Use of DHS Data to Influence FP/MNCH Programs & Policies: India National Family Health

SurveySheena Chhabra

Chief, Health Systems Division, USAID/India

Reconvening BangkokMarch 9, 2010

India’s National Family Health Survey (NFHS):A key data-base for promoting data-based decision-making in health • National Five Year Plans• National Population Policy• National Nutrition Policy• State Health & Population Policies• Reproductive and Child Health (RCH)-1 & -2 designs• Integrated Child Development Scheme design• National Urban Health Mission design• Development Partners PHN Strategies & Programs- USAID,

UNICEF, DFID, World Bank, UNFPA, EC, etc.• Designing & tracking program progress• Monitoring MDGs

NFHS data were instrumental in revitalizing routine immunization

Percentage of children age 12-23 months

30

6254

42

52

14

72

63

5155

5

78 78

5955

0

20

40

60

80

100

None BCG Polio3 Measles DPT3

NFHS-1 NFHS-2 NFHS-3

Key Findings• Immunization coverage

stagnant for DPT• Health system is reaching

vast majority of children at least once

• Substantial decrease in full vaccination coverage among children in better-performing states

Response• Strategies for Routine

Immunization• Community mobilization

through Village Health & Nutrition Days

• Improved program monitoring

DPT 1: 76%DPT 2: 67%DPT 3: 55%

NFHS reiterated the need to focus on proven & simple child health interventionsKey findings• Basic package of child

health services is not being delivered– Stagnant ORS use– 69% of the children with ARI

symptoms sought treatment

Response• Newborn & Child Health

Policy• Strategies for home-based

as well as institutional care

33 3325 24

0

20

40

60

80

100

Urban Rural

NFHS-2 NFHS-3

Percentage of children age with diarrhoea in the past 2 weeks

RCH-2

51

4543

40

2023

0

10

20

30

40

50

60

Stunted Underweight Wasted

NFHS-2 NFHS-3

Percent

NFHS highlighted the need for focused attention on malnutrition

Key Findings• No significant

improvements in nutrition status among children under age 3.

• Anemia among children age 6-35 months has increased over the past 7 years.

Response• Prime Minister’s letter to

Chief Minister urging action to address malnutrition especially among children under six.

• Establishment of the Coalition for Sustainable Nutrition Security in India under chairmanship of Prof. M.S Swaminathan.

Key Findings• Only a third of the

eligible children receive any service from an Anganwadi Centre (AWC) under the ICDS

Response• Strategic shift in the

design of Integrated Child Development Services Scheme (ICDS)-3

33

2623

2018

16

0

10

20

30

40

50

60

70

80

Any se

rvice

Supp

lem

entary

food

Pre-sc

hool

Imm

unizations

Gro

wth m

onito

ring

Health

chec

k-up

s

Percent of age-eligible children in areas with an AWC

NFHS-3 informed programs for improving nutritional status

NFHS data influenced design of JSYJanani Suraksha Yojana

• NFHS data helped in improving program focus on coverage and quality of antenatal care & institutional deliveries.

• National Maternity Benefit Scheme modified (JSY) from nutrition-improving scheme to one of addressing all aspects of maternal health.

• Janani Suraksha Yojana designed for promoting institutional deliveries.

Report on the Working Group on Health of Women & Children for the 11th 5 year plan (2007-2012)

NFHS data helped improve focus on birth spacingKey Findings• Contraceptive use increased

steadily with vast majority continuing to rely on female sterilization.

• Some gains in modern spacing method use but use of IUDs remained static.

Response• Shift of the family welfare

program to target-free approach.

• Strategy for repositioning IUDs.

• Enhanced commitment to expand basket of contraceptive methods.

• Standard Days method introduced in National program.

41

37

27

42

12

48

43

34

2 2 3

56

49

37

12

5

23

Any method Any modernmethod

Femalesterilization

Malesterilization

IUD Pill Condom

NFHS-1 NFHS-2 NFHS-3

Percent of currently married women age 15-49

NFHS data helped to evolve strategies for healthy timing and spacing of births

72

56

50

77

80

62

47

64

37

30

50

86

0 10 20 30 40 50 60 70 80 90 100

40-4930-3920-29

< 20MOTHER'S AGE AT BIRTH

7 or more 4-6 2-3

1BIRTH ORDER

4 years or more3 years2 years

< 2 yearsPREVIOUS BIRTH INTERVAL

Deaths in the first year of life per 1000 live births

NFHS-3 helped devise appropriate strategies for vulnerable population groupsKey Findings• Health conditions of urban

poor are similar to or worse than rural population and far worse than urban averages.

• 27% of teenage women and 21% of women age 20-24 have unmet need for family planning.

• Child mortality rate is 61% higher for girls than for boys.

• Two in five currently married women age 15-49 have ever experienced spousal violence in their current marriage.

Response• Design of the draft National

Urban Health Mission highlighting need for programming resources for urban poor.

• Adolescent Reproductive and Sexual Health Strategy (ARSH).

• Improved commitment for gender programming including gender-based budgeting.

• Inputs for the Domestic Violence Act 2005.

Top Guns High Achievers Movers and Shakers

Promising

GoaKeralaSikkim

UttaranchalHimachal PradeshKarnatakaMaharashtraTamil NaduManipur

ChhattisgarhMadhya PradeshOrissaAndhra PradeshGujaratHaryanaJammu & KashmirPunjabWest BengalMeghalayaMizoram, Tripura

BiharJharkhandRajasthanUttar PradeshArunachal PradeshAssamNagaland

NFHS-3 Key Data Source for RCH-2 Performance Review of States

Source: RCH-2 – Program Management Support Group (PMSG), Donor Coordination Division

Segmentation of States based on RCH-2 Performance

Key Learnings

• Government stewardship essential from design stage

• Involve various government departments on Steering & Technical Committees

• Widen ownership by engaging multiple stakeholders early on

• Provide adequate funding• Build various data quality checks

…Key Learnings

• Provide world-class technical assistance• Engage premier local institutions• Anticipate barriers for acceptance of data and plan

appropriately• Disseminate data widely at all levels

– 2 National & 29 State NFHS-3 fact-sheets– National and 29 state reports – 27 dissemination seminars at national and state level– 4 subject reports & 5 subject factsheets– Estimated 2000 media reports including over 500 wholly or

largely based on NFHS-3 results– 124 peer-reviewed journals using NFHS data

• Make data-sets available in public domain (wwwnfhsindia.org)