National Rural Health MissionNational Rural Health Mission

Monitoring & EvaluationMonitoring & Evaluation

Dr. S.P. YadavDr. S.P. Yadav

Where we are Where we are

CBR CBR 28.3 (2006)28.3 (2006)

CDRCDR 6.9 (2006)6.9 (2006)

TFRTFR 3.2 (2005-06)3.2 (2005-06)

IMRIMR 65 NFHS (2005-06)65 NFHS (2005-06)

MMRMMR 445 (2001-2003)445 (2001-2003)

CPRCPR 46.4 (2007-08)46.4 (2007-08)Institutional Institutional DeliveriesDeliveries 55.2 (2007-08)55.2 (2007-08)

Targets of Health Indicators for 11Targets of Health Indicators for 11 thth Five year Five year plan 2007-2012plan 2007-2012

IndicatorsIndicators 2007-082007-08 2008-092008-09 2009-102009-10 2010-112010-11 2011-122011-12

CBRCBR 25.625.6 24.424.4 23.323.3 22.122.1 2121

IMRIMR 5151 4646 4141 3737 3232

MMRMMR 285285 248248 213213 180180 148148

TFRTFR 2.62.6 2.42.4 2.32.3 2.22.2 2.12.1

Inst. DeliveryInst. Delivery 6060 7171 8080 9090 100100

3 ANC 3 ANC

Check-upCheck-up6262 7171 8181 9090 100100

Health Information System Health Information System in in

RajasthanRajasthan

Key FeaturesKey Features

Among the first state to implement TFA in April, Among the first state to implement TFA in April, 1996.1996.

Implemented CNAA since April, 1999.Implemented CNAA since April, 1999. Implemented Eligible Couple Survey since 1995.Implemented Eligible Couple Survey since 1995. Village wise Annual Action Plans Village wise Annual Action Plans

(FORM-KA)(FORM-KA) Transform EC survey information into SDRs.Transform EC survey information into SDRs. Tracking of ECs as per SDR.Tracking of ECs as per SDR.

Flow of Information

Sub-center

PHC

Block CMO

District

State

Form 1 & 6

Form 2 & 7

Form 4 & 9

CHC/FRU/UFWC Form 3 & 8

Eligible Couple SurveyEligible Couple Survey Continue since 1995 in all rural and urban slums.Continue since 1995 in all rural and urban slums. EC survey updated every year in April.EC survey updated every year in April. Survey format has 44 columns.Survey format has 44 columns. Information on age, Education, youngest child, Information on age, Education, youngest child,

delivery in previous calendar year, infant/maternal delivery in previous calendar year, infant/maternal death, immunization status of child born last year, death, immunization status of child born last year, current pregnancy status, current contraceptive use, current pregnancy status, current contraceptive use, unmet need etc., collected.unmet need etc., collected.

The CBR, IMR, MMR & CPR also calculated on the The CBR, IMR, MMR & CPR also calculated on the basis of EC survey.basis of EC survey.

The information of Blindness, T. B. and Leprosy is The information of Blindness, T. B. and Leprosy is also collected during EC survey.also collected during EC survey.

Eligible Couple SurveyEligible Couple SurveySurvey supervision & MonitoringSurvey supervision & Monitoring At PHC level:At PHC level:

– LHV/SS – Physically verify 10 percent of total EC.LHV/SS – Physically verify 10 percent of total EC.– MOIC – Physically verify 5 percent of total EC verified by MOIC – Physically verify 5 percent of total EC verified by

supervisory staff. supervisory staff.– 5-5 ECs in 2 village of each sub-center.5-5 ECs in 2 village of each sub-center.

At Block level:At Block level:– Block CMO is sole responsible for timely conduct of EC survey and it’s Block CMO is sole responsible for timely conduct of EC survey and it’s

quality.quality.– Physically verify 10 % ECs in one Sub-center per PHC.Physically verify 10 % ECs in one Sub-center per PHC.

At District level:At District level:– CM&HO will ensure the timely conduct of survey & will make alternative CM&HO will ensure the timely conduct of survey & will make alternative

arrangements for vacant sub-centers.arrangements for vacant sub-centers.– RCHO, Addle/Dy CM&HO (FW) will also physically verify the survey.RCHO, Addle/Dy CM&HO (FW) will also physically verify the survey.– The statistical staff posted at district & block level will physically verify The statistical staff posted at district & block level will physically verify

and monitor the EC survey in their respective areas.and monitor the EC survey in their respective areas.

Service Delivery RegisterService Delivery Register

Service delivery records are maintained in Service delivery records are maintained in service delivery registers (SDR).service delivery registers (SDR).

Separate SDR for each village.Separate SDR for each village. Information of EC survey transformed in SDR.Information of EC survey transformed in SDR. SDR has 16 tables.SDR has 16 tables.

– Table no. 1-4 : Regarding contraceptives, current Table no. 1-4 : Regarding contraceptives, current users & unmet need.users & unmet need.

– Table no. 5 : ANC services.Table no. 5 : ANC services.– Table no. 6&7 : ImmunisationTable no. 6&7 : Immunisation– Table 8&9 : Birth & Death registration.Table 8&9 : Birth & Death registration.– Table 10-12 : Regarding diseases.Table 10-12 : Regarding diseases.– Table 13-16: Tetanus Cases, IEC activities (RTI/STI) Table 13-16: Tetanus Cases, IEC activities (RTI/STI)

& Dai traning & Dai traning

Various ReportsVarious Reports Form 1-5 : Annual Action Plan under CNAA.Form 1-5 : Annual Action Plan under CNAA. Form 6-9 : Monthly Progress Reports.Form 6-9 : Monthly Progress Reports. Form-KA : Village AAP.Form-KA : Village AAP. Weekly progress of sterilisation.Weekly progress of sterilisation. Daily report of sterilisation camps (from Oct to Daily report of sterilisation camps (from Oct to

March every year).March every year). Weekly report of sterilisation progress.Weekly report of sterilisation progress. PHC wise quarterly progress report of FW PHC wise quarterly progress report of FW

programmes.programmes. Camp wise monthly progress report of Camp wise monthly progress report of

sterilisation.sterilisation. Annual report of FW according to age, caste, Annual report of FW according to age, caste,

parity etc.,parity etc.,

Data Monitoring & ValidationData Monitoring & Validation

The Monitoring & Validation Exercise.The Monitoring & Validation Exercise. Every month exercise will be done in one district.Every month exercise will be done in one district. 20 PHCs selected in each district.20 PHCs selected in each district. The services of maternal & child health and FP will The services of maternal & child health and FP will

be validated.be validated. The services will be validated through cross check The services will be validated through cross check

by team (MO-1, LHV-1, LS of WCD).by team (MO-1, LHV-1, LS of WCD). The reported information will be verified by records The reported information will be verified by records

& physically verification.& physically verification. Availability, Accessibility, Utilisation &Coverage of Availability, Accessibility, Utilisation &Coverage of

services will be analysed.services will be analysed.

Community Based Community Based MonitoringMonitoring

Towards Ensuring TransparencyTowards Ensuring Transparency

and Public Accountabilityand Public Accountability

I: I: Self monitoring tool (SMT) and social Self monitoring tool (SMT) and social map map

II: II: people based monitoring committee people based monitoring committee

III: III: Monitoring through Gram SabhaMonitoring through Gram Sabha

IV: IV: Social AuditSocial Audit

Health Management Information System Health Management Information System (HMIS)(HMIS) ToTo establishment of computer based establishment of computer based Health Management Information System Health Management Information System in in the department to facilitate reliable and cost effective mechanism for better decision making , the department to facilitate reliable and cost effective mechanism for better decision making , monitoring , planning and implementation for effective service delivery.monitoring , planning and implementation for effective service delivery.

Current scenario• HMIS developed by NIC under EC-SIP;• System is regularly being updated;• Central Server Room established in Swasthya Bhawan;• 155 client PCs in different sections of Swasthya Bhawan ;• 15 client PCs in different sections of Secretariat;• 12 PCs for all 6 Jt. Directorates (2 each);• 104 computers for all 104 Dy. CMHO offices;• Computers for all 237 Block Health Offices.

Milestones

• The website of medical department www.rajswasthya.nic.in has been developed. The site was launched by Hon’ble Chief Minister;

• Health Information system for Government (HEALING) http://rajmedical.raj.nic.in has been developed and implemented for various application areas;

• Field level operational training to about 300 persons from all over the state and e-mail id to all CMHOs, JDs, State level Officers.

• Sub-Center monitoring system being developed, is in implementation phase;

• Financial Monitoring, Hospital Management and Personnel Information System being developed.

Health Management Information System Health Management Information System (HMIS)(HMIS)HEALING Application Areas

• Integrated Disease Surveillance Program (IDSP) ;• Malaria Monitoring;• Disease Outbreak Cases;• Cold Chain Equipments Monitoring;• Routine Immunisation Program Monitoring;• Acute Flaccid Paralysis Surveillance;• Patients Monitoring (Sanjivani camps);• Pulse Polio Campaign Monitoring;• TB Control Program Monitoring;• Sterlisation Monitoring;• Institutional Delivery Monitoring;• Drug Control Information System;• Personnel Information System;• Public Grievances Redressal;• File & Letter Monitoring;• NRHM Monitoring;• Blindness Programme Monitoring;• Office Cigma;• Rajsthan Swasthya Bima Yojna;• www.rajswasthya.nic.in• www.nrhmrajasthan.nic.in

Parameters of health careParameters of health care

AwarenessAwareness AvailableAvailable AccessibleAccessible AffordableAffordable

QualityQuality– Performance vs agreed standardsPerformance vs agreed standards

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Monitoring Outcomes of NRHMMonitoring Outcomes of NRHM

1.1. Right to HealthRight to Health– An inalienable right of all citizensAn inalienable right of all citizens– Incorporate in monitoring framework of MissionIncorporate in monitoring framework of Mission

2.2. Preparation of Household Specific Preparation of Household Specific Health CardsHealth Cards

– Record of births, deaths, illness, disease, health Record of births, deaths, illness, disease, health expenditureexpenditure

– Age/sex profile of householdAge/sex profile of household– Means of livelihood, food availability, Means of livelihood, food availability, – Food habits, alcohol consumption etcFood habits, alcohol consumption etc– Availability of health facility/providersAvailability of health facility/providers

Monitoring Outcomes of NRHM Monitoring Outcomes of NRHM (cont’d)(cont’d)

3.3. Preparation of Preparation of Habitation/Village Health Habitation/Village Health RegisterRegister

4.4. Periodic Periodic Health Facility SurveyHealth Facility Survey at SC, PHC, at SC, PHC, CHC, DHQCHC, DHQ

– Facilities availableFacilities available

– Service Guarantees Service Guarantees

5.5. Formation of Health Monitoring & Formation of Health Monitoring & Planning Committees at PHC, Block, Planning Committees at PHC, Block, District and State LevelDistrict and State Level

– Regular Monitoring of Activities at each level Regular Monitoring of Activities at each level

– Inputs for planning for local level, IDHAP, SPIP etcInputs for planning for local level, IDHAP, SPIP etc

Monitoring Outcomes of NRHM(cont’dMonitoring Outcomes of NRHM(cont’d))

6.6. Sharing of dataSharing of data at all levels – full at all levels – full

transparencytransparency

7.7. Display of agreed serviceDisplay of agreed service guarantees at guarantees at

health facilitieshealth facilities

8.8. Sample household and facility surveys Sample household and facility surveys

by by external agencies/NGOsexternal agencies/NGOs

9.9. Public ReportingPublic Reporting of household & health of household & health

facility findingsfacility findings

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Program Planning & Service Delivery

MIES System Model in NRHM/RCH II

MIES

Validation

EvaluationQuality Assessment

Monitoring

MIES

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Agreed Indicators … (1)13 Process Indicators – 6 monthly review

1. % of ANM positions filled

2. % of states and districts having full time program manager for RCH with financial and administrative powers delegated

3. % of sampled state and district program managers aware of their responsibilities

4. % of sampled state and district program managers whose performance was reviewed during the past six months

5. % of districts not having at least one month stocks of (a) Measles vaccine, (b) Oral Contraceptive Pills and (c) Gloves

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Agreed Indicators … (2)

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

6. % of districts reporting quarterly financial performance in time7. % of district plans with specific activities to reach vulnerable

communities8. % of sampled districts that were able to implement M&E

triangulation involving communities9. % of sampled outreach sessions where guidelines for AD

syringe use and safe disposal are followed10. % of sampled FRUs following agreed infection control and

health care waste disposal procedures11. % of 24 hrs PHCs conducting minimum of 10 deliveries/month12. % of upgraded FRUs offering 24 hr. emergency obstetric care

services13. % of sampled health facilities offering RTI/STI facilities as per

agreed protocols

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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)

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Agreed Indicators … (3)

5. % of 24 hrs PHCs conducting minimum of 10 deliveries/month

6. % of upgraded FRUs offering 24 hr. emergency obstetric care services

7. % of 12-23 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

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– 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

Disseminate data with analysis to all stakeholders (up & down stream)

Encourage Feedback– Reinforce with recognition/reward

Budget for M&E in the PIPs