Institutional Complexity Index for the Latin American 2005 WHO Global Survey on Maternal and Perinatal Health

Lic. Daniel Wojdyla

A complexity index used to summarized the features of the health institutions included in the survey was developed using the different characteristics included in the institutional form.  The index was constructed grading the institutions as high, medium or low complexity level in each of eight different categories that were part of the institutional data collection form.  The categories refer to the capacity of the hospital to provide:

1.      Basic Services                                                

2.      Screening Tests                                              

3.      Basic Emergency Obstetric Resources          

4.      Intrapartum Care

5.      General Medical Services                              

6.      Anaesthesiology Resources

7.      Human Resources

8.      Academic Resources and Clinical Protocols

 For each category, a set of essential services or resources was identified and institutions lacking any of them were considered as low level. For most of the categories, an additional set of optional services or resources was selected and institutions having the complete set of services (essential and optional) were classified as high level, while those lacking any of the optional services or resources were classified as medium level institutions.  An overall unweighted score was obtained assigning 2 points to high level institutions, 1 point to medium level institutions, and 0 points to low level institutions in each of the abovementioned categories, and adding across the eight categories a maximum of 16 points.  The following table presents essential and optional services or resources for each of the 8 categories.





·             Reliable water supply

·             Sanitation facilities

·             Electricity

·             Generator

·             Refrigerator

·             Telephone

·        None

General Medical Services

·             Blood bank

·             Safe blood

·             Adult intensive care unit

·             Neonatal intensive care unit

·             High risk pregnancy beds

·             Radiology department

·             Ultrasound services

·             Biochemical / Clinical laboratories

·             Sterilization equipments

·        Any other newborn care unit with incubators

·        Independent high risk consultation clinic

·        Medical clinics for referral in the same building


·             Rhesus antibodies / ABO

·             Proteinuria

·             Hepatitis B

·             Glucose tolerance test

·             Pap smear

·             HIV

·             Syphilis

·             Urine Culture

·        Alpha Feto Protein

·        Colposcopy

Anaesthesiology Resources

·             Anaesthesiologist 24hs / day in hospital


·        Anaesthesiologist on call but outside hospital

·        Nurse / paramedics anaesthetist from hospital performing anaesthesia

·        General anaesthesia equipment

Basic Emergency Obstetric Services

·             Parenteral antibiotics

·             Parenteral oxytocic drugs

·             Parenteral anticonvulsants for pre-eclampsia and eclampsia

·             General anaesthetic equipments

·             Blood transfusion

·             Neonatal resuscitation

·             Maternal cardio pulmonary resuscitation

·             Hysterectomy

·        None

Intrapartum Care

·             Fetal / obstetric ultrasound

·             Partograph

·             Staff skilled:
In forceps extraction
In vacuum extraction
In caesarean section
In breech vaginal  delivery
For newborn care at delivery

·        Electronic fetal monitoring

·        Fetal scalp pH

Human Resources

At least one:

·             OB/GYN specialist

·             Anaesthesiologist

·             Nurses

At least one:

·        Clinical officers / medical  

·        Residents MD in training

Academic Resources and Clinical Protocols

·             Medical library

·             Formal protocols for Antenatal care

·             Intrapartum care

·             Post partum care

·             Neonatal care

·        Continuous medical education programme

·        WHO Reproductive Health Library / Cochrane library

·        Other medical / nursing protocols


The following figure shows the distribution of the health institutions selected in Latin America according to their type and complexity index score.