Reporting, Monitoring and Review mechanism for Anemia Mukt Bharat Dr Sila Deb DC, Child Health Ministry of Health and Family Welfare

Presentation outlines Monitoring domains Digitalized monitoring process for AMB - HMIS data reporting process - Quarterly Progress Report (QPR) - Key Performance Indicators (KPIs) Strengthening existing review mechanisms for AMB AMB monitoring under Poshan Abhiyaan

Time-bound reporting, monitoring and review mechanism Robust reporting, monitoring and review mechanism for effective implementation and success of AMB Time-bound reporting, monitoring and review mechanism Accuracy and completeness of data reporting for effective AMB strategy implementation

Monitoring Domains IFA supplementation across the age groups IFA Stock availability Compliance and capacity building - by NCEAR-A Activities w.r.t. Non- nutritional causes of anemia in Endemic pockets IEC/ BCC activities

Digitalised Monitoring Process for AMB 26 existing HMIS indicators pertaining to anemia are identified to capture data for Quarterly AMB Performance Report Card 12 new indicators proposed to be included in HMIS 6 Key Performance Indicators (KPI) for Score Card (generated by Dashboard) Awards for best 3 performing States – annually – Score Card based ranking No manual reporting for Monthly Progress Report (e.g. WIFS MPR)

HMIS data elements identified for AMB Data elements for IFA supplementation to children and adoloscents HMIS Code Description 9.9 Number of children (6-59 months) provided 8-10 doses (1ml) of IFA syrup (Bi weekly) 22.1.1.a Girls (6th -12th class) provided 4 IFA tablets in schools 22.1.1.b Boys (6th -12th class) provided 4 IFA tablets in schools 22.1.3 Number of out-of-school adolescent girls (10-19 years) provided 4 IFA tablets at Anganwadi Centres 23.1 Number of children covered under RKSK JUNIOR (6 - 10 years ) provided 4-5 IFA tablets in schools 23.3 Number of out-of-school children (6-10 years) given 4-5 IFA tablets at Anganwadi Centres

HMIS data elements identified for AMB Data elements related to Pregnant Women HMIS Code Description 1.1 Total number of pregnant women registered for ANC 1.2.4 Number of PW given 180 Iron Folic Acid (IFA) tablets 1.4.2 Number of PW having Hb level<11 (tested cases)(7.1 to 10.9) 1.4.3 Number of PW having Hb level<7 (tested cases) 1.4.4 Number of PW having severe anaemia (Hb<7) treated 6.3 Number of mothers provided full course of 180 IFA tablets after delivery

HMIS data elements identified for AMB Data elements related to stock status HMIS Code Description 19.6 Total Stock of IFA tablets ( Adult) 19.7 Total Stock of IFA - Blue ( Adolescent 10-19 yrs) 19.8 Total Stock of IFA- Pink ( Junior 6-10 yrs) 19.9 Total Stock of IFA Syrup (Paediatric)

List of New Indicators Proposed in HMIS for AMB School-going male 10-19 years, who were screened for anemia (Under RBSK program) School-going male 10-19 years who are severely anemic (Under RBSK program) School-going male 10-19 years who are severely anemic and received treatment (Under RBSK program) School-going female 10-19 years, who were screened for anemia (Under RBSK program) School-going female 10-19 years who are severely anemic (Under RBSK program) School-going female 10-19 years who are severely anemic and received treatment (Under RBSK program) Schools, where monthly Nutrition Health Education sessions held against planned (Under RKSK program) Number of women of reproductive age (WRA) 20-24 years, provided 4 iron and folic acid (IFA) tablets (Under Mission Parivar Vikas). Women of reproductive age (WRA) 20-24 years, provided albendazole (Under Mission Parivar Vikas) Eligible beneficiaries provided with long lasting /insecticide treated bednets (Only for malaria endemic geographies) Nutrition Health Education sessions planned in AWCs the reporting month (under MAA programme) Stock of LLIN/ITNs

Current Issues in HMIS Data Reporting

Challenges in Data reporting on HMIS Huge quantity of IFA supplements lying unusable in State/ UT stores HMIS proper data entry and validation of data is imperative for quality data reporting Letter from JS (RCH)

Field validation of AMB data during regular field visits by AMB nodal persons AMB nodal persons to develop complete understanding of HMIS data elements used for AMB QPR including the source of data During field visits HMIS data can be validated with appropriate data source available in field

Examples

HMIS : 9.9 Children (6-59 months) provided 8-10 doses (1ml) of IFA syrup (Bi weekly) Definition: Total number of children, aged 6-59 months, who were given 8-10 doses of IFA syrup during the reporting month. Guideline: As per national guidelines, children aged 6-59 months should be given one ml of IFA syrup containing 20 mg of elemental iron and 100 mcg of folic acid biweekly for 100 doses in a year. Those children who were given biweekly dose of IFA syrup for all weeks in the reporting month should be reported. Source: RCH Register Data Collection Formats: SC/PHC

HMIS 1.2.4: Number of mothers provided full course of 180 IFA tablets after delivery Definition: Total number of mothers who were given 180 IFA tablets (equivalent to 60 mg of elemental iron and 0.5 mg of folic acid per tablet daily) during the reporting month. Guideline: The number of mothers who were given 180 IFA tablets are to be reported and NOT the number of IFA tablets. If the number of IFA tablets given to a mother is less than 180, then she should not be reported till she is given 180th tablet. If more than 180 IFA tablets are given to any mother, she should be counted when she had received 180 IFA tablets and should not be counted for extra tablets given to her. Any person other than woman (who has recently delivered) given IFA tablets should not be counted here. Data Source –Pregnancy Register/Post natal Register Formats: SC/PHC/CHC/SDH/DH

Fixation of Denominator for Target based monitoring State/UT-wise as well as district-wise targets are to be fixed before hand for monitoring coverage of each beneficiary age-group Targets will be updated annually as per the target beneficiary numbers provided by States/UTs

Annual Target Fixation for Reporting under AMB Fixation of Service denominator: By the district - district-wise targets (census) for the beneficiary groups Validation of target– by WCD (Out-of-School) and Dept of Education Data flow for denominator- from district - to State - to MoHFW –at the beginning of FY (in PIP) Annual Drug Requirement: IFA Syrup IFA Tablets – Red, Blue, Pink

Quarterly Progress Report (QPR) calculation Example for HMIS calculation Jan 18 Feb 18 Mar 18 Total quarter Numerator (HMIS 9.9) 40 25 90 Denominator 100 300 Quarterly progress Report (QPR) (Jan+Feb+Mar-18 numerator) x 100 Target x 3 (i.e. (40+25+25)/100*3=90/300=30 %

Data monitoring and review for AMB The process flow: Informed decision for necessary action to strengthen AMB strategies HMIS reporting of data elements for AMB (Anemia status for PW, IFA supplementation and IFA stock status) Review of Key Performance Indicators- Score Card generation Data pulled to AMB dashboard Quarterly Progress Report QPR AMB Dashboard

Key Performance Indicators of AMB The quarterly report card will be prepared using data reported for the HMIS data elements for AMB The report card will assess the progress as the percentage coverage against eligible denominators and performance will be monitored based on the coverage review Out of the identified indicators of the quarterly report card, Key Performance Indicators (KPIs) are identified in order to monitor and rank the States and districts based on their performance on a quarterly basis

Key performance indicators for AMB Key performance indicators Percentage of children 6-59 months who received at least 8 doses of IFA syrup (HMIS 9.9) Percentage of school children 5-9 years who received at least 4 pink IFA tablets (HMIS 23.1) Percentage of school-going adolescents 10-19 years (girls and boys), eligible under RKSK programme, who received at least 4 blue IFA tablet (HMIS 22.1.1) Percentage of women of reproductive age 20-24 years, eligible under Mission Parivar Vikas, who received at least 4 red IFA tablet (will be reported later) Percentage of eligible pregnant women who received at least 180 IFA tablets during antenatal contact point (HMIS 1.2.4) Percentage of States/districts with available of adequate stocks of IFA for all age groups (dash board)

Monitoring of IEC/ BCC activities for AMB AMB nodal officers to carry out periodic monitoring of budget utilization for IEC / BCC activities for AMB activities Compilation of Key IEC/ BCC activities undertaken for AMB Total budget available for all IEC/ BCC activities for AMB in FY Total budget utilized for all IEC/ BCC activities for AMB in FY Analysis of IEC budget utilization

Implemenation Research by National Centre of Excellence and Advanced Research (NCEAR) The National Centre of Excellence and Advanced Research on Anemia Control (NCEAR-A) will support MoHFW in monitoring through annual rapid assessments of the strategy at the field level Implemenation research to understand community uptake of interventions under AMB

Monitoring of Non nutritional causes of Anemia AMB strategies include intensifying awareness, screening and treatment of non-nutritional causes of anemia in endemic pockets, with special focus on malaria, fluorosis and hemoglobinopathies State / district nodal person for AMB to coordinate with the NVBDCP, NPPCF officials and officials in-charge of management of blood disorder (hemo-globinopathies) for status of malaria and fluorosis prevention and management of hemo-globinopathy cases AMB unit at National level carry out monitoring for status of implemenation of programmes related to non nutritional causes of anemia Note: In AMB guidelines Annexure 5 list of States / Districts under National Programme for Prevention and Control of Fluorosis (NPPCF) has been provided

Existing review mechanisms to be geared up for AMB review The existing review mechanisms at district/state/national levels through common review missions, integrated joint monitoring visits, quarterly/biannual reviews at District Magistrate (DM)/ Mission Director (MD) level should integrate the KPIs for monitoring the progress of implementation of Anemia Mukt Bharat

Review under POSHAN Abhiyaan Specific targets for anaemia reduction has been set under Poshan Abhiyaan: Reduce anaemia among young children (6-59 months), adolescent girls and young women in the age group 15-49 years by 9%, @ 3% per annum – by 2020 AMB performance to be reported in the six monthly Poshan Abhiyaan review report submitted by MoHFW as a part of periodic review by NITI Aayog Review mechanisms envisaged under the POSHAN Abhiyaan should also be effectively utilized for reviewing the implementation of Anemia Mukt Bharat strategy

Six institutional mechanisms

AMB Dashboard National Coordinator State Focal Point

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