The Maternal and Neonatal Programme Effort Index (MNPI)

A new index is presented that measures the effort levels of national progra mmes to reduce maternal and neonatal mortality. These indices come from a q uestionnaire instrument composed of 14 major headings and 81 items. Forty-n ine countries including most of the population in each geographical region are covered. Data were collected from 10 to 25 raters in each country, who rated the 81 items for both the current year and 3 years ago, using a 0-5 s cale running from no adequacy to full adequacy. The raters were drawn from a variety of positions and backgrounds, and were identified by a consultant retained in each country for that purpose. On average, country programmes score at about half of the maximum score, but this varies considerably acro ss the 14 components of effort, from very low scores for access to treatmen t by rural women, to high scores for neonatal care. Regional averages are n ot far apart for the overall score, although South Asia scores are especial ly low and East Asia's are especially high. To a considerable extent region s agree in the relative stress they give to each of the 14 components. Over the 3-year period, average scores rose by about 10%. When countries are di vided into three groups by their maternal mortality levels, most of the 14 components distinguish the high from the medium mortality countries; and ab out half of the components distinguish the medium from the low mortality co untries. This new Maternal and Neonatal Programme Effort Index (MNPI) appea rs to yield useful measures for various dimensions of programme effort, and it relates sensibly to the output measure of maternal mortality, at least as it is currently measured.