ORISSA HMIS Towards an equity based monitoring system Institute of Public Health Bangalore (with the support of DFID, Delhi) July 2007

2 Objectives of this assignment Rationalisation of the HMIS STATE PERIPHERY

3 Methodology

4 LevelNumber State / National level15 District level29 PHC / CHC level13 Subcentre level7

5 Results – status of HMIS Have introduced a comprehensive NRHM reporting format But this a copy of Form 6 with some additions e.g. ASHA, JSY, NLEP, NPCB, IMNCI and details of infant deaths All other reports and registers continue

6 Results – status of HMIS LevelNumber of registers Number of reports Number of variables Sub centre level 3233~ 444 PHC level2035~ 492 CHC level4374~ 532 District level1946~ 680 TOTAL114188~ 2148

7 NRHM New registers – 8, of which 5 are at the block level New reports – 22, of which 8 are at the SC level, 10 are at the PHC / CHC level and 4 at the District level. More on the pipeline NRHM – GoI apparently wants to monitor the programme, down to SC activities

8 Results – status of HMIS Severe shortage of statistical staff at all levels Quality of data is unsatisfactory Data overload, so very little analysis Feedback is limited - mostly irregular, critical and occurs only when there are problems Validation of data is adhoc, NRHM staff are interested in monitoring, but require capacity building

9 Recommendation – I Rationalisation of registers & reports –Comprehensive NRHM is a good first step –Not clear what is the use of adding national programmes when they are being monitored separately –Reduce duplicate registers and reports. Have already recognised 26 –A lot of reduction possible if national programmes can be rationalised, especially malaria –Need to start with the GoI and work oneself down –Beware of increasing more because of NRHM.

10 Framework of indicators Quarterly analysis – at State / district level  Child health 1.% of children fully immunised 2.% of children with malnutrition 3.% of low birth weight babies 4.Number of months that there was stock out of measles vaccine 5.……

11 Framework of indicators Quarterly analysis – at State / district level  Reproductive health 1.Proportion of women how have delivered and who have received full antenatal check up 2.Proportion of deliveries attended by skilled providers 3.Proportion of deliveries in institutions 4.Proportion of deliveries in government institutions 5.Proportion of BPL mothers who received JSY funds 6.……

12 Framework of indicators Quarterly analysis at State / District level  Malaria 1.Incidence rate of malaria 2.Mortality rate due to malaria 3.Case fatality ratio due to malaria 4.Malaria treatment failure rate 5.Proportion of pregnant women who have received full dose of CHQ chemoprophylaxis 6.% of facilities that did not have CHQ / PMQ at least once in the quarter

13 Framework of indicators Quarterly analysis at State / District level  TB 1.Case detection rate 2.NSP case detection rate 3.TB cure rate 4.% of NSP cases put on DOTS within 7 days

14 Framework of indicators Quarterly analysis – at State / District level  Performance of hospitals 1.% of Institutions with BOR > 75% 2.Mortality rate in institutions by depts 3.Infection rate in institutions by depts 4.ALOS in institutions by depts

15 Framework of indicators Quarterly analysis at State / District level  ASHA 1.% of Gram sabhas that have selected ASHAs 2.% of selected ASHAs who have been trained 3.% of trained ASHAs who have accompanied women for delivery 4.% of trained ASHAs who are DOTS providers 5.% of ASHAs who motivated mothers for the BCG immunisation

16 Framework of indicators Annually at State level 1.Crude Birth rate 2.Crude Death rate 3.Infant mortality rate (by cause of death) 4.Neonate mortality rate 5.Still birth rate 6.Child mortality rate (by cause of death) 7.Maternal mortality ratio 8.Incidence of near miss events

17 Framework of indicators Annually at State level 9.Total fertility rate 10.Couple protection rate 11.Incidence of TB 12.Mortality rate due to TB 13.Incidence of Malaria 14.Mortality rate due to Malaria 15.Prevalence of leprosy 16.Prevalence of HIV

18 Framework of indicators Annually at State level 17.Outpatient contact rate in government hospitals 18.Inpatient admission rate in government hospitals (by depts) 19.% of SGDP allocated to health 20.% of health budget on primary care 21.Per capita public health expenditure 22.% of Districts with integrated societies, QA committees and RKS in place 23.% of districts who have submitted UC on time

19 Framework of indicators Annually at State level 24.Ratio of doctor to population 25.Ratio of ANM to population 26.Vacancy rate (at various levels) 27.% of Directors who were in position for more than 6 months in a year 28.% of District staff who were in position for more than 6 months in a year 29.% of districts with full time DPM in place 30.% of districts that did not having at least one month’s stock of essential drugs (ATT, measles vaccine, ORS, OC) 31.% of CHCs upgraded to IPHS 32.% of CHCs / SDH / DH providing EmOC

20 Recommendation – III Special studies Health seeking behaviour Health expenditure studies Awareness Patient satisfaction studies Utilisation studies Mortality studies

21 Recommendation – IV Strategy for monitoring Not enough to collect information Need to analyse it systematically and regularly Good to have an operational manual detailing on how to interpret the indicators and what action to be taken Important to supervise, triangulate and validate the data also

Thank you Dr. N. Devadasan, Dr. Lalnuntlangi Ralte Dr Upendra Bhojani