Table 1 Operational definition of HF readiness index for normal low-risk delivery services

Domain 1: Trained provider

1 indicator – At least one trained provider, regardless of the duration of training, is available to provide essential childbirth care regardless of the timing and duration of the training

Domain score = Indicator (0% = no provider, 100% = at least one provider)

Domain 2: Guidelines

1 indicator – Observed availability of at least one guideline on essential childbirth care, checklists and/or job aids for essential childbirth care

Domain score = Indicator (0% = no guideline, 100% = at least one guideline)

Domain 3: Equipment and supply

13 indicators – Observed availability and reported functionality of: i) emergency transport—this included ambulance or another vehicle for emergency transport, ii) delivery pack: a sterile delivery pack or all of the following 5 items: cord clamp, episiotomy scissors, scissors or blade, suture material with a needle, and needle holder, iii) examination light, iv) suction apparatus (mucus extractor), v) neonatal bag and mask, vi) delivery bed, vii) a blank partograph, viii) infant weighing scale, and ix) blood pressure (BP) set, x) latex gloves, xi) sterilization equipment, xii) manual vacuum extractor, and xiii) vacuum aspiration kit

Domain score = Percentage of functioning items available (Range: From 0% = no items to 100% = (at least 1 functioning unit of) all 13 items, e.g. 9/13 = 69.2% in the case of 9 functioning items available)

Domain 4: Essential medicines for mothers

5 indicators – Observed availability of at least one valid unit of: i) injectable uterotonic, ii) injectable antibiotic, iii) injectable magnesium sulfate, iv) skin disinfectant, and v) fluid with an infusion set

Domain score = Percentage of essential medicines for mothers available (Range: From 0% = no medicines to 100% = (at least 1 valid unit of) all 5 medicines, e.g. 4/5 = 80.0% in the case of 4 essential medicines for mothers available)

Domain 5: Essential medicines for newborns

5 indicators – Observed availability of at least one valid unit of: i) chlorhexidine gel, ii) tetracycline eye ointment, iii) injection gentamycin, iv) amoxicillin syrup, and v) ceftriaxone powder for injection

Domain score = Percentage of essential medicines for newborns available (Range: From 0% = no medicines to 100% = (at least 1 valid unit of) all 5 medicines, e.g. 2/5 = 40.0% in the case of 2 essential medicines for newborns available)

HF readiness index for normal low-risk delivery services

Readiness for normal low-risk delivery service is measured across 5 domains: i) trained provider, ii) guidelines, iii) equipment and supplies, iv) essential medicines for mothers, and v) essential medicines for newborns

HF readiness Index = Mean score of the five domain scores. (Range: From 0% = no readiness to 100% = complete readiness, e.g. (0% + 0% + 69.2% + 80.0% + 40.0%) / 5 = 37.8%)