1. Reporting, Monitoring and Review mechanism for Anemia Mukt Bharat
Dr Sila Deb
DC, Child Health
Ministry of Health and Family Welfare

2. Presentation outlines
Monitoring domains
Digitalized monitoring process for AMB
- HMIS data reporting process
- Quarterly Progress Report (QPR)
- Key Performance Indicators (KPIs)
Strengthening existing review mechanisms for AMB
AMB monitoring under Poshan Abhiyaan

3. Time-bound reporting, monitoring and review mechanism
Robust reporting, monitoring and review mechanism for effective implementation and success of AMB
Time-bound reporting, monitoring and review mechanism
Accuracy and completeness of data reporting for effective AMB strategy implementation

4. Monitoring Domains IFA supplementation across the age groups
IFA Stock availability
Compliance and capacity building - by NCEAR-A
Activities w.r.t. Non- nutritional causes of anemia in Endemic pockets
IEC/ BCC activities

5. Digitalised Monitoring Process for AMB
26 existing HMIS indicators pertaining to anemia are identified to capture data for Quarterly AMB Performance Report Card
12 new indicators proposed to be included in HMIS
6 Key Performance Indicators (KPI) for Score Card (generated by Dashboard)
Awards for best 3 performing States – annually – Score Card based ranking
No manual reporting for Monthly Progress Report (e.g. WIFS MPR)

6. HMIS data elements identified for AMB
Data elements for IFA supplementation to children and adoloscents
HMIS Code
Description
9.9
Number of children (6-59 months) provided 8-10 doses (1ml) of IFA syrup (Bi weekly) a
Girls (6th -12th class) provided 4 IFA tablets in schools b
Boys (6th -12th class) provided 4 IFA tablets in schools
22.1.3
Number of out-of-school adolescent girls (10-19 years) provided 4 IFA tablets at Anganwadi Centres
23.1
Number of children covered under RKSK JUNIOR ( years ) provided 4-5 IFA tablets in schools
23.3
Number of out-of-school children (6-10 years) given 4-5 IFA tablets at Anganwadi Centres

7. HMIS data elements identified for AMB
Data elements related to Pregnant Women
HMIS Code
Description
1.1
Total number of pregnant women registered for ANC
1.2.4
Number of PW given 180 Iron Folic Acid (IFA) tablets
1.4.2
Number of PW having Hb level<11 (tested cases)(7.1 to 10.9)
1.4.3
Number of PW having Hb level<7 (tested cases)
1.4.4
Number of PW having severe anaemia (Hb<7) treated
6.3
Number of mothers provided full course of 180 IFA tablets after delivery

8. HMIS data elements identified for AMB
Data elements related to stock status
HMIS Code
Description
19.6
Total Stock of IFA tablets ( Adult)
19.7
Total Stock of IFA - Blue ( Adolescent yrs)
19.8
Total Stock of IFA- Pink ( Junior 6-10 yrs)
19.9
Total Stock of IFA Syrup (Paediatric)

9. List of New Indicators Proposed in HMIS for AMB
School-going male years, who were screened for anemia (Under RBSK program)
School-going male years who are severely anemic (Under RBSK program)
School-going male years who are severely anemic and received treatment (Under RBSK program)
School-going female years, who were screened for anemia (Under RBSK program)
School-going female years who are severely anemic (Under RBSK program)
School-going female years who are severely anemic and received treatment (Under RBSK program)
Schools, where monthly Nutrition Health Education sessions held against planned (Under RKSK program)
Number of women of reproductive age (WRA) years, provided 4 iron and folic acid (IFA) tablets (Under Mission Parivar Vikas).
Women of reproductive age (WRA) years, provided albendazole (Under Mission Parivar Vikas)
Eligible beneficiaries provided with long lasting /insecticide treated bednets (Only for malaria endemic geographies)
Nutrition Health Education sessions planned in AWCs the reporting month (under MAA programme)
Stock of LLIN/ITNs

10. Current Issues in HMIS Data Reporting

11. Challenges in Data reporting on HMIS
Huge quantity of IFA supplements lying unusable in State/ UT stores
HMIS proper data entry and validation of data is imperative for quality data reporting
Letter from JS (RCH)

12. Field validation of AMB data during regular field visits by AMB nodal persons
AMB nodal persons to develop complete understanding of HMIS data elements used for AMB QPR including the source of data
During field visits HMIS data can be validated with appropriate data source available in field

13. Examples

14. HMIS : 9.9 Children (6-59 months) provided 8-10 doses (1ml) of IFA syrup (Bi weekly)
Definition: Total number of children, aged 6-59 months, who were given 8-10 doses of IFA syrup during the reporting month.
Guideline: As per national guidelines, children aged 6-59 months should be given one ml of IFA syrup containing 20 mg of elemental iron and 100 mcg of folic acid biweekly for 100 doses in a year. Those children who were given biweekly dose of IFA syrup for all weeks in the reporting month should be reported.
Source: RCH Register
Data Collection Formats: SC/PHC

15. HMIS 1.2.4: Number of mothers provided full course of 180 IFA tablets after delivery
Definition: Total number of mothers who were given 180 IFA tablets (equivalent to 60 mg of elemental iron and 0.5 mg of folic acid per tablet daily) during the reporting month.
Guideline: The number of mothers who were given 180 IFA tablets are to be reported and NOT the number of IFA tablets. If the number of IFA tablets given to a mother is less than 180, then she should not be reported till she is given 180th tablet. If more than 180 IFA tablets are given to any mother, she should be counted when she had received 180 IFA tablets and should not be counted for extra tablets given to her.
Any person other than woman (who has recently delivered) given IFA tablets should not be counted here.
Data Source –Pregnancy Register/Post natal Register
Formats: SC/PHC/CHC/SDH/DH

16. Fixation of Denominator for Target based monitoring
State/UT-wise as well as district-wise targets are to be fixed before hand for monitoring coverage of each beneficiary age-group
Targets will be updated annually as per the target beneficiary numbers provided by States/UTs

17. Annual Target Fixation for Reporting under AMB
Fixation of Service denominator:
By the district - district-wise targets (census) for the beneficiary groups
Validation of target– by WCD (Out-of-School) and Dept of Education
Data flow for denominator- from district - to State - to MoHFW –at the beginning of FY (in PIP)
Annual Drug Requirement:
IFA Syrup
IFA Tablets – Red, Blue, Pink

18. Quarterly Progress Report (QPR) calculation
Example for HMIS calculation
Jan 18
Feb 18
Mar 18
Total quarter
Numerator (HMIS 9.9) 40 25 90
Denominator
100
300
Quarterly progress Report
(QPR)
(Jan+Feb+Mar-18 numerator) x 100
Target x 3
(i.e. ( )/100*3=90/300=30 %

19. Data monitoring and review for AMB
The process flow:
Informed decision for necessary action to strengthen
AMB strategies
HMIS reporting of data elements for AMB
(Anemia status for PW, IFA supplementation and IFA stock status)
Review of
Key Performance Indicators- Score Card generation
Data pulled to AMB dashboard
Quarterly Progress Report QPR
AMB Dashboard

20. Key Performance Indicators of AMB
The quarterly report card will be prepared using data reported for the HMIS data elements for AMB
The report card will assess the progress as the percentage coverage against eligible denominators and performance will be monitored based on the coverage review
Out of the identified indicators of the quarterly report card,
Key Performance Indicators (KPIs) are identified in order to monitor and rank the States and districts based on their performance on a quarterly basis

21. Key performance indicators for AMB Key performance indicators
Percentage of children 6-59 months who received at least 8 doses of IFA syrup (HMIS 9.9)
Percentage of school children 5-9 years who received at least 4 pink IFA tablets (HMIS 23.1)
Percentage of school-going adolescents years (girls and boys), eligible under RKSK programme, who received at least 4 blue IFA tablet (HMIS )
Percentage of women of reproductive age years, eligible under Mission Parivar Vikas, who received at least 4 red IFA tablet (will be reported later)
Percentage of eligible pregnant women who received at least 180 IFA tablets during antenatal contact point (HMIS 1.2.4)
Percentage of States/districts with available of adequate stocks of IFA for all age groups (dash board)

22. Monitoring of IEC/ BCC activities for AMB
AMB nodal officers to carry out periodic monitoring of budget utilization for IEC / BCC activities for AMB activities
Compilation of Key IEC/ BCC activities undertaken for AMB
Total budget available for all IEC/ BCC activities for AMB in FY
Total budget utilized for all IEC/ BCC activities for AMB in FY
Analysis of IEC budget utilization

23. Implemenation Research by National Centre of Excellence and Advanced Research (NCEAR)
The National Centre of Excellence and Advanced Research on Anemia Control (NCEAR-A) will support MoHFW in monitoring through annual rapid assessments of the strategy at the field level
Implemenation research to understand community uptake of interventions under AMB

24. Monitoring of Non nutritional causes of Anemia
AMB strategies include intensifying awareness, screening and treatment of non-nutritional causes of anemia in endemic pockets, with special focus on malaria, fluorosis and hemoglobinopathies
State / district nodal person for AMB to coordinate with the NVBDCP, NPPCF officials and officials in-charge of management of blood disorder (hemo-globinopathies) for status of malaria and fluorosis prevention and management of hemo-globinopathy cases
AMB unit at National level carry out monitoring for status of implemenation of programmes related to non nutritional causes of anemia
Note: In AMB guidelines Annexure 5 list of States / Districts under National Programme for Prevention and Control of Fluorosis (NPPCF) has been provided

25. Existing review mechanisms to be geared up for AMB review
The existing review mechanisms at district/state/national levels through common review missions, integrated joint monitoring visits, quarterly/biannual reviews at District Magistrate (DM)/ Mission Director (MD) level should integrate the KPIs for monitoring the progress of implementation of Anemia Mukt Bharat

26. Review under POSHAN Abhiyaan
Specific targets for anaemia reduction has been set under Poshan Abhiyaan:
Reduce anaemia among young children (6-59 months), adolescent girls and young women in the age group years by 3% per annum – by 2020
AMB performance to be reported in the six monthly Poshan Abhiyaan review report submitted by MoHFW as a part of periodic review by NITI Aayog
Review mechanisms envisaged under the POSHAN Abhiyaan should also be effectively utilized for reviewing the implementation of Anemia Mukt Bharat strategy

27. Six institutional mechanisms

28. AMB Dashboard
National Coordinator
State Focal Point

29. THANK YOU