National Rural Health Mission Monitoring & Evaluation Dr. S.P. Yadav

Where we are CBR CBR 28.3 (2006) CDR 6.9 (2006) TFR 3.2 ( ) IMR 65 NFHS ( ) MMR 445 ( ) CPR 46.4 ( ) Institutional Deliveries 55.2 ( )

Targets of Health Indicators for 11 th Five year plan Indicators CBR IMR MMR TFR Inst. Delivery ANC Check-up

Health Information System in Rajasthan

Key Features Among the first state to implement TFA in April, Among the first state to implement TFA in April, Implemented CNAA since April, Implemented CNAA since April, Implemented Eligible Couple Survey since Implemented Eligible Couple Survey since Village wise Annual Action Plans Village wise Annual Action Plans(FORM-KA) Transform EC survey information into SDRs. Transform EC survey information into SDRs. Tracking of ECs as per SDR. Tracking of ECs as per SDR.

Flow of Information Sub-center PHC Block CMO District State Form 1 & 6 Form 2 & 7 Form 4 & 9 CHC/FRU/UFWC Form 3 & 8

Eligible Couple Survey Continue since 1995 in all rural and urban slums. Continue since 1995 in all rural and urban slums. EC survey updated every year in April. EC survey updated every year in April. Survey format has 44 columns. Survey format has 44 columns. Information on age, Education, youngest child, delivery in previous calendar year, infant/maternal death, immunization status of child born last year, current pregnancy status, current contraceptive use, unmet need etc., collected. Information on age, Education, youngest child, delivery in previous calendar year, infant/maternal death, immunization status of child born last year, current pregnancy status, current contraceptive use, unmet need etc., collected. The CBR, IMR, MMR & CPR also calculated on the basis of EC survey. The CBR, IMR, MMR & CPR also calculated on the basis of EC survey. The information of Blindness, T. B. and Leprosy is also collected during EC survey. The information of Blindness, T. B. and Leprosy is also collected during EC survey.

Eligible Couple Survey Survey supervision & Monitoring At PHC level: At PHC level: –LHV/SS – Physically verify 10 percent of total EC. –MOIC – Physically verify 5 percent of total EC verified by supervisory staff. – 5-5 ECs in 2 village of each sub-center. At Block level: At Block level: –Block CMO is sole responsible for timely conduct of EC survey and it’s quality. –Physically verify 10 % ECs in one Sub-center per PHC. At District level: At District level: –CM&HO will ensure the timely conduct of survey & will make alternative arrangements for vacant sub-centers. –RCHO, Addle/Dy CM&HO (FW) will also physically verify the survey. –The statistical staff posted at district & block level will physically verify and monitor the EC survey in their respective areas.

Service Delivery Register Service delivery records are maintained in service delivery registers (SDR). Service delivery records are maintained in service delivery registers (SDR). Separate SDR for each village. Separate SDR for each village. Information of EC survey transformed in SDR. Information of EC survey transformed in SDR. SDR has 16 tables. SDR has 16 tables. –Table no. 1-4 : Regarding contraceptives, current users & unmet need. –Table no. 5 : ANC services. –Table no. 6&7 : Immunisation –Table 8&9 : Birth & Death registration. –Table : Regarding diseases. – Table 13-16: Tetanus Cases, IEC activities (RTI/STI) & Dai traning

Various Reports Form 1-5 : Annual Action Plan under CNAA. Form 1-5 : Annual Action Plan under CNAA. Form 6-9 : Monthly Progress Reports. Form 6-9 : Monthly Progress Reports. Form-KA : Village AAP. Form-KA : Village AAP. Weekly progress of sterilisation. Weekly progress of sterilisation. Daily report of sterilisation camps (from Oct to March every year). Daily report of sterilisation camps (from Oct to March every year). Weekly report of sterilisation progress. Weekly report of sterilisation progress. PHC wise quarterly progress report of FW programmes. PHC wise quarterly progress report of FW programmes. Camp wise monthly progress report of sterilisation. Camp wise monthly progress report of sterilisation. Annual report of FW according to age, caste, parity etc., Annual report of FW according to age, caste, parity etc.,

Data Monitoring & Validation Data Monitoring & Validation The Monitoring & Validation Exercise. The Monitoring & Validation Exercise. Every month exercise will be done in one district. Every month exercise will be done in one district. 20 PHCs selected in each district. 20 PHCs selected in each district. The services of maternal & child health and FP will be validated. The services of maternal & child health and FP will be validated. The services will be validated through cross check by team (MO-1, LHV-1, LS of WCD). The services will be validated through cross check by team (MO-1, LHV-1, LS of WCD). The reported information will be verified by records & physically verification. The reported information will be verified by records & physically verification. Availability, Accessibility, Utilisation &Coverage of services will be analysed. Availability, Accessibility, Utilisation &Coverage of services will be analysed.

Community Based Monitoring Towards Ensuring Transparency and Public Accountability I: Self monitoring tool (SMT) and social map II: people based monitoring committee III: Monitoring through Gram Sabha IV: Social Audit

Health Management Information System (HMIS) To establishment of computer based Health Management Information System in the department to facilitate reliable and cost effective mechanism for better decision making, monitoring, planning and implementation for effective service delivery. To establishment of computer based Health Management Information System in the department to facilitate reliable and cost effective mechanism for better decision making, monitoring, planning and implementation for effective service delivery. Current scenario HMIS developed by NIC under EC-SIP; System is regularly being updated; Central Server Room established in Swasthya Bhawan; 155 client PCs in different sections of Swasthya Bhawan ; 15 client PCs in different sections of Secretariat; 12 PCs for all 6 Jt. Directorates (2 each); 104 computers for all 104 Dy. CMHO offices; Computers for all 237 Block Health Offices. Milestones

The website of medical department has been developed. The site was launched by Hon’ble Chief Minister; Health Information system for Government (HEALING) has been developed and implemented for various application areas; Field level operational training to about 300 persons from all over the state and id to all CMHOs, JDs, State level Officers. Sub-Center monitoring system being developed, is in implementation phase; Financial Monitoring, Hospital Management and Personnel Information System being developed.

Health Management Information System (HMIS) HEALING Application Areas Integrated Disease Surveillance Program (IDSP) ; Malaria Monitoring; Disease Outbreak Cases; Cold Chain Equipments Monitoring; Routine Immunisation Program Monitoring; Acute Flaccid Paralysis Surveillance; Patients Monitoring (Sanjivani camps); Pulse Polio Campaign Monitoring; TB Control Program Monitoring; Sterlisation Monitoring; Institutional Delivery Monitoring; Drug Control Information System; Personnel Information System; Public Grievances Redressal; File & Letter Monitoring; NRHM Monitoring; Blindness Programme Monitoring; Office Cigma; Rajsthan Swasthya Bima Yojna;

Parameters of health care Awareness Awareness Available Available Accessible Accessible Affordable Affordable Quality Quality –Performance vs agreed standards 16

Monitoring Outcomes of NRHM 1. Right to Health –An inalienable right of all citizens –Incorporate in monitoring framework of Mission 2. 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

Monitoring Outcomes of NRHM (cont’d) 3. Preparation of Habitation/Village Health Register 4. Periodic Health Facility Survey at SC, PHC, CHC, DHQ –Facilities available –Service Guarantees 5. 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 ) 6. Sharing of data at all levels – full transparency 7. Display of agreed service guarantees at health facilities 8. Sample household and facility surveys by external agencies/NGOs 9. Public Reporting of household & health facility findings

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

21 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 (a) (a)Measles vaccine, (b) (b)Oral Contraceptive Pills and (c) (c)Gloves

22 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

23 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)

24 Agreed Indicators … (3) 5. % of 24 hrs PHCs conducting minimum of 10 deliveries/month 6. % of upgraded FRUs offering 24 hr. emergency obstetric care services 7. % of 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

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 – –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 Disseminate data with analysis to all stakeholders (up & down stream) Encourage Feedback – –Reinforce with recognition/reward Budget for M&E in the PIPs