Chief, Health Systems Division, USAID/India Use of DHS Data to Influence FP/MNCH Programs & Policies: India National Family Health Survey Sheena Chhabra Chief, Health Systems Division, USAID/India Reconvening Bangkok March 9, 2010

India’s National Family Health Survey (NFHS): A key data-base for promoting data-based decision-making in health National Five Year Plans National Population Policy National Nutrition Policy State Health & Population Policies Reproductive and Child Health (RCH)-1 & -2 designs Integrated Child Development Scheme design National Urban Health Mission design Development Partners PHN Strategies & Programs- USAID, UNICEF, DFID, World Bank, UNFPA, EC, etc. Designing & tracking program progress Monitoring MDGs

NFHS data were instrumental in revitalizing routine immunization Key Findings Immunization coverage stagnant for DPT Health system is reaching vast majority of children at least once Substantial decrease in full vaccination coverage among children in better-performing states Response Strategies for Routine Immunization Community mobilization through Village Health & Nutrition Days Improved program monitoring DPT 1: 76% DPT 2: 67% DPT 3: 55% Data Source: For NFHS-2 and NFHS-3 - Table no. 9.6 (NFHS-3 Chapter) For NFHS-1 India fact sheet (NFHS-3)

NFHS reiterated the need to focus on proven & simple child health interventions Key findings Basic package of child health services is not being delivered Stagnant ORS use 69% of the children with ARI symptoms sought treatment Response Newborn & Child Health Policy Strategies for home-based as well as institutional care Percentage of children age with diarrhoea in the past 2 weeks Data Source: For NFHS-3 India fact sheet For NFHS-2 Table no. 6.20 India report,(NFHS-2) RCH-2

NFHS highlighted the need for focused attention on malnutrition Key Findings No significant improvements in nutrition status among children under age 3. Anemia among children age 6-35 months has increased over the past 7 years. Response Prime Minister’s letter to Chief Minister urging action to address malnutrition especially among children under six. Establishment of the Coalition for Sustainable Nutrition Security in India under chairmanship of Prof. M.S Swaminathan. Percent

NFHS-3 informed programs for improving nutritional status Key Findings Only a third of the eligible children receive any service from an Anganwadi Centre (AWC) under the ICDS Response Strategic shift in the design of Integrated Child Development Services Scheme (ICDS)-3 Percent of age-eligible children in areas with an AWC

NFHS data influenced design of JSY Janani Suraksha Yojana NFHS data helped in improving program focus on coverage and quality of antenatal care & institutional deliveries. National Maternity Benefit Scheme modified (JSY) from nutrition-improving scheme to one of addressing all aspects of maternal health. Janani Suraksha Yojana designed for promoting institutional deliveries. Report on the Working Group on Health of Women & Children for the 11th 5 year plan (2007-2012)

NFHS data helped improve focus on birth spacing Key Findings Contraceptive use increased steadily with vast majority continuing to rely on female sterilization. Some gains in modern spacing method use but use of IUDs remained static. Response Shift of the family welfare program to target-free approach. Strategy for repositioning IUDs. Enhanced commitment to expand basket of contraceptive methods. Standard Days method introduced in National program. Percent of currently married women age 15-49

Deaths in the first year of life per 1000 live births NFHS data helped to evolve strategies for healthy timing and spacing of births Deaths in the first year of life per 1000 live births

NFHS-3 helped devise appropriate strategies for vulnerable population groups Key Findings Health conditions of urban poor are similar to or worse than rural population and far worse than urban averages. 27% of teenage women and 21% of women age 20-24 have unmet need for family planning. Child mortality rate is 61% higher for girls than for boys. Two in five currently married women age 15-49 have ever experienced spousal violence in their current marriage. Response Design of the draft National Urban Health Mission highlighting need for programming resources for urban poor. Adolescent Reproductive and Sexual Health Strategy (ARSH). Improved commitment for gender programming including gender-based budgeting. Inputs for the Domestic Violence Act 2005.

NFHS-3 Key Data Source for RCH-2 Performance Review of States Segmentation of States based on RCH-2 Performance Top Guns High Achievers Movers and Shakers Promising Goa Kerala Sikkim Uttaranchal Himachal Pradesh Karnataka Maharashtra Tamil Nadu Manipur Chhattisgarh Madhya Pradesh Orissa Andhra Pradesh Gujarat Haryana Jammu & Kashmir Punjab West Bengal Meghalaya Mizoram, Tripura Bihar Jharkhand Rajasthan Uttar Pradesh Arunachal Pradesh Assam Nagaland Source: RCH-2 – Program Management Support Group (PMSG), Donor Coordination Division

Key Learnings Government stewardship essential from design stage Involve various government departments on Steering & Technical Committees Widen ownership by engaging multiple stakeholders early on Provide adequate funding Build various data quality checks

…Key Learnings Provide world-class technical assistance Engage premier local institutions Anticipate barriers for acceptance of data and plan appropriately Disseminate data widely at all levels 2 National & 29 State NFHS-3 fact-sheets National and 29 state reports 27 dissemination seminars at national and state level 4 subject reports & 5 subject factsheets Estimated 2000 media reports including over 500 wholly or largely based on NFHS-3 results 124 peer-reviewed journals using NFHS data Make data-sets available in public domain (wwwnfhsindia.org)