National Rural Health Mission Monitoring & Evaluation

Where we are …(1) Total Rural Urban CBR 23.8 25.6 19.1 CDR 7.6 8.1 6.0 TFR 2.9 3.2 2.1 Illiterate 3.9 4.1 3.3 Literate 2.2 2.5 1.9 Mean Age at Marriage 20.2 19.7 21.7 % Infant to Total Deaths 18.5 20.1 12.6 Pop’n 2001 (in Millions) 1,029 (1,112 – 2006) 742 286

Population Projections Demographic Indicators 2001-05 2006-10 2011-15 NRHM 2012 2016-20 2021-25 Population growth rate 1.6 1.4 1.3 1.1 0.9 Crude Birth rate (CBR) 23.2 21.3 19.6 18.0 16.0 Crude Death rate (CDR) 7.5 7.3 7.2 7.1 Infant Mortality Rate (IMR) 61.3 54.3 49.2 30 44.0 40.2 Under-5 mortality rate (q5) 82.0 72.8 65.9 59.0 54.0 Total Fertility Rate (TFR) 2.9 2.6 2.3 2.1 2.2 2.0 Life expectancy of males 63.8 65.8 67.3 68.8 69.8 Life expectancy of females 66.1 68.1 69.6 71.1 72.3

Demographic scenario

< US$ 900 pa (approximately Rs 36,783) Where we are …(2) Indicators Threshold Level During 1998-99 2005-06 Status vs Threshold Proportion of births with skilled health personnel > 60 % 42.4 48.3 Not satisfied Contraceptive prevalence rate (modern methods only) > 25 % 42.8 48.5 Satisfied HIV prevalence rate in adults (15-49 years old) < 5 % 3.5 million 5.134 million Satisfied?? % with symptoms of RTI/STI - Male   12.3 7.6 % with symptoms of RTI/STI - Female 29.7 32.3 Adolescent fertility rate < 65/1000 52.1 45.9 Under-five mortality rate < 60/1000 20.4 17.3 Maternal mortality ratio <100 /100,000 398.0 301.0 Literacy rate among 15-24 year old females > 80 % 54.2 67.7 Proportion of Population aged 10-24 < 35 % 31.5 30.6 Per capita GNP (at 1999-2000 prices) in Rs: < US$ 900 pa (approximately Rs 36,783) 16,105.0 23,313.0

Level of Hospitalisation Avg Total Expenditure (Rs) Some Bare Facts Level of Hospitalisation Avg Total Expenditure (Rs) Rural Urban Govt hospitals 42% 38% 3,238 3,877 Private 58% 62% 7,408 11,553 Total 100% 6,225 9,367

Funds not a constraint Year Central Govt. NRHM Allocation Recurring Non-Recurring State Contribution Total (in Rs crores) 2005-06 6,500 - 2006-07 9,500 9,000 500 2007-08 12,350 11,000 1,350 2,179 14,529 2008-09 17,290 13,000 4,290 3,051 20,341 2009-10 24,206 16,206 8,000 4,272 28,478 2010-11 33,884 23,884 10,000 5,980 39,864 2011-12 47,439 42,439 5,000 8,372 55,811

Parameters of Health Care Awareness Available Accessible Affordable Quality Performance vs agreed standards 8

Monitoring Outcomes of NRHM Right to Health An inalienable right of all citizens Incorporate in monitoring framework of Mission Preparation of Household Specific Health Cards Record of births, deaths, illness, disease, health expenditure Age/sex profile of household Means of livelihood, food availability, Food habits, alcohol consumption etc Availability of health facility/providers Through ASHA/AWW etc

Monitoring Outcomes of NRHM (cont’d) Preparation of Habitation/Village Health Register Periodic Health Facility Survey at SC, PHC, CHC, DHQ Facilities available Service Guarantees Formation of Health Monitoring & Planning Committees at PHC, Block, District and State Level Regular Monitoring of Activities at each level Inputs for planning for local level, IDHAP, SPIP etc

Monitoring Outcomes of NRHM (cont’d) Sharing of data at all levels – full transparency Display of agreed service guarantees at health facilities Sample household and facility surveys by external agencies/NGOs Public Reporting of household & health facility findings

MIES System Model in NRHM/RCH II Program Planning & Service Delivery MIES Validation Monitoring MIES Quality Assessment Evaluation 12 12

Agreed Indicators … (1) 13 Process Indicators – 6 monthly review % of ANM positions filled % of states and districts having full time program manager for RCH with financial and administrative powers delegated % of sampled state and district program managers aware of their responsibilities % of sampled state and district program managers whose performance was reviewed during the past six months % of districts not having at least one month stocks of Measles vaccine, Oral Contraceptive Pills and Gloves 13

13 Process Indicators – 6 monthly review (cont’d) Agreed Indicators … (2) 13 Process Indicators – 6 monthly review (cont’d) % of districts reporting quarterly financial performance in time % of district plans with specific activities to reach vulnerable communities % of sampled districts that were able to implement M&E triangulation involving communities % of sampled outreach sessions where guidelines for AD syringe use and safe disposal are followed % of sampled FRUs following agreed infection control and health care waste disposal procedures % of 24 hrs PHCs conducting minimum of 10 deliveries/month % of upgraded FRUs offering 24 hr. emergency obstetric care services % of sampled health facilities offering RTI/STI facilities as per agreed protocols 14

Agreed Indicators … (3) Output Indicators from Mid & End-line Surveys The states are to set levels of achievement based on their own assessments. 1. Contraceptive prevalence rate 2. % eligible couples using any spacing method for more than 6 months 3. % of women delivered during past one year who received 100 IFA tablets 4. % deliveries conducted by skilled providers (doctors, nurses or ANMs) 5. % of 24 hrs PHCs conducting minimum of 10 deliveries/month 6. % of upgraded FRUs offering 24 hr. emergency obstetric care services 7. % of 12-23 months children fully immunized 8. % of mothers and newborn children visited within 2 weeks of delivery by a trained community level health provider/AWW or health staff (ANM/Nurse/Doctor) 9. % of children suffering from diarrhoea during past 2 weeks received Oral Re-hydration Solution 10. Polio free status achieved since Details of numerator and denominator and sources of information given in Appendix IV of National PIP 15

Plan for Monitoring & Evaluation (M&E) As an integral component in the State PIP and IDHAP Plan for Household, facility surveys Resource mapping Community Monitoring External/NGO evaluation IT interventions H/W, S/W, Networking, Web-site Training of manpower on IT – medical, paramedical also MIS data Maintain District and Sub-district MIS data for evaluation Regular flow on New Format On Public Domain Disseminate data with analysis to all stakeholders (up & down stream) Encourage Feedback Reinforce with recognition/reward Budget for M&E in the PIPs

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