Sources of Health Information in India By Dr. Pranali Kothekar Moderator : Dr. Abhishek Raut

“data” means an organized collection of individual measurements for each subject, in respect of every variable of interest. Once this data has been collected, collated and “summarized” it is called “Information”. Thus, information is a “factual presentation” i.e. a “Summary of facts” from the data and as they exist without any added element of interpretation of facts.

Minimum Information required by a Public Health Specialist in most Settings General Information Socio - demographic profile Morbidity and Mortality Health Related indicators Health Services Preventive / Promotive Health programmes

Uses of Health Information To measure the health status of the people & to quantify their health problems & medical & health care needs For local , national & international comparisons of health status For planning ,administration & effective management of health services and programmes For assessing whether health services are accomplishing their objectives in terms of their effectiveness & efficiency For assessing the attitudes & degree of satisfaction of the beneficiaries with the health system For research into particular problems of health & disease

Sources of health information Census Registration of vital events Sample registration system Notification of Diseases Hospital Records Disease Registers Record Linkage Epidemiological Surveillance Health Service Records Environmental Health Data Health manpower statistics Population Surveys Non-quantifiable Information

Census Census provides- UN Defination-The total process of collecting, compiling & publishing demographic, economic & social data pertaining at a specified time or times to all persons in a country or delimited territory. Census provides- Demographic information Information on social & economic characteristics of the people A frame of reference & base line for planning , action & research Basic data needed to compute vital statistical rates & other health ,demographic & socio economic indicators.

Massive undertaking to contact every member of population in a given time & collect a variety of information. Needs considerable organization, vast preparation & several years to analyze the results. The full results are usually not available quickly.

Two methods of collection of data in a census de - facto method : Persons are enumerated according to their location at the time of enumeration. This method is used in developing countries like India. de - jure method:The persons are assigned according to their“usual” place of residence and not according to their location at the time of census. This method is used in USA.

Census in India The first census in India in modern times was conducted in 1872. It carried out every 10 years. It is carried out by the office of the Registrar General and Census Commissioner of India, Delhi, an office in the Ministry of Home Affairs, Government of India, under the 1948 Census of India Act.

The 15th Indian National census was conducted in two phases, house listing and population enumeration. Covered 640 districts, 5767 tehsils, 7742 towns and more than 6 lac villages. Approximately twenty five lakh (or 2.5 million) enumerators and 2 lakh supervisors were engaged for this operation and information was collected on 35 items and 1.5 crore Census Schedules were canvassed in 16 Indian languages.

Census Operations Preparatory Work Enumeration Data processing Indian population census organisation is considered as the largest administrative network in the world. It is one of the most extensive and complicated statistical operations which needs careful planning to avoid defects and inefficiencies. The census operations can broadly be divided into the following sequential phases: Preparatory Work Enumeration Data processing Evaluation of results Analysis of results Dissemination of the results Systematic recording of Census experience

MINISTRY OF HOME AFFAIRS REGISTAR GENERAL AND CENSUS COMMISSIONER DIRECTOR OF CENSUS OPERATIONS STATE/UT PRINCIPAL CENSUS OFFICERS CHARGE OFFICERS SUPERVISORS ENUMERATOR STATE GOVT./UT NODAL OFFICER

Density of population ( per sq km ) is 382. India accounts for 2.4 percent of the world surface area, it supports 17.5 percent of the world population. Density of population ( per sq km ) is 382.

State wise break-up State-wise break up

Census report of 2011

Registration of vital events Definition : The United Nations defines it as including Legal registration, statistical recording &reporting of the occurrence of, & the collection, compilation, presentation, analysis & distribution of statistics pertaining to vital events. The office of the Registrar General of India was created in 1951 and the vital statistics department was transferred to this office from the Director of Health Services in 1960. Vital Events-Live births, Deaths, Foetal deaths, Marriages, Divorces, Adoptions.

The Central Birth & Registration Act 1969 came in force on 1st April 1970. The act provides for compulsory registration of birth & deaths & other Vital events throughout the country. The time limit for registration of birth and death is 21 days. But still there is lack of registration of birth & death because of illiteracy, ignorance, lack of concern & motivation. Lay Reporting-It is the collection of information , its use, and its transmission to other levels of the health system by non-professional health workers.

Sample Registration System (SRS) Double recording method. The first part of record collection is done by a part time enumerator in his or her area. In the second part, once in six months, an official from the SRS department, who is a full time enumerator independently collects data on these aspects form all the households in the sample villages and urban blocks. Undertaken under the authority of the Registrar General of India.

Instead of covering the whole population, only a sample, which is representative of the population, is studied. It more than 6670 sampling units, including 4435 in rural and 2235 in urban areas, covering a sample population of almost 6 million population. Each rural sampling unit has a complete village (maximum population of 1500) while each urban sampling unit is equivalent to an urban census enumeration block with population of 750 to 1,000. Retrospective in nature, in a defined period of recall, usually kept as 1 year form the date of interview. The reports of findings are published as annual report and half-yearly bulletins.

Notification of Diseases Usually diseases considered to be serious public menace are notified. As per International Health Regulation, Cholera, Plague , Yellow Fever are to be notified to WHO, Geneva. International Surveillance is required for Louse borne Typhus, relapsing Fever, Polio, Influenza, Malaria, Rabies, Salmonellosis. The primary purpose of notification is to effect prevention & control of disease. Mainly Health workers at grass-root level report the disease. Limitation-covers only small part of the total sickness in the community, under reporting, many cases like atypical and subclinical cases escape notification due to non recognition.

Hospital Records They consitute the “tip of the ICE-BERG.” Admission policy varies from hospital to hospital. There are no precise boundaries to the catchment area of the hospital. Lot of useful information about health care activities and utilization can be derived. Indices such as bed occupancy rates,duration of stay, cost effectiveness of treatment are useful. Example discharge card.

Disease Registers A register is a permanent record & the cases can be followed-up. Examples-Tuberculosis Register, Leprosy Register If the reporting system is effective & the coverage is on national basis, then register can provide useful data on disease specific morbidity & mortality.

Record Linkage It is the process of bringing together records relating to one individual. “Medical Record Linkage” is the assembly & maintenance for each individual in a population , of a file of the more important records relating to his health. Drawback is the volume of data it can accumulate. Used only on limited scale e.g. in twin studies & genetic diseases.

Epidemiological Surveillance Surveillance systems are often set-up in case where a disease is endemic e.g., Malaria. To report new cases To know the result of efforts to control the diseases.

Other Health Service Records Records of hospitals OPD Primary Health Centres Private practitioners Maternal & Child Health Centres School health records NCD clinic

Environmental Health Data It may be the data of Air, water & noise pollution Industrial intoxicants Harmful food activities Inadequate waste disposal

Health Manpower Statistics State Medical/ dental / Nursing Council can provide information of the respective health manpower. Ministry of Health & Family Welfare , Govt. Of India publishes every year the statistics data as “Health Information of India.” Institute of Applied Manpower Research attempts to estimate manpower. Planning Commission.

Population Surveys Health surveys can be broadly classified into 4 types on basis of method applied for data collection Health Interview survey Health examination survey Health records survey Mailed questionnaire survey

National Family Health Survey (NFHS) It is a large-scale, multi-round survey conducted in a representative sample of households throughout India. Three rounds of the survey have been conducted since NFHS -1 (1992 – 93) NFHS -2 (1998 – 99) NFHS -3 (2005 – 06) NFHS -4 (2014 – 15) Ongoing

Rural sample Urban sample the selection of Primary Sampling Units , which are villages, with probability proportional to population size random selection of an equal number of households within each PSU wards were selected with PPS sampling one Census Enumeration Block was randomly selected from each sample ward an equal number of households were randomly selected within each sample CEB.

NFHS has had two specific goals: 1. To provide essential data on health and family welfare needed by the Ministry of Health and Family Welfare and other agencies for policy and programme purposes. 2. To provide information on important emerging health and family welfare issues. For decisions about policies and procedures, NFHS‐3 were reviewed by three project committees, namely: 1. A Steering Committee 2. An Administrative and Finance Management Committee 3. A Technical Advisory Committee.

International Institute for Population Sciences, Mumbai, is the nodal agency, responsible for providing coordination and technical guidance. Technical assistance was provided mainly by ORC Macro (USA) and other organizations on specific issues. The funding provided by USAID, DFID, the Bill and Melinda Gates Foundation, UNICEF, UNFPA, and MOHFW, GOI. Web link - http://www.rchiips.org/NFHS/index.shtml

Survey provides state and national information for India on Fertility Infant and Child mortality Practice of family planning Maternal and child health Reproductive health Nutrition & Anemia utilization Quality of health and family planning services

Total Fertility Rate

Infant Mortality Rate

District Level Household Survey (DLHS) Largest ever demographic and health surveys carried out in India, with a sample size of about seven lakh households covering all districts of the country. Specific goal,to provide district level estimates on health indicators to assist policy makers and program administrators in decentralized planning, monitoring and evaluation. Three rounds of the survey have been conducted since RCH -1 (1998 – 99) RCH -2 (2002 – 04) DLHS -3 (2007 – 08) DLHS -4 (2011 – 12)

provides state and national information for India on Maternal and child health Reproductive health New born care Perinatal care Practice of family planning Performance of NHM Accessibility and utilization of health facilities Health facility adequacy and performance Role of ASHA Coverage of JSY Integration of facility survey of health institution accessible to sample villages

International Institute for Population Sciences, Mumbai, play role in design, development of survey tools and softwares, training of regional agencies, overall supervision and management of household and facility survey. Information generated will help goernment to effectively monitor the ongoing health and family welfare programme.

Percentage of Women Received Full Antenatal Check‐up DLHS-2 DLHS-3

Full Vaccination of Children DLHS-3 DLHS-2

Annual Health Survey AHS yields a comprehensive, representative dataset on core vital indicators including composite ones like IMR, MMR and TFR at the district level. Enable direct monitoring of UN Millennium Development Goals on Child Mortality and Maternal Health at the district level. Help in identifying high focus districts meriting special attention in view of stark inter-district variations in these States. Provide critical inputs to assess the milestones of various interventions including NHM and pave the way for evidence based planning. Web link - http://censusindia.gov.in/2011-common/AHSurvey.html

Coverage of AHS

Longitudinal Ageing Study in India (LASI) Focuses on the health, economic, and social well-being of India's elderly population. Conceptually comparable to the Health and Retirement Study in the United States. Technical support by IIPS Mumbai, Harvard School of Public Health and RAND Corporation. Coverage-29 states and 2 union territories.

Health Management Information System The Ministry of Health and Family Welfare, GOI, has established a dedicated Health Management Information System portal for all Public Health related information,in October, 2008 to enable capturing data from both public and private institutions in rural and urban areas across the country. The agency involved in collection, compilation, analysis, dissemination of information.

Central Bureau of Health Intelligence It is the National nodal Institute in the Directorate General of Health Services, Ministry of Health & Family Welfare, Govt. of India,since 1961. Headquarter at Nirman Bhavan, New Delhi. four divisions Policy & Infrastructure Training, Collaboration & Research Information & Evaluation Administration It has Six Health Information Field Survey Units located in different Regional Offices of Health and Family Welfare of GOI at Bangalore, Bhopal, Bhubaneswar, Jaipur, Lucknow & Patna.

References 1. K. Park, Park’s Textbook of preventive and social medicine.23th edition. Banarsidas Bhanot Publishers;2015. 2. Bhalwar R, Vaidya R, Tilak R, Gupta R, Kunze R,editors.Text book of Public Health and Community Medicine. 1st edition. New Delhi:Dept of Community Medicine Armed Force Medical College Pune; 2009. 3. www.censusindia.gov.in 4. www.rchiips.org 5. Data.gov.in 6. www.iipsindia.org 7. www.unicef.org