DASHBOARD MONITORING: STATE SCORE CARD MSG STRATEGIC CONSULTING PVT. LTD

 Introduction  Context of the problem  Idea Summary  Implementation Plan: Methodology  Select indicators for analysis  16 sample indicators  Ranking of the states  Sample depiction of findings  Implementation Plan: Anticipated Challenges  Measuring Success / Proposed way forward  Impact PRESENTATION STRUCTURE

CONTEXT OF THE PROBLEM  Over the years, the web-based HMIS has steadily improved in terms of coverage and reliability of data.  At present all states/ UTs upload state and district level data, and this year, it is expected that facility level data would be available.  There is considerable variation across states in terms of the effectiveness of the web based HMIS.  However, in general, there are three areas of concern:  Data uploading could be more timely.  Data could be more reliable.  There could be greater use of data for improved decision- making.

IDEA SUMMARY In this context, we propose to develop a state level scorecard which would assess performance of states across a series of health indicators. The objective of the score card would be to catalyse states to:  Provide more accurate and timely data.  Use data for improved decision making.  Prepare similar score cards for districts.

Dashboard indicators would be selected from parameters across the spectrum of RMNCH+A, i.e.:  outcome indicators (MMR, IMR, TFR)  output indicators (institutional deliveries, full immunization, number of IUD insertions)  RCH monitorable indicators (pregnant women registered for ANC in first trimester, home delivery by SBA, percentage of children breastfed within one hour of birth)  Supply indicators (density of health workers per population)  Indicators of enabling environment (health expenditure; girl’s enrollment in classes VI-VIII) IMPLEMENTATION PLAN: Methodology 1. Select indicators for analysis.

IMPLEMENTATION PLAN: Methodology Maternal HealthChild Health 1. 1st Trimester registration9.Newborns visited within 24hrs of home delivery 2. PW received 3 ANC check ups10.Live births reported 3. Pregnant women received TT2 or Booster to ANC registration 11.Newborns weighed 4.Pregnant women having severe anaemia (Hb<7) treated at institution 12.Newborns breast fed within 1 hour 5. SBA attended home deliveries13.Newborns given OPV0 at birth 6.Women discharged under 48 hours of delivery14.Newborns given BCG 7.Institutional deliveries Family Planning 8.Women receiving post partum check-up within 48 hours after delivery 15.Vasectomies as proportion of total sterilisation 16.Tubectomies as proportion of total sterilisation Ideally a maximum of 20 indicators should be considered for ranking. 16 sample indicators:

IMPLEMENTATION PLAN: Methodology 2. State ranking.  All India average for each indicator would be taken as the baseline  States would be scored for each indicator based on their contribution towards the national average:  Positive scores for favourable contribution towards the national average (> country average).  Negative scores for adverse contribution towards the country average (< country average).

IMPLEMENTATION PLAN: Methodology  Positive contributors would be classified into quartiles: top positive contributor quartile would be given a score of +4.  Negative contributors would be classified into quartiles and the top negative contributor quartile would be given a score of -4.  Remaining states would be scored based on their quartile number.  In this way, all states would be scored based on their quantum of contribution (either positive of negative) to the national average.

 All 16 indicator scores for each state would be consolidated as state score.  States would be ranked and classified into four categories based on their scores.  Frequency of the ranking : Quarterly.  In the first model ranking exercise, this would be done for a sample of 16 states across two quarters. IMPLEMENTATION PLAN: Methodology

1 State 16State 6 2 State 27State 7 3 State 38State 811State 11 4 State 49State 912State 12 5 State 5 10 State 10 13State 13 High performance states (Contributing most positively to India's RCH indicators) 14State 14 15State 1516State 16 17State 17 Promising states 18State 18 19State 19 Low Performance states 20State 20 Very Low performance states (Contributing most negatively to national indicators ) Sample depiction of findings

1. Identification of indicators for analysis. Factors to consider:  Whether there is data available from the HMIS standard report for the selected indicator  Whether the data available is of sufficient quality  Whether the indicator can help improve decision making  Whether corrective action can be taken based on performance on the selected indicator IMPLEMENTATION PLAN: Anticipated Challenges

2. Collection of data for analysis.  Motivating states to check and commit all HMIS data within a specified time frame will likely prove to be a challenge  State-level contacts may be needed to ensure that these requests are entertained IMPLEMENTATION PLAN: Anticipated Challenges

 After carrying out the model ranking exercise for 16 states, results would be assessed to derive lessons learned: - Potential for impact on overall public health in States. - Likelihood of available accurate data for the selected indicators. - Amenability to improved decision-making.  Based on this assessment, ranking methodology and choice of indicators would be revisited.  Once the methodology and indicators are finalized, the ranking exercise would be carried out for the 20 large states.  States would be encouraged to begin preparing similar scorecards at the district or facility-level MEASURING SUCCESS / WAY FORWARD

IMPACT  Apart from improving the timeliness with which States upload data and use data in decision making, the State level scorecard would facilitate mid-course policy corrections.  Health Systems Strengthening and Gap filling (e.g.)  30% Higher financial allocation under NRHM (State PIP)  Relaxation of norms for HR, Infrastructure as per guidance from GOI  Additional incentives, difficult area allowance, residential facilities for HR  Need-based capacity building

IMPACT  State scorecard would also improve overall accountability in the public health system.  Beyond this, the State level scorecard could ultimately provide a framework for a district-level scorecard.  This would facilitate States in continuously identifying districts and strategies requiring greater attention.  States would be in a position to identify the root cause of the relatively poor performance and subsequent corrective action required.

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