1. Monitoring & Evaluation
Key Findings of District Level Household Survey – III (2008)
Concurrent Evaluation of NRHM
Health Management Information System (HMIS)

2. Trends in Vital Rates

3. Evidence of NRHM at Work ...

4. Several States/UTs have improved during 2007

5. District Level Household Survey-3 Preliminary Results Ministry of Health and Family Welfare (DLHS-3 nodal agency: IIPS, Mumbai)

6. Background
DLHS III survey preliminary results for 15 states (AP, BIH, CHT, GOA, JRK, KAR, KER, MP, ORS, PON, RAJ, SIK, TN, UP, WB)
results from DLHS II & III have been compared
Analysis includes the following:
Marriage-main findings;
Fertility / infertility;
Maternal Health;
Child Health;
Family Planning;
General (VHSC, ANMs living at AC quarters)

7. Marriage Mean Age at Marriage
Boys
Girls
% of girls marrying before reaching 18 years of age

8. Mean age at marriage for boys-years

9. Mean age at marriage for girls-years

10. Percentage of girls married below age 1810

11. Marriage – main findings
Mean age at marriage for both boys and girls has increased between the two rounds of DLHS.
The difference in mean age of marriage (both boys and girls) between states reporting lowest and highest was in the range of 8 years

12. Marriage –main points
Rajasthan is the only state where mean age at marriage for boys and girls is lower than the legal age at marriage
Bihar is the other state where female mean age at marriage is lower than legal age. Bihar reported the lowest (17.6 years) mean age while it was the highest in Goa (25.1 years)
In case of males, Goa reported the highest (29.6 yrs) while Rajasthan (20.7 yrs) reported the lowest
% of females marrying before reaching 18 years of age had come down in high-focus states yet it has a long way to go to attain the stage reached by Kerala and Goa.

13. Fertility Births to women during age 15-19 out of total births, DLHS-3
Women with two children wanting no more
Mean children ever born to women aged years
Infertility among women years

14. Births to women during age 15-19 out of total births, DLHS-3 (%)14

15. Women with two children wanting no more children15

16. Mean children ever born to women aged 40-44 years.16

17. 17

18. Fertility/infertility-main points
Out of total births, many states like AP, Bih, Jrk, Cht, Kar, UP, WB have higher % of births to women aged years
Large no. of women (44% or higher) do not want any child after two children
Mean number of children ever born to women aged have declined in most states.
Infertility is as high as 14% in some states (Goa, Kar, WB)

19. Maternal Health Any antenatal care
Complete antenatal care package of services
Institutional births
Mothers who received JSY financial assistance

20. % mothers who availed any ANC service

21. % mothers who availed complete package of ANC services

22. % mothers who availed any ANC and complete package of ANC services (DLHS-3)

23. Antenatal Care Services
Proportion of women availing any ANC and complete package of ANC services has increased
The difference between availing any ANC and complete package was substantial in high-focus states
Follow-up ANC care services for ensuring complete coverage are required in all states

24. Institutional Deliveries

25. % increase/decrease in institutional deliveries

26. 26

27. Institutional Deliveries
Institutional deliveries have increased in most of the states in the country
High-focus states have shown tremendous growth in institutional deliveries barring Sikkim, Jharkhand and Chattisgarh
Maximum increases in institutional deliveries have been witnessed in states of Orissa, Bihar, Rajasthan and MP

28. Institutional Deliveries
Using a cut-off of 40% of institutional births, the states were classified by DLHS results. Eight out of 15 states in DLHS II had reported more than 40% of institutional births while it had increased to 11 states in DLHS III
High-focus states of MP, Orissa, Rajasthan and Bihar have shown good progress and the former three states have joined the other 8 states.
In states like Bih, Cht, Goa, Jrk, UP, the JSY assistance received is received by a lower percentage of women

29. Child Health Coverage in Child Immunization
Other Child Health Indicators

30. Coverage in Child Immunization

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33. 33

34. Coverage in Child Immunization
Full immunization coverage has improved across the states in the country
Quantum of change or increase has been good in high- focus states
Jharkhand, Rajasthan and Bihar have shown very positive results while MP, UP and Chattisgarh have lagged behind
Proportion of children who received no vaccination has declined

35. Family Planning Modern CPR Method-wise CPR
Unmet Need for Family Planning
Limiting Need
Spacing Need

36. Trends in Modern Contraceptive Prevalence-Overall

37. Family Planning
Increase in CPR has been marginal in most of the states barring Rajasthan
Increase in spacing use has been witnessed in only six out of the 15 states.
States such as UP, Jharkhand, MP, Bihar, Chattisgarh, Karnataka, TN, Kerala and Pondicherry have depicted decline in spacing method use

38. Unmet Need for Family Planning-Total

39. Unmet Need for Family Planning-Limiting

40. Unmet Need for Family Planning-Spacing

41. Unmet Need for Family Planning
Pace of increase in CPR is a concern and there is still substantial unmet need for limiting and spacing
The unmet need for family planning varies considerably across the states and is particularly high in high focus states
Ranges from a minimum of 8.7% in AP to 37% in Bihar
One in four to three women in high-focus states had unmet need for family planning
Limiting and spacing needs were the highest in Bihar, UP and Jharkhand
Unmet need for limiting has increased in several states. This is a poor reflection of availability of services and service provisions especially when majority of clients depend on public health services in high focus states

42. CPR and Unmet Need for Family Planning -DLHS III

43. CPR and Unmet Need for Family Planning
States with low CPR have higher levels of unmet need and the converse is true.
Unmet need for family planning is higher than CPR in states of UP, Bihar and Jharkhand
The line graph from the intersection point on wards (refer previous slide) clearly depicts that family planning programme has not gained the needed momentum in these states
On prioritization, states of UP, Bihar and Jharkhand will have to gear up with necessary service provisions to tap the potential demand and convert latent need into real need

44. 44

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47. Program implications
Campaigns around increasing female age at marriage should be undertaken especially in high-focus states
Maternal health indicators have progressed reasonably well. ANC and institutional deliveries have increased. Yet follow-up ANC services and promotion of JSY should be continued
On the child health front, immunization coverage has improved substantially. Sustaining and further improvements through VHNDs should be aimed at
Community perceptions related to behavioural practices on initiation and exclusive breastfeeding, use of ORS and timely treatment for ARI needs reinforcement in the form of IPC and BCC.

48. Program implications
The pace of overall contraceptive change in high-focus states seems to be an area of concern. High-focus states have high unmet need for both limiting and spacing methods
Unmet need has to be addressed systematically through appropriate service provisions, sterilization camps, IPC and BCC strategies
Re-strategizing and re-focusing on family planning programme should be taken up on priority, as improvement in family planning will significant result in positive changes in maternal and child health indicators.
Infertility treatment services also required
Obstetric fistula treatment services

49. Program implications
Centrality of addressing family planning within the RCH framework should be the focus specifically in high-focus states
VHSC formation needs to be geared up
Why ANMs are staying at the SC quarter when it is available

50. Over to Concurrent Evaluation of NRHM …