Frequently Asked Questions

We welcome your feedback on ways to enhance the utility of MANDATE. Please contact us at mandateproject@rti.org to help make it the most relevant tool for your work.

Here are answers to some frequently asked questions about MANDATE.

General Questions

  1. What is MANDATE?
  2. MANDATE is a decision support tool that helps to inform the development of appropriate and effective technologies and strategies to reduce maternal, fetal, and neonatal mortality in low-resource settings, with emphasis on sub-Saharan Africa and India. As an interactive, quantitative model, MANDATE enables users to compare the potential number of lives saved based on the availability, utilization and efficacy of technologies in different care settings.

  3. How do I use MANDATE?
  4. Tutorials on how to use MANDATE efficiently and effectively are available here. If you have additional questions, please contact us at mandateproject@rti.org.

  5. What MANDATE is not…
  6. MANDATE is designed to address the major causes of maternal, fetal, and neonatal mortality. It is not designed to address the following: child health beyond the neonatal period, family planning/contraceptive methods, HIV, or a cost-benefit analysis. We welcome feedback on areas that users identify as important to enhance the utility of MANDATE. Please contact us for feedback at mandateproject@rti.org to help us continue to make this a relevant tool for your work.

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Questions about MANDATE Care Settings

  1. MANDATE uses home, clinic and hospital for its settings. What is the definition of each setting?
  2. MANDATE defines settings of antenatal, delivery and postnatal care in the home, clinic and hospital in the following ways:

    • The home setting is care in the pregnant woman’s home/community and is defined as having a very limited availability of skilled providers and no cesarean or surgical capabilities.
    • The clinic setting is defined as having some availability of skilled providers and access to basic health medicines and technologies.
    • The hospital setting is defined as having the availability of skilled providers and generally having cesarean and surgical capabilities.

  3. MANDATE includes rates of where women receive antenatal care. What factors influence where a woman receives antenatal care?
  4. Rates of antenatal, delivery, and neonatal care are based on the most current Demographic & Health Surveys (DHS) data. MANDATE users can change the rates to reflect additional data that may be available for a specific region.

  5. MANDATE includes rates of where women seek care for delivery. What factors influence where a woman delivers?
  6. Rates of antenatal, delivery, and neonatal care are based on the most current Demographic & Health Surveys (DHS) data. MANDATE users can change the rates to reflect additional data that may be available for a specific region.

  7. Throughout the MANDATE model there are opportunities for transfer. What does transfer mean?
  8. MANDATE created a transfer option in the Web model to allow users to change the rates of use of health facilities. For example, newborns with fever may transfer from home to a clinic or hospital for better care.

    Transfer rates may be affected by multiple factors, including transport availability, health access, community norms, personal beliefs, health cost, and ability of the woman and/or provider to recognize and diagnose health conditions that require additional care.

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Questions about Technology

  1. MANDATE uses the terms penetration, utilization and efficacy for each intervention. What do these terms mean?
  2. Penetration, utilization, and efficacy are important to the impact of an intervention:

    • Penetration is the availability of an intervention in a given setting.
    • Utilization is the rate of appropriate use of an intervention in a given setting when available.
    • Efficacy is the ability of an intervention to achieve a successful outcome given the intended purpose, such as successfully preventing, diagnosing or treating a condition.

  3. What factors influence penetration?
  4. The availability of an intervention can vary, depending on multiple factors, including the cost of an intervention, supply chain disturbances, demand, health policy, and the availability of health workers.

  5. What factors influence utilization?
  6. The appropriate use of an intervention can be affected by multiple factors, including the following:

    • Functionality of the intervention — For example, a broken ultrasound machine cannot be used appropriately; or heat may degrade a medication.
    • Lack of knowledge — For example, health providers may not know that an intervention should be used or may not have received sufficient training to use it effectively
    • Cultural/health beliefs — For example, belief by a provider and/or pregnant woman that a particular intervention is harmful may impact its appropriate use.
    • Severity/timing of disease — For example, if a pregnant women is transferred to the hospital 5 minutes before a premature neonate is delivered, the women will not have enough time to receive corticosteroids to protect the neonate.
    • Standards of protocol — For example, it may be a norm for a health provider to not wash their hands, which may impact the utilization of clean delivery practices.

  7. When would efficacy rates be adjusted?
  8. Efficacy rates reflect the ability of an intervention to perform its function— such as to prevent, diagnose, or treat a condition— successfully under ideal conditions. Efficacy rates may be adjusted to explore the impact on lives saved of changes that are made to an intervention to make it more efficacious.

  9. How do penetration, utilization, efficacy, and transfer relate to each other?
  10. The penetration, utilization, efficacy, and transfer factors are interactive. Here are some examples:

    • An improved intervention may have a higher efficacy rate. If, however, that new intervention is more complex to use appropriately, the utilization rate may be reduced.
    • If the new intervention is more expensive, the penetration rate may be reduced because of inadequate funding for widespread availability.
    • Education to use a diagnostic tool or procedure better may result in more women transferring to a different care setting.

    MANDATE allows users to evaluate the relative impact of these factors on maternal, fetal, and neonatal mortality.

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Need more help?

If you have additional questions, concerns or comments, we can help! Please contact us at mandateproject@rti.org.