Indicators for Climate-SRHR Action
Using consistent indicators across climate-SRHR projects and portfolios is a critical step towards strengthening our understanding of what approaches are most impactful.
What this is
A short-list of evidence-based indicators and measures for funders and implementers to get started with climate-SRHR MEL
Aligned with existing guidance, national monitoring tools, and global goals where possible
However, work at the intersection of climate change and SRHR is incredibly diverse - and there is a need to ensure that MEL frameworks are adapted to the local context and are inclusive of local knowledge and priorities.
What this isn’t
A comprehensive list of all indicators related to SRHR and climate
A fully validated or definitive list of indicators
A set of survey questions or data collection instruments
Indicator 01:
Climate-SRHR projects contribute to improved SRHR outcomes
Purpose
Ultimately, projects at the nexus of climate change and SRHR aim to generate meaningful improvements in SRHR outcomes. This indicator is used to track changes in SRHR outcomes for key areas of SRHR targeted by the project.
Change in SRHR outcomes that were assessed to be or expected to be sensitive to climate hazards and were targeted by the project, in climate-vulnerable areas benefitting from climate-responsive SRHR activities, by SRH outcome (see sub-indicators).
Geographic scope may be defined as “in climate-vulnerable areas” or “at sites (e.g., regions, facilities, communities, etc.) benefitting from climate-responsive SRHR activities.” Geographic scope may also be further restricted to “facilities benefitting from climate-responsive SRHR activities” or such a facility’s catchment area if a climate-SRHR project serves a subset of facilities within a specific region.
Varies by type of outcome. Data may be available from health facilities, national health information systems, or representative national surveys (e.g., PMA, DHS). Projects should strive to work within and strengthen local health information reporting systems; if timely data is not available with the level of granularity required, coordinate with local health officials to develop a data collection approach that does not disrupt or conflict with ongoing efforts.
May be disaggregated by gender, age, income, education, geography, etc.; if gathered at facility-level, type of facility
Definition
Geography
Data source & measurement
Disaggregation
Sub-indicators
Abortion
1.1 Number of unsafe abortions averted in climate-vulnerable areas benefiting from climate-responsive SRHR activities
Comprehensive sexuality education
1.2 Proportion of young men and women aged 15-24 in climate-vulnerable areas benefiting from climate-responsive SRHR activities with basic knowledge about SRHR
Gender-based violence and harmful practices
1.3 Proportion of women aged 20-24 married before 15 and before 18 in climate-vulnerable areas benefiting from climate-responsive SRHR activities
1.4: Proportion of women of reproductive age (15-19) who have undergone female genital mutilation/cutting in climate-vulnerable areas benefiting from climate-responsive SRHR activities
1.5: Proportion of ever-partnered women and girls aged 15 years and older in climate-vulnerable areas benefitting from climate-responsive SRHR activities subjected to physical, sexual or psychological violence by a current or former intimate partner in the previous 12 months, by age and place of occurrence
HIV and STIs
1.6 Number of new HIV infections per 1,000 uninfected population, by sex, age and key populations in climate-vulnerable areas benefiting from climate-responsive SRHR activities
1.7 Proportion of females who have received the recommended number of doses of HPV vaccine prior to age 15 in climate-vulnerable areas benefiting from climate-responsive SRHR activities
Maternal Health (pregnancy and childbirth)
1.8 Maternal mortality rate in climate-vulnerable areas benefiting from climate-responsive SRHR activities
1.9 Proportion of births attended by skilled health personnel in climate-vulnerable areas benefiting from climate-responsive SRHR activities
1.10 Proportion of births occurring in health facilities in climate-vulnerable areas benefiting from climate-responsive SRHR activities
1.11 Adolescent birth rate in climate-vulnerable areas benefiting from climate-responsive SRHR activities
Menstrual health
1.12 Proportion of women of reproductive age (15-49) in climate-vulnerable areas benefiting from climate-responsive SRHR activities who reported having enough menstrual materials during their last menstrual period
Modern contraception (family planning)
1.13 Proportion of women of reproductive age (15-49) in climate-vulnerable areas benefiting from climate-responsive SRHR activities who have their need for family planning satisfied with modern methods
1.14 Proportion of women of reproductive age (15-49) in climate-vulnerable areas benefitting from climate-responsive SRHR activities who make their own informed decisions regarding sexual relations, contraceptive use and reproductive health care
Interviews and/or focus groups with project beneficiaries about SRH outcome changes they have experienced over the intervention time period
Outcome
Project. May also be tracked at facility, regional, or national level. May be aggregated up to the portfolio level.
1 aggregates up to 3.1 Number and percent of climate-SRHR investments that contributed to an improvement in SRH outcomes.
1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.8, 1.9, 1.10, 1.11, 1.13, 1.14: UNFPA Integrated Results and Resources Framework
1.2, 1.7: Guttmacher SRHR Indicators for the SDGs
1.12: Global MHH Technical Working Group: Priority List of Indicators
For guidance on how extreme climate and weather emergencies may impact project performance and how to plan for/adjust MEL implementation in such circumstances, see What if a climate hazard or emergency affects my implementation site?
Indicator 02:
Climate-vulnerable regions have access to climate-responsive SRH services.
Expanding access to SRH services is a critical step towards improving SRHR outcomes. However, in climate-vulnerable regions, it is imperative for these SRH services to also be responsive to local climate hazards. This indicator will be used to track access to SRH services that are responsive to climate change in climate vulnerable regions.
Change in the number and percent of people in climate-vulnerable areas with access to climate-responsive SRH services
Note that this indicator reflects the total number of people within the catchment area of a facility that provides SRH services and is implementing actions to make those services more-responsive to climate change, whereas sub-indicator 2.5 reflects the number of people recorded receiving SRH services.
Geographic scope may be defined as “in climate-vulnerable areas” or “at sites (e.g., regions, facilities, communities, etc.) benefitting from climate-responsive SRHR activities.” Geographic scope may also be further restricted to “facilities benefitting from climate-responsive SRHR activities” if a climate-SRHR project serves a subset of facilities within a specific region.
Project records and health facility records. In some geographies, it may be supplemented by VAA data.
May be disaggregated by type of facility/service delivery point, type of climate-responsive adaptation (e.g., workforce training, preparedness planning, infrastructure upgrades, etc.), SRH service type, provider type, age, gender, geography
2.1 Number of individuals in climate-vulnerable areas receiving SRH services, disaggregated by climate hazard, additionally disaggregated by whether or not the SRH services are climate-responsive (output)
2.2 Number of individuals in climate-vulnerable areas receiving SRH services from mobile clinics (output)
2.3 Number / Change in the number and percent of SRH service delivery points in climate-vulnerable areas offering climate-responsive SRH services (output/outcome)
2.4 Number and percent of health facilities that provide essential SRH services in climate-vulnerable areas benefiting from climate-responsive SRHR activities (output)
2.5 Change in number and percent of people in climate-vulnerable areas receiving SRH services (outcome)
2.6 Percent change in the number of individuals benefitting from climate-responsive SRH services who report satisfaction with the services delivered
Quarterly report on climate-responsive SRH service delivery approach and/or mobile clinic delivery approach, including implementation quality assessment, challenges, lessons learned, and implementation improvements/ adjustments
Interviews and/or focus groups with SRH service recipients, mobile clinic SRH service recipients, and providers about SRH service accessibility and satisfaction with climate-responsive SRH services they have experienced over the intervention time period
Outcome
Project, facility, regional, national
2 aggregates up to 3: Climate-SRH investments contribute to greater access to climate-responsive SRH services.
2.4: Adapted from Guttmacher SRHR Indicators for the SDGs
For guidance on how to approach measures of contraception access in climate-related projects in a rights-based manner, see How can a project forward a rights-based approach when working on contraception access and climate change?
Indicator 03:
Climate-SRHR investmentment portfolios increase access to climate-responsive SRH services.
Data source & measurement
Disaggregation
Sub-indicators
Qualitative Validation & Contextualization
Indicator type
Indicator level
Aggregation
Indicator Source
Funders need to ensure that their climate-SRHR investments yield benefits in terms of improved access to SRH services and improved SRH outcomes. This indicator will be used to track portfolio performance with respect to the contribution of climate-SRHR investments on SRH service access and outcomes.
Total number of individuals receiving SRH services that have been adapted to be more responsive to climate change across the portfolio
Aggregated project records across the portfolio
May be disaggregated by climate-responsive adaptation type, climate hazard, age, gender, SRH service type, provider type, facility type, and geography
3.1 Number and percent of climate-SRHR investments that contributed to an improvement in SRH outcomes (outcome)
3.2 Change in targeted SRHR outcomes across investment regions
3.3 Total number of health facilities providing SRH services built or retrofitted to be climate-proof
3.4 Total number of health workers reached with information and training on climate change and SRHR to protect their health and their patients from climate hazards
3.5 Total number of people reached through advocacy campaigns
N/A
Outcome
Portfolio. 3.2 may be measured at the national level.
1 aggregates up from 2: Climate-responsive SRH services are accessible in climate-vulnerable regions.
3.1 aggregates up from 1: Climate-SRHR projects contribute to improved SRHR outcomes.
3.3 aggregates up from 4.1: Number of health facilities providing SRH services built or retrofitted to be climate-proof.
3.4 aggregates up from 7.1: Number of health workers reached with information and training on climate change and SRHR to protect their health and their patients from climate hazards.
3.5 aggregates up from 14.2: Number of people reached through campaigns to raise awareness about climate change and SRHR.
3.3 and 3.4: Adapted from WHO
Indicator 04:
SRH service delivery points are prepared for climate hazards.
Purpose
Definition
Data source & measurement
Disaggregation
Sub-indicators
Qualitative Validation & Contextualization
Indicator type
Indicator level
Aggregation
Indicator Source
Health facilities and other SRH service delivery points must be ready for the climate hazards they are facing. These readiness upgrades can include upgrades to water and energy system, building infrastructure, heating and cooling systems, and more. This indicator will be used to track infrastructure upgrades at SRH service delivery points.
Percent change in SRH delivery points’ health facility climate resilience assessment score
Pre-/post-assessment using the WHO Checklists to Assess Vulnerabilities in Health Care Facilities in the Context of Climate Change or other checklist
May be disaggregated by facility type, upgrade type, SRH service type, climate hazard, and geography
4.1 Number and percent / change in number and percent of health facilities providing SRH services built or retrofitted to be climate-proof (output / outcome )
4.2 Change in the number and percent of health facilities completing regular (e.g., annual) facility climate vulnerability and resilience assessments
4.3 Change in the number and percent of individuals benefitting from climate-responsive infrastructure upgrades (receiving health services) at facilities that provide SRHR services
Quarterly report on health facility retrofitting approach, including implementation quality assessment, challenges, lessons learned, and implementation adaptations
Interviews and/or focus groups with facility staff, clients, and construction/infrastructure staff about the health facility infrastructure changes they have experienced over the intervention time period
Outcome
Project, facility
4.1 aggregates to 3.3: Total number of health facilities providing SRH services built or retrofitted to be climate-proof
4: Adapted from WHO Checklists to Assess Vulnerabilities in Health Care Facilities in the Context of Climate Change
4.1 and 4.2: Adapted from WHO
Indicator 05:
SRH supply chains are resilient to climate change.
Purpose
Definition
Geography
Data source & measurement
Disaggregation
Sub-indicators
Qualitative Validation & Contextualization
Indicator type
Indicator level
Aggregation
Indicator Source
Implementation guidance
Climate change can interrupt SRH supply chains by destroying stockpiles, damaging road infrastructure, and exposing SRH commodities to adverse environmental conditions (e.g., extreme temperature and humidity). This indicator will be used to track the contribution of activities to the climate resilience of SRH supply chains.
Change in the number and percent of service delivery points reporting no stock outs of SRH medications and commodities during and two weeks following an extreme climate or weather event.
Geographic scope may be defined as “within climate-vulnerable regions” or “at sites (e.g., regions, facilities, communities, etc.) benefitting from climate-responsive SRHR activities.” Geographic scope may also be further restricted to “facilities benefitting from climate-responsive SRHR activities” if a climate-SRHR project serves a subset of facilities within a specific region.
Per UNFPA, data for this indicator are obtained from UNFPA Supplies Surveys, SPA, SARA, other National Surveys and LMIS Reports, GHSC-PSM Annual and Quarterly Reports of stockouts by method. Within projects, data may also be gathered via survey.
May be disaggregated by region, type of climate or weather emergency, type of pharmaceutical product or supply (e.g., pharmaceuticals for labor and delivery, contraceptive products by method, menstrual health products, etc.) and type of service delivery point. If a climate-SRHR project serves a subset of facilities within a specific region, this may also be disaggregated by whether or not a facility was a beneficiary of project activities to enable comparison.
5.1 Percentage of service delivery points stocked out, by method offered, on the day of assessment at facilities benefiting from climate-responsive SRHR activities
5.2 Percentage of service delivery points reporting no stock outs, by method offered, at facilities benefiting from climate-responsive SRHR activities
5.3 Percentage of service delivery points with at least three modern contraceptive methods available, at facilities benefiting from climate-responsive SRHR activities
5.4 Percentage of service delivery points with at least five modern contraceptive methods available at facilities benefiting from climate-responsive SRHR activities
Quarterly report on climate-responsive SRH service delivery approach and/or mobile clinic delivery approach, including implementation quality assessment, challenges, lessons learned, and implementation improvements/ adjustments
Interviews and/or focus groups with SRH service recipients, mobile clinic SRH service recipients, and providers about SRH service accessibility and satisfaction with climate-responsive SRH services they have experienced over the intervention time period
Outcome
Project, facility, regional, national
N/A
5 and 5.1: Adapted from FP2030 Measurement Framework
5.2, 5.3, and 5.4: Adapted from UNFPA Integrated Results and Resources Framework
For additional guidance on defining SRH medications and commodities, see What SRH medications and commodities should a project track? For additional guidance on defining extreme climate and weather events, see What are extreme climate and weather events, and how should we measure and define them?
Indicator 06:
Health systems use evidence to monitor and respond to climate-SRHR risks.
Purpose
Definition
Data source & measurement
Disaggregation
Sub-indicators
Qualitative Validation & Contextualization
Indicator type
Indicator level
Aggregation
Indicator Source
Strengthening health information systems is a vital component of building the climate-SRHR evidence base, tracking emergent climate-SRHR risks, and ensuring early warnings and alerts are widely available. This indicator will be used to track integration of SRH into health early warning systems
Number of operational climate-informed health early warning systems for extreme weather and climate events developed, implemented and updated, and include SRH
Project records and national health system records
May be disaggregated by whether the health early warning system is new or updated, type of update, whether or not SRH is included, and type of SRH included
6.1 Number/change in the number of health institutions with improved capacity to use evidence to assess or address climate change risks to SRH, as defined by number of institutions reached with capacity-building activities (output/outcome)
Assessment of the climate-informed health early warning systems’ functioning, gaps, and integration of gender and SRH
Interviews and/or focus groups with health providers, early warning system developers, and other users about the health early warning system
Interviews and/or focus groups with health officials, health providers, and other capacity building recipients about the climate-SRHR assessment capacity changes they have experienced over the intervention time period
Output
Project, facility, national
N/A
6: Adapted from WHO
6.1: Adapted from Ebi et al. 2018
Indicator 07:
The health workforce has the knowledge and skills to deliver climate-responsive SRH services.
Purpose
Definition
Data source & measurement
Disaggregation
Sub-indicators
Qualitative Validation & Contextualization
Indicator type
Indicator level
Aggregation
Indicator Source
Implementation guidance
Knowledge and capacity gaps are major barriers to delivery of climate-responsive SRH services. Health workforce training is an important part of ensuring that providers have what they need to address the way SRH needs and preferences shift in response to climate change. This indicator will be used to track changes in health workforce knowledge and skills with respect to climate change and SRHR.
Number and percent of health providers with increased knowledge about climate change and SRHR, including the impact of climate change on SRHR and strategies for responding to these impacts
Pre-/post-training evaluation
May be disaggregated by age, gender, type of provider, type of training, type of facility, geography, etc.
7.1 Number of health workers reached with information and training on climate change and SRHR to protect their health and their patients from climate hazards (output)
7.2 Number and percent of health providers reporting increase in perceived capacity to deliver SRH services in a rights-based way that is responsive to climate change after participating in project activities (outcome)
7.3 Number and percent of health providers reporting using adaptive behaviors and/or shifting their approach to care provision after participating in project activities (outcome)
7.4 Number / change in the number of health practitioner curricula that include climate change and its impacts on SRHR, disaggregated by target audience and whether the curricula is new or amended (output / outcome)
Report on training approach, including covered content, implementation quality assessment, challenges, lessons learned, and implementation adaptations
Interviews and/or focus groups with health providers about the climate-SRHR knowledge changes and climate-responsive SRH service delivery capacity changes they have experienced over the intervention time period
Interviews and/or focus groups with trainers and trainees about the training approach and implementation efficacy
Interviews and/or focus groups with health sector trainees and professors about how curricula have changed to incorporate climate and SRHR over the intervention time period
Outcome
Project
7.1 aggregates up to 3.4: Total number of health workers reached with information and training on climate change and SRHR to protect their health and their patients from climate hazards.
7.1: Adapted from WHO
For more information on effective health workforce training approaches, visit the Health Workforce page.