WHO region 43

Figure 34. Availability of national policies/guidelines on essential medicines and equipment, by WHO region 43Figure 35. Items indicated for use during pregnancy, childbirth and postpartum care included in national essential

drugs list and national list of commodities, globally 44Figure 36. Average proportion of items included in national essential drugs/commodities list, and proportion

of countries that include all items, by WHO region 45Figure 37. Map of countries where national policy/guideline on postnatal care for mothers and newborns is available 48Figure 38. National policy/guideline on postnatal care recommends assessment of both mother and newborn, mother

only or newborn only, by WHO region 49Figure 39. Availability of national policies/guidelines on management of low-birth-weight and preterm newborns,

by WHO region 50Figure 40. Components included in national policy/guideline on management of low-birth-weight and preterm

newborns, globally 50Figure 41. Average proportion of policy components and proportion of countries with all components included in

national policy/guideline on management of low-birth-weight and preterm newborns, by WHO region 51Figure 42. National policy/guideline on low-birth-weight and preterm newborns indicates level of facility where

Kangaroo Mother Care should be provided, by WHO region 52Figure 43. National standards on management of newborn infants with severe illness specify availability of SNCUs

and NICUs, by WHO region 53Figure 44. National standards on management of newborn infants with severe illness specify level at which SNCUs

are available, by WHO region 53Figure 45. National standards on management of newborn infants with severe illness specify level at which NICUs

are available, by WHO region 54Figure 46. Availability of national policy/guideline that recommends routine haemoculture before starting on

antibiotics in case of suspected sepsis, and availability of national policy/guideline for treatment of sick newborns with PSBI at primary health care facilities when referral is not feasible, by WHO region 54

Figure 47. Map of countries where national policy/guideline on child health and development of children is available 56Figure 48. Availability of national policies/guidelines on child health and development of children, by WHO region 57Figure 49. Availability of national policy/guideline setting forth a competency framework for child health care, and

availability of a continuous professional education system for primary health care clinicians and/or nurses to receive child-specific training, by WHO region 58

Figure 50. Availability of national policies/guidelines on management of childhood pneumonia, by WHO region 58Figure 51. National policy/guideline on management of childhood pneumonia specifies facility level at which pneumonia

with chest indrawing can be treated, by WHO region 59Figure 52. National policy/guideline on management of childhood pneumonia specifies first line of treatment for

pneumonia with chest indrawing or fast breathing, globally 60Figure 53. Availability of national policies/guidelines on management of childhood diarrhoea, by WHO region 60Figure 54. Recommended treatment for diarrhoea with dehydration specified in national policy/guideline,

by WHO region 61

ixContents

Figure 55. Availability of national policies/guidelines on management of malaria with appropriate recommendations for children, by WHO regiona) 62

Figure 56. National policy/guideline on management of malaria with appropriate recommendations for children specifies recommended parasitological confirmation (microscopy or RDT) of malaria before treatment, by WHO regiona) 63

Figure 57. Availability of national policies/guidelines on management of acute malnutrition in children, by WHO region 63

Figure 58. Availability of national policies/guidelines on routine assessment of children for overweight or obesity in health facilities, by WHO region 64

Figure 59. Availability of national policies/guidelines on management of hospitalized children (aged 1 month to 9 years) and availability of national clinical standards 65

Figure 60. Medicines indicated for management of childhood illness included in national essential drugs list, globally 66Figure 61. Average proportion of medicines and proportion of countries with all medicines indicated for management of

childhood illness included in national essential drugs list, by WHO region 67Figure 62. Availability of national policies/guidelines on ECD, by WHO region 68Figure 63. Availability of national policies/guidelines on IMCI, by WHO region 68Figure 64. Components included in national policy/guideline on IMCI, globally 69Figure 65. Average proportion of policy components and proportion of countries with all components included in

national IMCI guidelines, by WHO region 70Figure 66. Availability of national policies/guidelines for treatment of young infants with PSBI at primary health care

facility when referral is not feasible, by WHO region 70Figure 67. Availability of national policies/guidelines for management of childhood illness by trained community

health workers, by WHO region 71Figure 68. National policy/guideline on management of childhood illness by trained community health workers

(CHWs) specifies which activities can be performed, by WHO region 72Figure 69. Availability of national policies/guidelines on iCCM, by WHO region 73Figure 70. Availability of national policies/guidelines on supporting home-care practices by trained community

health workers, by WHO region 73Figure 71. Components included in national policy/guideline on supporting home-care practices by trained

community health workers, globally 74Figure 72. Average proportion of components and proportion of countries with all components included in national

policy supporting home-care practices by trained community health workers, by WHO region 75Figure 73. Map of countries where national policy/guideline on adolescent health is available 78Figure 74. Availability and components of national standards for delivery of health services to adolescents,

by WHO region 79Figure 75. Availability of national standards for health-promoting schools and related monitoring activities,

by WHO region 80Figure 76. Availability and components of national adolescent health programmes, by WHO region 81Figure 77. Availability of national policies/guidelines related to health worker competency and training in adolescent

health, by WHO region 81Figure 78. Map of countries that report having national multisectoral plans of action for response to violence

against women 85Figure 79. Proportion of countries with national guidelines/protocols on health system response to violence

against women, by WHO region 85Figure 80. Inclusion of seven key components in national guideline/protocol to address violence against women,

globally 86Figure 81. Average proportion of components included in national guideline/protocol to address violence against

women, by WHO region 87Figure 82. Proportion of countries reporting national training programmes to strengthen the capacity of

health-care providers to respond to violence against women/gender-based violence, by WHO region 87Figure 83. Availability of national targets for monitoring key SRMNCAH indicators, by WHO region 90Figure 84. Availability of national coordinating body overseeing all components of SRMNCAH, by WHO region 91Figure 85. Availability of national policies to ensure engagement of civil society organization representatives

in national-level planning and periodic reviews of SRMNCAH programmes, by WHO region 92

Sexual, reproductive, maternal, newborn, child and adolescent health policy survey 2018–2019: reportx

Figure 86. Participation by stakeholders in reviews of national SRMNCAH programmes, by WHO region 93Figure 87. Service areas addressed by national policies/guidelines to improve quality of care in SRMNCAH, globally 94Figure 88. Average proportion of service areas and proportion of countries with all service areas included i

n national policy/guideline to improve quality of care in SRMNCAH, by WHO region 95Figure 89. Availability of national quality of care steering committee/technical working group for SRMNCAH,

by WHO region 95Figure 90. Most commonly used data sources to compare maternal, newborn, child and adolescent mortality rates,

by WHO region 96

List of tablesTable 1. Response rate for the 2018 global SRMNCAH policy survey ............................................... 14

Annex 2. Tables

Table A.2.1. Availability of national policies/guidelines on reproductive health 213Table A.2.2. Components included in national policies/guidelines on reproductive health care, by WHO

region and World Bank income group 214Table A.2.3. Availability of national policies/guidelines on family planning/contraception and inclusion of

requirement of contraceptive commodity security plan, by WHO region and World Bank income group 215

Table A.2.4. Availability of national clinical practice guidelines on family planning/contraception using latest WHO guidelines, by WHO region and World Bank income group 215

Table A.2.5. Family planning commodities included in national essential drugs list, by WHO region and World Bank income group 216

Table A.2.6. Availability of national policies/guidelines on task-sharing of family planning services, by WHO region and World Bank income group 217

Table A.2.7. Availability of national policies/guidelines on diagnosis, treatment and counselling for sexually transmitted infections (STIs), by WHO region and World Bank income group 217

Table A.2.8. Components included in national policy/guideline on STI diagnosis, treatment and counselling, by WHO region and World Bank income group 218

Table A.2.9. Availability of national policies/guidelines on comprehensive national cervical cancer prevention and control, by WHO region and World Bank income group 218

Table A.2.10. Components included in national comprehensive cervical cancer control policies/guidelines, by WHO region and World Bank income group 219

Table A.2.11. Availability of national policies/guidelines on antenatal care (ANC), by WHO region and World Bank income group 219

Table A.2.12. National policy/guideline on ANC specifies minimum number of ANC contacts during a normal pregnancy, by WHO region and World Bank income group 220

Table A.2.13. National policy/guideline on ANC specifies time of first contact, by WHO region and World Bank income group 221

Table A.2.14. National policy/guideline on ANC includes statement on counselling and interventions, by WHO region and World Bank income group 221

Table A.2.15. Components included in ANC policies/guidelines, by WHO region and World Bank income group 222Table A.2.16. National policy/guideline on ANC recommends use of ultrasound before 24 weeks of

gestation, by WHO region and World Bank income group 223Table A.2.17. Average proportion of policy components and proportion of countries with all components

included in ANC national policy/guideline, by WHO region and World Bank group 223Table A.2.18. Availability of national policy/guideline on childbirth and inclusion of the right to access to

skilled care during childbirth, by WHO region and World Bank income group 224Table A.2.19. Components included in national childbirth policies/guidelines, by WHO region and World Bank

income group 224

xiContents

Table A.2.20. Average proportion of policy components and proportion of countries with all components included in national policy/guideline on the right of every woman to have access to skilled care at childbirth, by WHO region and World Bank income group 225

Table A.2.21. Availability of national policies/guidelines on availability of clean water and sanitation and essential equipment in facilities where births take place, by WHO region and World Bank income group 225

Table A.2.22. Availability of national policies/guidelines/laws on maternal, stillbirth and neonatal death notification and review, by WHO region and World Bank income group 226

Table A.2.23. Availability of national policies/guidelines setting forth a competency framework for maternal and/or newborn health care, by WHO region and World Bank income group 226

Table A.2.24. Availability of national policies/guidelines on essential medicines and equipment, by WHO region and World Bank income group 227

Table A.2.25. Items indicated for use during pregnancy, childbirth and postpartum care included in national essential drugs list and national commodities list, by WHO region and World Bank income group 227

Table A.2.26. Items indicated for use during pregnancy, childbirth and postpartum care included in national essential drugs list and national commodities list, by WHO region and World Bank income group (continued) 228

Table A.2.27. Average proportion of items and proportion of countries with all items included in national essential drugs list and list of essential commodities, by WHO region and World Bank income group 229

Table A.2.28. National policy/guideline on postnatal care recommends assessment of both mother and newborn, mother only, or newborn only by WHO region and World Bank income group 229

Table A.2.29. Availability of national policies/guidelines on management of low-birth-weight and preterm newborns, by WHO region and World Bank income group 230

Table A.2.30. Components included in national policies/guidelines on management of low-birth-weight and preterm newborns, by WHO region and World Bank income group 231

Table A.2.31. National policy/guideline on low-birth-weight and preterm newborns indicates level of facility where Kangaroo Mother Care (KMC) should be provided, by WHO region and World Bank income group 232

Table A.2.32. National standards exist for management of newborn infants with severe illness and specify availability of special newborn care units (SNCUs) and newborn intensive care units (NICUs), by WHO region and World Bank income group 232

Table A.2.33. National standards on management of newborn infants with severe illness specify level at which SNCUs and NICUs are available, by WHO region and World Bank income group 233

Table A.2.34. Availability of national policy/guideline that recommends routine haemoculture in newborns before starting on antibiotics in case of suspected sepsis, and availability of national policy/ guideline for treatment of sick newborns with possible serious bacterial infection (PSBI) at primary health care facilities when referral is not feasible, by WHO region and World Bank income group 233

Table A.2.35. Availability of national policies/guidelines on child health and development of children, by WHO region and World Bank income group 234

Table A.2.36. Availability of national policy/guideline setting forth a competency framework for child health care, and availability of a continuous professional education system for primary health care clinicians and/or nurses to receive child-specific training, by WHO region and World Bank income group 234

Table A.2.37. Availability of national policies/guidelines on management of childhood pneumonia, by WHO region and World Bank income group 235

Table A.2.38. National policy/guideline on management of childhood pneumonia specifies level of system at which pneumonia with chest indrawing can be treated, by WHO region and World Bank income group 235

Table A.2.39. National policy/guideline on management of childhood pneumonia specifies first line of treatment for pneumonia with chest indrawing and fast breathing, by WHO region and World Bank income group 236

Sexual, reproductive, maternal, newborn, child and adolescent health policy survey 2018–2019: reportxii

Table A.2.40. Availability of national policies/guidelines on management of childhood diarrhoea, by WHO region and World Bank income group 237

Table A.2.41. Recommended treatment for diarrhoea with dehydration specified in national policy/ guideline, by WHO region and World Bank income group 237

Table A.2.42. Availability of national policies/guidelines on management of malaria with appropriate recommendations for children, by WHO region and World Bank income group 238

Table A.2.43. National policy/guideline on management of malaria with appropriate recommendations for children specifies recommended parasitological confirmation (microscopy or RDT) of malaria before treatment, by WHO region and World Bank income group 239

Table A.2.44. Availability of national policies/guidelines on management of acute malnutrition in children, by WHO region and World Bank income group 239

Table A.2.45. Availability of national policies/guidelines on routine assessment of children for overweight or obesity in health facilities, by WHO region and World Bank income group 240

Table A.2.46. Availability of national policies/guidelines on management of hospitalized children (aged 1 month to 9 years), and availability of national clinical standards for management of children with severe illnesses in hospitals, by WHO region and World Bank income group 240

Table A.2.47. Drugs indicated for management of childhood illness included in national essential drugs list, by WHO region and World Bank income group 241

Table A.2.48. Availability of national policies/guidelines on early childhood development (ECD), by WHO region and World Bank income group 242

Table A.2.49. Availability of national policies/guidelines on integrated management of childhood illness (IMCI), by WHO region and World Bank income group 242

Table A.2.50. Service areas included in national policies/guidelines on IMCI, by WHO region and World Bank income group 243

Table A.2.51. Availability of national policies/guidelines for treatment of young infants with PSBI at primary health care facilities when referral is not feasible, by WHO region and World Bank income group 243

Table A.2.52. Availability of national policies/guidelines for management of childhood illness by trained community health workers, by WHO region and World Bank income group 244

Table A.2.53. National policy/guideline on management of childhood illness by trained community health workers specifies which activities can be performed, by WHO region and World Bank income group 244

Table A.2.54. Availability of national policies/guidelines on integrated community case management (iCCM), by WHO region and World Bank income group 245

Table A.2.55. Availability of national policies/guidelines on supporting home-care practices by trained community health workers, by WHO region and World Bank income group 245

Table A.2.56. Components included in national policies/guidelines on supporting home-care practices by trained community health workers (CHWs), by WHO region and World Bank income group 246

Table A.2.57. Availability of national policy guideline that specifically addresses adolescent (10–19 years) health issues, by WHO region and World Bank income group 246

Table A.2.58. Availability of national standards for delivery of health services to adolescents that include clearly defined comprehensive package of health services, and activities to monitor implementation of these standards, by WHO region and World Bank income group 247

Table A.2.59. Availability of national standards for health-promoting schools, and activities to monitor implementation, by WHO region and World Bank income group 247

Table A.2.60. Availability of national adolescent health programme with at least one designated full-time employee and regular government budget allocation, by WHO region and World Bank income group 248

Table A.2.61. Availability of national policy/guideline that specifies competencies of health workers in adolescent health, availability of continuous professional education system for primary health workers to receive adolescent-specific training, and availability of pre-service training for clinicians, nurses and community health workers that includes adolescent health, by WHO region and World Bank income group 249

Table A.2.62. Availability of national multisectoral plan of action for response to violence against women, by WHO region and World Bank income group 249

xiiiContents

Table A.2.63. Availability of national guidelines/protocols for the health sector to address violence against women/gender-based violence, by WHO region and World Bank income group 250

Table A.2.64. Components included in national guidelines/protocols to address violence against women, by WHO region and World Bank income group 251

Table A.2.65. Availability of national training programme to strengthen capacity of health-care providers to respond to violence against women/gender-based violence, by WHO region and World Bank income group 252

Table A.2.66. Availability of national targets for key monitoring indicators, by WHO region and World Bank income group 253

Table A.2.67. Availability of national coordinating body responsible for SRMNCAH or its components, by WHO region and World Bank income group 254

Table A.2.68. Availability of national policy to ensure engagement of civil society organization representatives in national-level planning and periodic reviews of SRMNCAH programmes, by WHO region and World Bank income group 254

Table A.2.69. Participation of stakeholders in periodic reviews of SRMNCAH programmes, by WHO region and World Bank income group 255

Table A.2.70. Areas addressed by national policies/guidelines to improve quality of care in SRMNCAH services, by WHO region and World Bank income group 256

Table A.2.71. Availability of national quality of care steering committee/technical working group for SRMNCAH, by WHO region and World Bank income group 256

Table A.2.72. Most commonly used data sources to compare national maternal, newborn, child and adolescent mortality rates to mortality rates in other countries, by WHO region and World Bank income group 257

Sexual, reproductive, maternal, newborn, child and adolescent health policy survey 2018–2019: reportxiv

List of abbreviations

AFR African Region

AIDS acquired immune deficiency syndrome

AMR Region of the Americas

ANC antenatal care

BCG Bacillus Calmette-Guerin

CHW community health worker

CPR contraceptive prevalence rate

CSE comprehensive sexuality education

DHS Demographic and Health Survey

ECD early childhood development

EMOC emergency obstetric care

EMR Eastern Mediterranean Region

EUR European Region

EWEC Every Woman Every Child

HIS health information system

HIV human immunodeficiency virus

HPV human papilloma virus

iCCM integrated community case management

ICM International Confederation of Midwives

IMCI integrated management of childhood illness

IPTp intermittent preventive treatment in pregnancy

IUD intrauterine device

IVF in-vitro fertilization

KMC Kangaroo Mother Care

LBW low birth weight

MCA WHO Department of Maternal, Newborn, Child and Adolescent Health and Ageing

MICS Multiple Indicator Cluster Survey

MNCAH maternal, newborn, child and adolescent health

MoH Ministry of Health

NICU newborn intensive care unit

ORS oral rehydration solution

PEP postexposure prophylaxis

PID pelvic inflammatory disease

PPH postpartum haemorrhage

PRG Policy Reference Group

PSBI possible serious bacterial infection

RDT rapid diagnostic test

RMNCAH reproductive, maternal, newborn, child and adolescent health

SARA Service Availability and Readiness Assessment

SDG Sustainable Development Goal

SDI service delivery indicators

SEAR South-East Asia Region

SNCU special newborn care unit

SPA Service Provision Assessment

SRH WHO Department of Sexual and Reproductive Health and Research

SRMNCAH sexual, reproductive, maternal, newborn, child and adolescent health

STI sexually transmitted infection

TB tuberculosis

UN United Nations

UNAIDS Joint United Nations Programme on HIV/AIDS

UNFPA United Nations Population Fund

UNICEF United Nations Children’s Fund

VLBW very low birth weight

WHA World Health Assembly

WHO World Health Organization

WPR Western Pacific Region

1Executive Summary

Executive summary

To track country progress in adopting World Health Organization (WHO) recommendations in national health legislation, policies, strategies and guidelines related to sexual, reproductive, maternal, newborn, child and adolescent health (SRMNCAH), WHO conducted the 2018 global Sexual, Reproductive, Maternal, Newborn, Child and Adolescent Health Policy Survey (global SRMNCAH policy survey).

The global SRMNCAH policy survey began with consultations with a Policy Reference Group (PRG) in order to identify priority policy areas to include in the survey. Next, a draft questionnaire was created based on PRG-identified priorities, available data and past rounds of maternal, newborn, child and adolescent health (MNCAH) policy surveys. This questionnaire, consisting of six modules (cross-cutting, maternal and newborn health, child health, adolescent health, reproductive health and gender-based violence), was programmed into an online platform, and all WHO Member States were invited to complete the survey. In each country, the WHO country office or other assigned country focal point was responsible for coordinating with the Ministry of Health and/or other United Nations agencies to complete the survey. Of the 194 WHO Member States, a total of 150 completed the survey for an overall response rate of 77%. The findings of this report are reflective of the 150 Member States that responded to this survey. Five additional countries that are not WHO Member States completed the survey; their responses are not reflected in this report but will be included in corresponding regional reports.

Countries were asked about the national availability of key policies, guidelines and laws related to SRMNCAH as well as specific contents of their policies. Across the continuum of care, availability of 16 key policies was assessed: family planning/contraception; diagnosis, treatment and counselling for sexually transmitted infections

(STIs); comprehensive national cervical cancer prevention; antenatal care (ANC); childbirth; postnatal care for mothers and newborns; management of low-birth-weight and preterm newborns; child health and development of children; early childhood development; integrated management of childhood illness; management of childhood pneumonia; management of childhood diarrhoea; management of malaria with appropriate recommendations for children (in malaria-endemic countries); management of acute malnutrition in children; adolescent (10–19 years) health issues; and availability of a multisectoral plan of action for gender-based violence (Fig. 1 and 2).

The results of the survey show that, globally, countries have on average 13 of the 16 (83%) key policies. Availability of the 16 key policies varies by region: 95% of countries in the South-East Asia Region have all 16 policies, compared to 69% of countries in the Western Pacific Region. While most countries have at least 75% of the key policies, 16 of the 150 countries fall below the 50% mark.

Sexual and reproductive healthGlobally, national policies/guidelines on reproductive health care are almost universal; 94% of countries report that they have a national policy or guideline for reproductive health.

Somewhat fewer countries (88%) have a national policy/guideline on family planning/contraception. All countries in the African Region and the South-East Asia Region have such a policy/guideline, as do most countries in the Eastern Mediterranean Region (93%) and the Region of the Americas (86%). Fewer countries in the European Region and the Western Pacific Region have a national policy/guideline on family planning/contraception (74% and 79%, respectively).

Sexual, reproductive, maternal, newborn, child and adolescent health policy survey 2018–2019: report2

Figure 1. Availability of key SRMNCAH policies, globally

The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement.

Data Source: Maternal, Newbon, Child, and Adolescent Health Policy Survey, 2018 Map Production: Department of Maternal, Newborn, Child, and Adolescent Health World Health Organization © WHO 2018. All rights reserved.

N

50%-75%

75%-99%

100%

Data not available

Not applicable

Proportion of key policies available

25%-50%

Globally, 87% of all countries have a national policy/guideline on STI diagnosis, treatment and counselling. Regionally, there are high proportions of countries with such a policy in the African Region (93%), Region of the Americas (93%), South-East Asia Region (91%) and Western Pacific Region (100%). A moderate proportion of countries in the Eastern Mediterranean Region (80%) and the European Region (72%) also have a national policy on STIs.

Globally, most countries have a national policy/guideline on comprehensive national cervical cancer prevention (80%). All countries in the South-East Asia Region, 87% of those in the European Region, 86% in the Western Pacific Region and 79% in both the African Region and the Region of the Americas have a comprehensive national cervical cancer prevention policy. In contrast, only 47% of countries in the Eastern Mediterranean Region have such a policy.

Antenatal careGlobally, almost all countries have a national policy/guideline on ANC (96%). All countries in the Region of the Americas and the South-East Asia Region, and 93–97% of those in the African Region, Eastern Mediterranean Region and European Region have

a national policy/guideline on ANC. In the Western Pacific Region, 86% of countries have such a policy/guideline.

In their national policies/guidelines on ANC, 93% of countries globally specify the minimum number of ANC contacts during a normal pregnancy, with 52% recommending at least four contacts and 39% recommending at least eight contacts. In addition, 94% of countries specify when the first ANC contact should occur, 94% include a statement on counselling and interventions to be delivered during ANC services, and 79% recommend the use of an ultrasound prior to 24 weeks of gestation.

ChildbirthGlobally, almost all countries (91%) have a national policy/guideline on childbirth. There is little variation by region, with more than 90% of countries in the African Region, Eastern Mediterranean Region, European Region, Region of the Americas and South-East Asia Region having a national policy on childbirth.

In addition, 87% of countries globally have a national policy/guideline on the right of every woman to

3Executive Summary

Figure 2. Availability of 16 key SRMNCAH policies, by WHO region

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* Excludes countries in the European Region and the Region of the Americas where malaria is not endemic.

* Excludes countries in the European Region and Region of the Americas where malaria is not endemic.


have access to skilled care at childbirth. The most common components included in this policy/guideline are: a recommendation for the prevention and treatment of postpartum haemorrhage (87%); a recommendation on the use of magnesium sulfate for the prevention and treatment of eclampsia (86%); and a recommendation on the place of childbirth (83%). Fewer national policies/guidelines on the right of every woman to have access to skilled care at childbirth include a recommendation on the presence of a companion of choice during labour and birth (59%) or a recommendation for the woman to choose the birthing position (46%).

Postnatal care for mothers and newbornsGlobally, 92% of countries have a national policy/guideline on postnatal care for mothers and newborns. All of these countries recommend a health assessment for both mother and newborn, with the exception of 3% of countries in the Region of the Americas where the recommendation is for mothers only.

Eighty-five per cent of countries globally have a national policy/guideline on the management of low-birth-weight and preterm newborns. Most of these national policies/guidelines: recommend feeding breastmilk (81%); specify the presence of skilled personnel to assist mothers who have difficulties breastfeeding (80%); and recommend Kangaroo Mother Care (or skin-to-skin contact) for clinically stable newborns weighing 2000 g or less at birth (71%). Some national policies/guidelines indicate the level of the health facility where Kangaroo Mother Care should be provided (55%).

Child healthGlobally, 93% of countries have a national policy/guideline on child health and development of children. In 55% of countries, this national policy/guideline is for ages 0–9 years. In 37% of countries, the national policy on child health and development of children is for ages 0–5 years only.

Globally, 80% of all countries have a national policy/guideline on the management of childhood pneumonia: 41% of countries have a policy for children aged 0–5 years, and 38% for ages 0–9 years.

Globally, 81% of countries have a national policy/guideline on the management of diarrhoea in children: 37% of countries specify this policy for ages 0–9 years, while 43% specify ages 0–5 years only.

Eighty-two per cent of countries globally have a national policy/guideline on the management of malaria with appropriate recommendations for children: 53% of countries include recommendations for children aged 0–9 years, 26% for ages 0–5 years only, and 3% for ages 5–9 years only.

Globally, 75% of all countries have a national policy/guideline on the management of acute malnutrition in children: in 37% of countries this national policy/guideline is for children aged 0–9 years, in a further 37% of countries it is for ages 0–5 years only, and in 1% of countries (all in the Western Pacific Region) it is for ages 5–9 years only.

Fifty-nine per cent of all countries have a national policy/guideline for routine assessment of overweight or obesity in health facilities for children: in 37% of countries the national policy/guideline is for children aged 0–9 years, in 21% it is for ages 0–5 years only, and in 1% of countries (all in the European Region) it is for ages 5–9 years only.

Globally, more than three quarters of countries (77%) have a national policy/guideline on early childhood development. These countries are most common in the Region for the Americas (83%), Europe (87%) and South-East Asia (82%).

Some 70% of countries have a national policy or guideline on integrated management of childhood illness (IMCI), including all countries in the South-East Asia Region and 95% of countries in the African Region. Nearly all low-income countries (97%) and lower-middle-income countries (92%) have policies/guidelines on IMCI.

Adolescent healthGlobally, 85% of countries have a national policy/guideline that specifically addresses adolescent health issues. In most regions, over 80% of countries have an adolescent health policy (Region of the Americas: 93%, African Region: 91%, Western Pacific Region: 86%, European Region: 82%, South-East Asia Region: 81%). However, only 60% of

5Executive Summary

countries in the Eastern Mediterranean Region have such a policy. Globally, 62% of countries have a national standard for delivery of health services to adolescents. However, only 44% of countries have a national standard for delivery of health services to adolescents that includes a clearly defined comprehensive package of health services, and in which activities are being carried out to monitor the implementation of these standards. In addition, 64% of countries have a national adolescent health programme: 52% of countries have at least one designated full-time employee for this programme, and 34% have regular government budget allocation.

Violence against womenGlobally, 73% of countries have a national multisectoral plan of action for responding to violence against women. Regionally, availability of a national multisectoral plan of action for violence against women varies. The highest availability is in the South-East Asia Region (91% of countries), followed by the Region of the Americas (79%), African Region (74%) and European Region (72%). The lowest availability is in the Eastern Mediterranean Region, where 53% of countries have such a plan, followed by the Western Pacific Region (64%). In addition, 79% of countries have a national guideline/protocol specifically for the health sector to address violence against women/gender-based violence. The most widely included topics, each reported by 71% of countries, are HIV postexposure

prophylaxis for survivors of sexual assault, STI prophylaxis for survivors of sexual assault and psychosocial support including psychological first aid/first-line support. The least frequently included topic is access to safe abortion in cases of rape or incest (45%).

Key conclusions of the 2018–2019 SRMNCAH policy surveyThe 2018–2019 global policy survey revealed progress in the adoption of WHO recommendations in national health policies and guidelines related to SRMNCAH across the world and highlighted several ongoing challenges. In general, the survey revealed disparities between regions in policy adoption and highlighted areas for increased focus across the continuum of care for mothers and children and gender-based violence. Countries in the South-East Asia Region are more likely to have the 16 key SRMNCAH policies in place, while countries in the Western Pacific Region and the European Region are less likely to have these key policies. Policies related to child health are less available across regions than policies relating to sexual and reproductive health, pregnancy, childbirth and postnatal care.

The results of this global survey should serve as a benchmark for countries and help focus national efforts to implement strong, evidence-informed, equity-focused policies at the country level that span the continuum of care in SRMNCAH.

7

1. Introduction


1.1. Background and rationale

Reducing maternal, newborn, child and adolescent morbidity and mortality remain key health priorities globally. Complications in pregnancy and childbirth are the leading cause of death for adolescent girls aged 15–19, globally (1). Though the global under-five mortality rate has declined from 93 to 39 per 1000 live births over the past three decades, this is still markedly higher than the 9 per 1000 live birth rate in the European Region (2). These figures suggest that intensified efforts to reduce mortalities and mitigate inequities are required. The Sustainable Development Goals (SDGs) set forth a number of ambitious targets to improve the health of women and children by 2030 (3). These targets include:

� Reduce the global maternal mortality ratio from 216 per 100 000 live births in 2015 to less than 70 per 100 000 live births by 2030.

� Reduce global neonatal mortality to at least as low as 12 per 1000 live births and under-five mortality to at least as low as 25 per 1000 live births by 2030.

� Ensure universal access to sexual and reproductive health-care services, including family planning, information and education, and the integration of reproductive health into national strategies and programmes.

� Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.

Under the SDGs and the United Nations (UN) Secretary-General’s Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030), all countries have committed to improving the health of women, children and adolescents via transformative multisectoral action to accelerate coverage of interventions, reduce gender and equity gaps and improve the quality of services. Achieving these goals requires the adoption and implementation of strong, evidence-informed and equity-focused policies spanning the continuum of care for sexual, reproductive, maternal, newborn, child and adolescent health (SRMNCAH), reaching

beyond traditional health system boundaries. To track country progress in adopting World Health Organization (WHO) recommendations, the Department of Maternal, Newborn, Child and Adolescent Health and Ageing (MCA) and the Department of Sexual and Reproductive Health and Research (SRH) conducted the global SRMNCAH policy survey.

1.2. History of policy surveys in SRMNCAHSince 2009, the MCA Department has regularly conducted a global policy survey among WHO Member States to track country progress in adopting WHO recommendations in national health policies related to maternal, newborn, child and adolescent health (MNCAH). To date four rounds of this survey have been held: 2009–2010, 2011–2012, 2013–2014 and 2016. In addition, as part of monitoring progress on the Global Reproductive Health Strategy approved by the World Health Assembly through resolution 57.12, the SRH Department has been tracking policies on sexual and reproductive health biennially since 2009. The 2018–2019 global SRMNCAH policy survey expands on these previous surveys by combining MNCAH and sexual and reproductive health into a single survey and by aligning with the SDGs and the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030).

1.3. Key objectives of the 2018–2019 global SRMNCAH policy surveyThe key objective of the 2018–2019 global policy survey was to track country progress in adopting WHO recommendations in national health legislation, policies, strategies and guidelines related to SRMNCAH. WHO seeks to stimulate greater global and national policy dialogue, and to link this dialogue with the development of country-specific investment plans and accountability for accelerated progress towards the goals and targets of the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030). By undertaking these activities, WHO aims to provide a useful source of information for governments, partners and the community on the challenging path of implementing this Global Strategy.

9

2. Methods


2.1. SRMNCAH Policy Reference Group (PRG)

In order to optimize the approach used for SRMNCAH policy tracking, the MCA Department and the SRH Department established a global SRMNCAH PRG to obtain expert advice on the contents of the policy survey and the use of related outputs. The first meeting of the PRG was held in February 2017 to discuss which policy areas should be tracked. At this meeting, PRG members agreed to identify priority policy indicators to include in the survey and to exclude topics from the survey that are covered in other data sources.

The PRG was convened a second time in April 2019 to review preliminary findings from the completed policy survey. At this meeting, the PRG decided to create both a global report and customized regional reports to meet the needs of a global audience as well as individual Member States.

2.2. PRG survey to prioritize SRMNCAH policy survey questionsIn July–August 2017, the MCA Department circulated a survey, via Survey Monkey, to PRG members as well as to a defined set of other SRMNCAH experts. This online survey included: questions about the respondent’s identity, institutional affiliation and areas of expertise; a series of questions in which respondents provided recommendations about whether to drop, consider retaining or keep tracking specific SRMNCAH policy areas; and a final section in which respondents were asked to suggest policy areas they felt were missing from the list.

Survey responses were compiled in an Excel spreadsheet by MCA Department staff and analysed in collaboration with an independent analyst in September 2017. Responses were assessed according to the number and percentage of respondents who said that WHO “must keep” tracking certain SRMNCAH policy areas, categorized by respondent type. This decision was made as only small numbers of respondents recommended that specific policy areas could be dropped (0–2 policy areas for PRG members, 0–3 policy areas for other respondents). Slightly higher numbers of respondents selected “consider retaining” specific policy areas (0–5 policy

areas for PRG members, 0–9 policy areas for other respondents). Qualitative responses to open-ended questions were grouped into categories by policy area, edited for concision and tallied. The results from the PRG survey, which are available in Annex 4, provided expert guidance on the prioritization of SRMNCAH policies to be tracked.

2.3. Review of existing data sourcesIn line with the PRG recommendation that global policy tracking be streamlined by examining existing sources from which relevant data could be extracted, the MCA Department developed a list of SRMNCAH policy data sources based on the Every Woman Every Child Global Strategy and WHO priorities in SRMNCAH. In addition, in February 2017 the PRG undertook a mapping of the policy tracking being done for the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030), which resulted in the identification of an additional 30 SRMNCAH policy data sources. A critical review of all these data sources was then undertaken by the MCA Department and indicators/sources selected and compiled in a single global SRMNCAH policy database. Results from this exercise can be found in Annex 5.

2.4. Mapping the MCA Department’s MNCAH questionnaire and new SRMNCAH policy database to frame priority policy areas

A mapping exercise was conducted to compare the data in the newly created global SRMNCAH policy database and the MCA Department’s questionnaire on MNCAH in order to decide which SRMNCAH policy areas to include in the 2018 global survey – taking into consideration the data already available through existing sources, which could therefore be excluded, thereby reducing the reporting burden on countries. Results from this exercise can be found in Annex 6.

2.5. Questionnaire developmentOn the basis of the information obtained from the prioritization mapping exercise, existing data sources and past rounds of MNCAH policy surveys, a

112. Methods

draft questionnaire was created. This questionnaire was shared with the PRG, United Nations Children’s Fund (UNICEF), United Nations Population Fund (UNFPA) and regional WHO SRMNCAH advisors for inputs, after which it was revised and a final version created. In the questionnaire, countries are asked about the availability/components of national policies in the following areas: family planning/contraception; diagnosis, treatment and counselling for sexually transmitted infections (STIs); comprehensive national cervical cancer prevention; antenatal care (ANC); childbirth; postnatal care for mothers and newborns; management of low-birth-weight and preterm newborns; child health and development of children; early childhood development; integrated management of childhood illness; management of childhood pneumonia; management of childhood diarrhoea; management of malaria with appropriate recommendations for children (in malaria-endemic countries); management of acute malnutrition in children; adolescent (10–19 years) health issues; and gender-based violence. The questionnaire and glossary of terms can be found in Annex 1.

2.6. Questionnaire administrationThe global SRMNCAH policy survey questionnaire, consisting of six modules (cross-cutting, maternal and newborn health, child health, adolescent health, reproductive health and gender-based violence), was programmed into an online platform. This online survey platform was developed to be administered in a modular approach, to allow for specific respondents to complete the module(s) in their area(s) of expertise. The tool also enabled respondents to upload source documents used to complete the questionnaire. Before the launch of the online platform, staff members from the MCA and SRH Departments and regional offices tested it to identify any programming modifications needed.

Regional WHO staff were introduced to the online survey platform through webinars led by the MCA and SRH Departments. Additionally, a training manual and video on how to use the platform were provided to regional focal points. The latter cooperated with assigned focal points for the survey in each country to collect information on respondents, including to which module(s) each

respondent was assigned. This information was relayed to MCA Department staff, who configured each country team on the survey platform, including mapping respondents to modules and generating unique login keys. The WHO country officer, or other assigned country focal point, was responsible for work with the Ministry of Health and/or other UN agencies to complete the survey. Country teams used various methods to complete the survey. In some countries, respondents completed assigned modules directly on the platform; in others, the survey was completed offline by respondents and then the data were entered by one individual onto the platform. Country teams reviewed the completed survey before submitting the final version. The survey and training materials were translated into all UN languages (Arabic, Chinese, English, French, Russian, Spanish) as well as Portuguese.

2.7. Data processingData were downloaded from the online platform into Excel. All data extraction and processing was conducted by the MCA Department. A cleaning code was written in STATA software to create and standardize value labels for response codes and to check for any validation errors that may have been missed in the survey platform programming. Data from the survey were split into two databases: the first containing direct responses to questions; and the second containing data stemming from information on source documents uploaded to the survey platform.

2.8. Data analysisStatistical analyses were carried out using STATA 14 software (4), and maps created using ArcGIS 10.5.1 (5). Subanalyses were conducted by WHO region and World Bank income group (2015 groupings) (see Annex 7 and Annex 8, respectively). The denominator used in analyses was the total number of respondent countries, either overall or by the subgroup of interest. One exception was for questions related to malaria and community health workers, which were not asked in countries from the European Region and some countries from the Region of the Americas because they were not considered relevant. Tables have a footnote


to denote where the denominator is less than the 150 respondent countries. Non-positive responses (for example, “No”, “Unknown” and items left unanswered) were treated equally. The results of the policy survey were compiled to align with the

objectives and key recommendations made to WHO Member States in the Secretary-General’s Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030).

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3. Response rate and scope of report


3.1. Response rate

The global SRMNCAH policy survey was distributed to all 194 WHO Member States. A total of 150 Member States completed the survey for an overall response rate of 77%. Regionally, response rates

ranged from 52% in the Western Pacific Region to 100% in the South-East Asia Region. By World Bank income group, response rates ranged from 66% for high-income countries to 89% for low-income countries (Table 1, Fig. 3).

Table 1. Response rate for the 2018 global SRMNCAH policy survey

Total number of Member States

Number of Member States responding

to the survey

Member State response rate

WHO region AFR 47 42 89%

AMR 35 29 83%

EMR 21 15 71%

EUR 53 39 74%

SEAR 11 11 100%

WPR 27 14 52%

World Bank income group Low-income 36 32 89%

Lower-middle-income 45 39 87%

Upper-middle-income 55 41 75%

High-income 58 38 66%

Global 194 150 77%

Key: AFR = African Region, AMR = Region of the Americas, EMR = Eastern Mediterranean Region, EUR = European Region, SEAR = South-East Asia Region, WPR = Western Pacific Region.

153. Response rate and scope of report

3.2. Scope of report

The findings of this report are reflective of the 150 Member States that responded to the SRMNCAH policy survey. Additional publications will be prepared to cover in depth questions related to

specific service areas. Region-specific reports will also be made available and may include data from non-Member States that responded to the survey. Further, all legislation-related questions will be reported on separately, as the relevant data are undergoing a critical validation process.

Figure 3. Map of WHO Member States that participated in the 2018 global SRMNCAH policy survey

The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement.

Data Source: Maternal, Newbon, Child, and Adolescent Health Policy Survey, 2018 Map Production: Department of Maternal, Newborn, Child, and Adolescent Health World Health Organization © WHO 2018. All rights reserved.

N

Responded

Did not respond

Not applicable