Table 1 Evaluation framework
| Aim | Outcome/RE-AIM element | Indicator | Definition |
|---|---|---|---|
| Effectiveness | Primary outcome 1: institutional birth | Institutional birth rate | % women delivering at a facility with a skilled birth attendant |
| Secondary outcome 1: child mortality | Under-2 mortality rate | # child deaths before age 2 per 1000 live births | |
| Secondary outcome 2: post-partum contraception | Post-partum contraceptive prevalence rate | % post-partum women using a modern form of contraception | |
| Implementation | Reach | Home visit coverage |
-% children under age 2 years receiving a CHW home visit, measured monthly -% pregnant women receiving a home visit by a CHW, measured monthly -% reproductive aged women receiving a pregnancy surveillance home visit, measured quarterly -% postpartum women receiving 1+ balanced counseling session, measured biannually |
| Group participation | % scheduled participants completing group sessions, measured monthly | ||
| Session completion | % scheduled group sessions completed, measured monthly | ||
| Demographic, geographic barriers and facilitators | Mapping households, describing barriers/facilitators to individuals’ access, and identifying contributors to variation/inequities | ||
| Efficacy | Pregnancy identification | % all pregnancies identified in first 12 weeks | |
| ANC completion |
-% women at 9+ months gestation completing 4+ ANC visits at a health care facility and eligible for government financial incentive out of total # of women delivered, measured monthly -% pregnant women who receive an obstetric ultrasound by their due date, measured monthly -% pregnant women with prenatal labs completed by 6 months gestation, measured monthly | ||
| Exclusive breastfeeding prevalence | % infants age 0–5 months who are exclusively breastfed, measured monthly | ||
| Pediatric pneumonia incidence | # new cases of pneumonia in children under age 2 years, measured monthly | ||
| Pediatric stunting prevalence | # children under age 2 years whose length-for-height/height-for-age is < 2 SDs WHO child growth standards median, measured monthly | ||
| Unmet contraceptive need | % eligible reproductive-age women within 12 months postpartum who desire to either stop or postpone childbearing for the next 2 years who are not currently using a modern contraceptive method or have a repeat unintended pregnancy while not using modern contraception, measured monthly | ||
| Contraception method mix | % women within 12 months postpartum using each method of modern contraception, measured quarterly | ||
| Contraception initiation and continuation | Contraceptive initiation and continuation probabilities at 3, 6, 12, and 24 months after method initiation, measured quarterly | ||
| Adoption | Village cluster adoption | % intended village clusters receiving intervention | |
| Timely adoption | % intended village clusters rolling-out intervention within 3 months of schedule | ||
| CHW adoption |
-# CHWs hired/trained in intervention implementation -# CHWs who resign | ||
| Government adoption |
-% group care sessions co-facilitated by a government health worker -# collaborative care meetings with government partners during implementation | ||
| Implementation | Supervision model |
-% scheduled supervision field visits completed, stratified by CHN and district -# data review meetings held with CHWs and CHNs, measured quarterly | |
| Group care content fidelity | % planned topics covered at each session, measured monthly | ||
| Home visit fidelity |
-% women with “adequate” number of home visits received -% appropriate ANC topics covered during each pregnancy care home visit -% child health topics covered during each under 2 home visit -% balanced counseling points covered at each postpartum contraception counseling session, measured biannually | ||
| Referral completeness | % referrals completed as prescribed by the clinical algorithm | ||
| Implementation challenges | Exploratory and hypothesis-generating as revealed through FGDs and KIIs | ||
| Maintenance | Total intervention cost | Cost of each intervention component and total costs using the Time Defined Activity Based Costing (TDABC) method | |
| Cost per unit |
-Intervention cost per 1000 people -Projected cost to scale intervention nationally | ||
| Maintenance cost | % breakdown of maintenance costs (personnel, materials, and other) | ||
| Facility vs. community costs | % of costs of health care divided between facility level and community level | ||
| Geographic cost variation | Variation of costs between village clusters and districts | ||
| Out-of-pocket patient costs | % costs of health care divided between facility level and community level | ||
| Integrated intervention cost-effectiveness | Pre/post intervention marginal effectiveness for primary outcomes, not account for secondary effects (e.g., increasing the costs of care through increased cesarean sections) |