1. National Rural Health Mission
Monitoring & Evaluation

2. Where we are …(1)
Total
Rural
Urban
CBR
23.8
25.6
19.1
CDR
7.6
8.1
6.0
TFR
2.9
3.2
2.1
Illiterate
3.9
4.1
3.3
Literate
2.2
2.5
1.9
Mean Age at Marriage
20.2
19.7
21.7
% Infant to Total Deaths
18.5
20.1
12.6
Pop’n 2001
(in Millions)
1,029
(1,112 – 2006)
742
286

3. Population Projections
Demographic
Indicators
NRHM
2012
Population growth rate
1.6
1.4
1.3
1.1
0.9
Crude Birth rate (CBR)
23.2
21.3
19.6
18.0
16.0
Crude Death rate (CDR)
7.5
7.3
7.2
7.1
Infant Mortality Rate (IMR)
61.3
54.3
49.2 30
44.0
40.2
Under-5 mortality rate (q5)
82.0
72.8
65.9
59.0
54.0
Total Fertility Rate (TFR)
2.9
2.6
2.3
2.1
2.2
2.0
Life expectancy of males
63.8
65.8
67.3
68.8
69.8
Life expectancy of females
66.1
68.1
69.6
71.1
72.3

4. Demographic scenario

5. < US$ 900 pa (approximately Rs 36,783)
Where we are …(2)
Indicators
Threshold Level
During
Status vs Threshold
Proportion of births with skilled health personnel
> 60 %
42.4
48.3
Not satisfied
Contraceptive prevalence rate (modern methods only)
> 25 %
42.8
48.5
Satisfied
HIV prevalence rate in adults (15-49 years old)
< 5 %
3.5 million
5.134 million
Satisfied??
% with symptoms of RTI/STI - Male
12.3
7.6
% with symptoms of RTI/STI - Female
29.7
32.3
Adolescent fertility rate
< 65/1000
52.1
45.9
Under-five mortality rate
< 60/1000
20.4
17.3
Maternal mortality ratio
<100 /100,000
398.0
301.0
Literacy rate among year old females
> 80 %
54.2
67.7
Proportion of Population aged 10-24
< 35 %
31.5
30.6
Per capita GNP (at prices) in Rs:
< US$ 900 pa (approximately Rs 36,783)
16,105.0
23,313.0

6. Level of Hospitalisation Avg Total Expenditure (Rs)
Some Bare Facts
Level of Hospitalisation
Avg Total Expenditure (Rs)
Rural
Urban
Govt hospitals
42%
38%
3,238
3,877
Private
58%
62%
7,408
11,553
Total
100%
6,225
9,367

7. Funds not a constraint Year Central Govt. NRHM Allocation Recurring
Non-Recurring
State Contribution
Total
(in Rs crores)
6,500 -
9,500
9,000
500
12,350
11,000
1,350
2,179
14,529
17,290
13,000
4,290
3,051
20,341
24,206
16,206
8,000
4,272
28,478
33,884
23,884
10,000
5,980
39,864
47,439
42,439
5,000
8,372
55,811

8. Parameters of Health Care
Awareness
Available
Accessible
Affordable
Quality
Performance vs agreed standards 8

9. Monitoring Outcomes of NRHM
Right to Health
An inalienable right of all citizens
Incorporate in monitoring framework of Mission
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
Through ASHA/AWW etc

10. Monitoring Outcomes of NRHM (cont’d)
Preparation of Habitation/Village Health Register
Periodic Health Facility Survey at SC, PHC, CHC, DHQ
Facilities available
Service Guarantees
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

11. Monitoring Outcomes of NRHM (cont’d)
Sharing of data at all levels – full transparency
Display of agreed service guarantees at health facilities
Sample household and facility surveys by external agencies/NGOs
Public Reporting of household & health facility findings

12. MIES System Model in NRHM/RCH II
Program Planning & Service Delivery
MIES
Validation
Monitoring
MIES
Quality Assessment
Evaluation 12 12

13. 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
Measles vaccine,
Oral Contraceptive Pills and
Gloves 13

14. 13 Process Indicators – 6 monthly review (cont’d)
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 14

15. 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)
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
Details of numerator and denominator and sources of information given in Appendix IV of National PIP 15

16. 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
H/W, S/W, 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
On Public Domain
Disseminate data with analysis to all stakeholders (up & down stream)
Encourage Feedback
Reinforce with recognition/reward
Budget for M&E in the PIPs

17. Thank You