1. Nutrition Surveillance System (NSS) in ICDS

2. The need for Nutrition Surveillance in ICDS

3. Reduction of malnutrition in India between 1998-99(NFHS-2) and 2005-06 (NFHS-3)

4. INDIA NFHS-3 2005-06) NFHS-2 1998-99) % of Underweight Children (0-3 years) Less than 30% 30% - 40% More than 40% 21.7 15.5 (35.3) 18.8 20.1 19.8 Tripura (37.3) (28.6) 21.3 53.2 52.2 51.5 50.8 50.3 48.1 46.7 45.3 44.8 41.6 38.6 34.2 31.5 24.7 36.5 36.3 29.2 (21.5) 21.2 17.3 35.8 23.7 19.5 14.2 Tripura (35.2) 42.9 21.3 47.8 54.9 54.6) 57.9 39.5 41.6 36.8 37.6 32.7 41.6 33.3 29.8 25.9 27 31.1 31.7 24.0 29.7

5. NFHS-3 results on the Nutritional Status of children have some surprises in store for the discerning observer. Chart indicates that the reduction in incidence of malnutrition underweight) on an all–India basis was hardly about 2.3% between NFHS-2 (1998-99) and NFHS-3 (2005-06), while in Tripura, the same was 2.1% % reduction in malnutrition between NFHS-2 and NFHS-3

6. During the same period, the states which focused to expose malnutrition, the silent killer, reduced malnutrition by highest percentage. The reduction was as high as 12.1% in Maharashtra followed by 10.2 % in Orissa. Both the states had adopted strategies to tackle malnutrition after nutrition surveillance revealed pockets of high malnutrition. Reduction Rate %) 2.3% 12.1% 10.2% Percentage of under-3 yrs. underweight children % reduction in malnutrition between NFHS-2 and NFHS-3

7. NFHS-3 (2005-06) revealed that more than 40% children of India are malnourished Regular ICDS Monthly Progress Report MPR) gave no indication of this scenario

8. Existing ICDS monitoring system Data Flow in ICDS

9. Data Capture and Data Flow for Process Monitoring

10. Data captured at AWC level

11. Data once again manually compiled at Supervisor level for individual AWC

12. Supervisor’s compilation report for a Sector

13. Project level compilation.. The data is further compiled in the MPR forms in 5 copies manually within a very short time span of (5-7days) by the CDPO office staff or Supervisor and flows to the higher levels. CDPO’s compiled report for a Project.

14. Limitation of the System  A lot of time is wasted in capturing the data at AWC level and then again at Supervisor level manually and thereby incurring huge Paper works and considerable man-hours.  Pockets of malnutrition within an ICDS Project remain un-seen.  Severely malnourished children, needing urgent therapeutic intervention are sometimes left unattended by health care system.  In the present system current month's data can't be compared with the previous months' figures. So, progress cannot be measured.  Chances of error increase as the compilation is done within a very short time span.  Many valuable information is lost as the data is collated at Project level.

15. Loss of valuable Data…

16. Sector Supervisor) Child Population …. Anganwadi Centers AWW) Below 6 mnths (Male & Female) 6mnths – 1 yr (Male & Female) 1 yr – 2 yrs (Male & Female) 2 yrs – 3 yrs (Male & Female) 3 yrs – 4yrs (Male & Female) 4 yrs – 5 yrs (Male & Female) 5 yrs – 6 yrs (Male & Female) Below 6 mnths (Male & Female) 6mnths – 1 yr (Male & Female) 1 yr – 3 yrs (Male & Female) 3 yrs – 6 yrs (Male & Female) Project CDPO) Below 6 mnths 6mnths – 1 yr 1 yr – 3 yrs 3 yrs – 6 yrs Government of India (Format-II) 0 - 6 yrs MPR Data lost ………… as it moves up

17. West Tripura Initiative..

18.  AWC level data capturing from 1771 rural/tribal/urban AWCs of the State.  The data has started revealing pockets of malnutrition along with age/sex break-up, this is leading to focussed intervention by the functionaries and communities. West Tripura Initiative..

19. Activities completed… Design and development of NSS version 1.0 with old GoI MPR by Riddhi Training of CDPOs and Supervisors on above system Design and development of NSS version 2.0 with new GoI MPR by Riddhi Training of CDPOs and Supervisors on above system Data Entry by CDPOs in the new system

20. What AWC level Data reveals ?

21. Nutrition Surveillance System West Tripura www.westtripura.nutritiongis.org

25. District level MPR

26. Nutritional Status of children out of children weighed)

27. GoI 78 column Report Generation

28. Generates monthly report for submitting to GoI

29. All AWCs are visible in the web

31. Data Analysis Graphical Spatial

32. Project wise Percentage Normal Children (May 2013)

33. Project wise Percentage Moderate Underweight Children (May 2013)

34. Project wise Percentage Severe Underweight Children (May 2013)

35. Motivated functionaries have taken charge of the new system Spatial Analysis

36. District map showing ICDS projects Mohanpur Hezamara Mandwih Agartala-II Dukli Jirania

37. District map showing 1771 Anganwadi Centres Individual AWCs are now visible along with nutritional status of children

38. %age of moderately underweight children (0-5 yrs.), May, 2013 Less than 15% Between 15% to 20% Above 20% Mohanpur 16.4) Hezamara 17.3) Mandwih 16.8) Agartala-II 11.3) Agartala-II13) Dukli 20.45) Jirania Data yet to be received)

39. Mohanpur 0.09) Hezamara 0) Mandwih 0.46) Agartala-II 0) Agartala-II0.08) Dukli 2.83) Jirania Data yet to be received) 0% Between 0% to 1% Above 1% %age of severely underweight children (0-5 yrs.), May, 2013 Disaggregated data analysis through Project level system

40. ICDS Project : Mandwih, West Tripura

41. Project Mandwih: Dashboard on AWC reporting status

42. Project Mandwih showing Anganwadi Centres

43. AWCs having more than 5 moderately underweight children (0-5 yrs.) Pockets of malnutrition are now visible

44. AWCs having 1 or more severely underweight children (0-5 yrs.) Severely underweight children are now visible through the system Focused action plan will now lead to rapid reduction of malnutrition Immediate Action

45. Tracking every child by name for Scaling Up Nutrition (SUN) 2 nd phase of Nutrition Surveillance:

46. The Janani initiative: 1000 Days Care for every child (-9 months to 2 years of age)

47. Improper care during first 1,000 days -9 months to 2 years) of the child i.e. the period from pregnancy upto a child’s 2 years after birth, leads to... High morbidity, Stunting and Poor Survival Why?

48. Addressing needs of mothers/children necessitates an innovative approach that calls for convergence and collaboration of different departments, as well as community awareness. A look at one such initiative..

49. “e-Janani” A Mother-Child Dyad Care Initiative by the Government of Tripura

50. e-Janani A combination of Mobile Telephony and Server based computer programMandwih

51. Real Time Tracking of all Pregnant Mothers and Children Bringing Focus to those at RISK

52. Registration Delivery PNC ANC 1 ANC 2 ANC 3 ANC 4 ANC 5 From Registration to Delivery 110 data fields are collected for a mother over a period of 1 year Proper capturing, storing and timely access to this information can save many lives

53. Helping frontline health workers MPWs and Anganwadi workers) to deliver timely and quality services to pregnant Women and children e-Janani e-Janani helps in converging H & FW and ICDS initiatives

54. Data flow from MPWs

55. Data flow system in Health

56. Voice Data capturing by MPWs of Mandwih Block

57. Data flow from AWWs

58. AWC Register Entry by Worker Monthly data entry from CDPO office to NIC Server Server at NICServer at Riddhi Analysis of Health & ICDS Data Data flow system in ICDS

59. Converging data through e-Janani

61. Activities completed… Design and development of new format for Health and ICDS data capturing Survey and geo-referencing of Health & ICDS facilities by Riddhi Development of data entry system for Health & ICDS by NIC Procurement and distribution of Android mobile phone to ANMs by H&FW Installation and training on real time mobile application by Riddhi Training of data transcriber at PHC level by Riddhi Development of online analysis tool by Riddhi Linkage between mother-child and health & ICDS  

62. Analysis of Data received so far…. Common linking field (e-RoR) is being worked out by individual departments. Till that time, instead of COHORT tracking, individual mother and child tracking has already started Analysis on following dataset: Mother’s data received from Health System Child’s data received from Health System Pregnant Mother’s data received from ICDS System Pregnant Mother’s data received from ICDS System Nursing Mother’s data received from ICDS System Nursing Mother’s data received from ICDS System Child’s data received from ICDS System

63. Data received from NIC’s server As on 5 th July 2013

64. Dashboard analysis of Mother’s ANC in Mandwih Block as on 5 th July 2013 ANC 1 ANC 2 Services in timeServices AwaitedServices delayed or not taken

65. Mother CodeMother's namePHC NameSub Center NameDate Range 160100300311300004Babita DebbarmaBorakha PHCPatni Sub-centre)03-01-2013 - 27-03-2013 160100300511300010Sabita DebbarmaBorakha PHCRajchantai Sub-centre)07-02-2013 - 01-05-2013 160100300811300001 Swarnalaxmi Debbarma Mandai PHCAshigarsh Sub-centre)03-06-2012 - 25-08-2012 160100301011300009Rebika DebbarmmaMandai PHCBrigudas Bari Sub-centre)30-12-2012 - 23-03-2013 160100301011300013Kalpana Rupini Saha)Mandai PHCBrigudas Bari Sub-centre)05-11-2012 - 27-01-2013 160100301211300003Malani DebbarmaMandai PHCLaxmipur Sub-centre)14-12-2012 - 07-03-2013 160100301211300007Dipali DebbarmmaMandai PHCLaxmipur Sub-centre)12-02-2013 - 06-05-2013 160100301211300008 Biswarani Debbarmma Mandai PHCLaxmipur Sub-centre)28-12-2012 - 21-03-2013 160100301711300013Pratima DebbarmaBorakha PHCKathiram Sub-centre)18-01-2013 - 11-04-2013 160100301811300002Namita DebbarmaBorakha PHCBinankobra Sub-centre)04-02-2013 - 28-04-2013 160100301811300005Anjana DebbarmaBorakha PHCBinankobra Sub-centre)08-01-2013 - 01-04-2013 160100301911300003Khajani DebbarmaBorakha PHCBorakha MCH Sub-centre)16-12-2012 - 09-03-2013 List of 12 Mothers who missed their second ANC

66. Dashboard analysis of individual Mothers of Mandwih Sub Centre Total Mothers: 40 mothers Suchitra Debbarma

67. Suchitra Debbarma’s dashboard showing delayed ANCs High-Risk Factor

68. MCISID IDChild Name BCG Status Polio 0 Status Hep B1 Dose DPT 1st Dose Polio 1st Dose HepB1 Dose DPT 2 Dose Polio 2 Dose 1601002102120013Sunita Debbarma 1601002102120014Sanjoy Debbarma 1601002102120029Sunita Debbarma 1601002102120030Sanjoy Debbarma 160100300621300004Anjuman Aktar 160100300621300005Tanbir Ahammad 160100300621300006Imran Hussain 160100301721200283kuhina Debbarma 160100301821300001Pitor Debbarma 160100301821300005Kokthai Debbarma Dashboard analysis of individual child on Immunization Wakhinagar Sub Centre Services in timeServices AwaitedServices delayed or not taken

69. ALERTALARM Sl. No Mother IdMother NameANC 2ANC 3 Expected Delivery Date Address 1160100300711300001Baijanti Debbarma 01-04-2013 - 23-06-2013 24-06-2013 - 15-09-2013 10-10-2013Mandai 2160100300711300002Sumita Debbarma 03-02-2013 - 27-04-2013 28-04-2013 - 20-07-2013 14-08-2013Baludhum Para 3160100300711300003Lucy Debbarma 20-03-2013 - 11-06-2013 12-06-2013 - 03-09-2013 28-09-2013Nakshirai Para 4160100300711300004Lilata Debbarma 18-02-2013 - 12-05-2013 13-05-2013 - 04-08-2013 29-08-2013Deb Charan Para 5160100300711300005Reshmi Debbarma 15-04-2013 - 07-07-2013 24-10-2013Mandai 6160100300711300006Patal Debbarma 27-02-2013 - 21-05-2013 22-05-2013 - 13-08-2013 07-09-2013Mandai Work Plan List of services fall due from 1-7-2013 to 8-7-2013 Mandwih Sub-Centre

70. Analysis on Mother’s age registered in MCTS

71. Analysis on Delivery Place

72. Child’s data received from ICDS System

73. Analysis on Gender wise number of Children

74. Analysis on Birth Weight of Children

75. Analysis on Nutrition Status of Children ICDS Data as on May 2013

76. Borakha 5) Mandainagar 17) Kai Rai 3) Vrigudasbari 2) Gram Panchayats having Severe Malnourished children May 2013

77. Analysis on Disability observed in the children

78. Thank You