Data Driven Decision Making in Ministry of Health and Family Welfare

Dr Vishnu Kant Srivastava CD (Stat) Health & Family Welfare

DATA DRIVEN DECISION MAKING IN

HEALTH & FAMILY WELFARE

Ministry of Health and Family Welfare

DATASET CONTRIBUTED BY THE MINISTRY OF HEALTH AND FAMILY WELFARE

OPEN GOVERNMENT DATA (OGD) PLATFORM INDIA (data.gov.in)

Resource(Data set)

Resource(App)

Total Resources

Total catalogs

Ministry of H&FW 3155 0 3155 201

Deptt. of H&FW 3141 0 3141 187

NIHFW 4 0 4 2Deptt. of AIDS Control

10 0 10 10

AYUSH 4 0 4 4

Note: Data from NIHFW, NACO and Ayush are uploaded by the contributors/controllers of these Departments


DEPTT. PUBLICATIONS:

- HEALTH AND FAMILY WELFARE STATISTICS IN INDIA

- RURAL HEALTH STATISTICS IN INDIA

SURVEY DATA

- NATIONAL FAMILY HEALTH SURVEY

- DISTRICT LEVEL HOUSEHOLD SURVEY

- ANNUAL HEALTH SURVEY

HEALTH MANAGEMENT INFORMATION SYSTEM (HMIS)

- SERVICE STATISTICS AT FACILITY LEVEL UPLOADED BY THE STATES/UTs

KEY INDICATORS FROM CENSUS AND SAMPLE REGISTRATION SYSTEM

- POPULATION BY SEX, REGION, CRUDE BIRTH RATE, INFANT MORTALITY RATE, NEO- NATAL MORTALITY RATE, UNDER 5 MORTALITY RATE, MATERNAL MORTALITY

RATIO(MMR) etc.

DETAILS OF DATA UPLOADED IN THE PORTAL by the Deptt. of H&FW


.Data disseminated by the ORGI, surveys, HMIS are used by the MoHFW to know the :

• Estimated number of pregnant women, live births, number of infant for immunisation activities in different States and UTs;

• To assess district-wise need to know the pregnant women, live births and infant for immunisation activities, service delivery;

• To estimate number of infant deaths, under 5 deaths and maternal deaths to assess the goals to be achieved under Millennium Development Goals (MDG) and Sustainable Development Goals (SDG) which would be monitored from 2017 to 2030;

• Data provides valuable input to know the status of different indicators of Maternal Health e.g. Institutional Delivery, Safe Delivery, ANC, nutritional status, anaemia, Child Health Indicators viz status of full immunization, nutritional status, anemia and current use of family planning methods, unmet needs for family planning

Uses of data


Annual Health Survey

o Conceived at the behest of the National Commission on Population, PMO and Planning Commission

Objectiveo Providing benchmarks of core vital and health indicators at the

district level and map its change on a continual basis to assess the efficacy of various health interventions under National Health Mission.

o Implemented through the ORGI in 284 districts of 8 EAG States and Assam


Geographical Coverage : Annual Health Survey

OdishaChhattisgarh

J harkhandMadhya Pradesh

BiharAssamRajasthan Uttar Pradesh

Uttarakhand


NEED FOR AHS

o 9 AHS States namely, Rajasthan, Uttar Pradesh, Uttarakhand, Bihar, Jharkhand, Odisha, Madhya Pradesh, Chhattisgarh and Assam constitute:

• 50 percent of country’s Population• 60 percent of Births• 71 percent of Infant Deaths• 72 percent of Under 5 Deaths• 62 percent of Maternal Deaths

There is large inter-district variations in these States. In the absence of District level vital data, State level

estimates from Sample Registration System (SRS) are used for formulating district level plans.


Annual Health Survey Contd…

o Baseline during 2010-11 and first updation round in 2011-12 and second updation round in 2012-13.

o A component on Clinical Anthropometric and Biochemical (CAB) tests to cover height / length & weight, test for anaemia and fasting blood glucose, blood pressure and salt testing to assess the level of iodine in salt consumed by households.

o The survey is funded by MoHFW


Subject CoverageFollowing broad areas are covered under AHS:

Childhood Disease

Birth Registration

Breastfeeding & Supplementation

Awareness in Mothers

Abortion

Family Planning Practices

Disability

Morbidity

Personal Habits: adults

Housing & HH Characteristics


AHS Contd…

KEY FEATURES

Coverage- All the 284 districts of 8 EAG States and Assam.

Sample Units- 20,694 statistically selected sample unit (Census Enumeration Blocks in urban areas and Villages or a part thereof in rural areas)

Sample Identification Work- to uniquely identify the sample units on ground, firm up its boundaries, demarcate the localities and prepare a notional map of the sample unit was done by the staff of ORGI.


KEY FEATURES Conduct of Field Work - hybrid approach wherein fieldwork has

been outsourced and supervision is being done by the ORGI.

Primary Level of Aggregation – District

Periodicity- Annual for 3 years

AHS Contd…


Results

State level Bulletins of all the three rounds containing the district level vital indicators viz. Crude Birth Rate, Crude Death Rate ,Infant Mortality Rate ,Neo-Natal Mortality Rate ,Under Five Mortality Rate ,Maternal Mortality Ratio ,Sex Ratio at Birth ,Sex Ratio(0-4 Years) ,Sex Ratio(All Ages) were released in 2011, 2013 and 2014.

District level fact sheets of all the three rounds containing different indicators on fertility, Mother and child care, Family planning practices , Mortality, disability ,marriage etc. also released

The survey work of CAB component has been completed and the results are available in the form of factsheets

AHS Contd…


National Family and Health Survey (NFHS)NFHS is a large scale nationally represented survey conducted during

1992-93, 1998-99 and 2005-06 and provides state and national level estimates

Information on fertility, family planning, morbidity, infant and child mortality, maternal and child health, utilization of health services, and nutrition with an emphasis on women and young children are available

Mortality:-

• Neonatal, Post natal ,IMR, CMR, Under-5 mortality

Fertility:-

• CBR, ASFR,TFR, Birth order

NFHS (2005-06) also provides population based HIV estimates for six states and provides estimates on a host of social and economic indicators as well


NFHS-4 as an Integrated Survey

• NFHS and DLHS were conducted with a time gap of 4 – 7 years.

• In spite of having different sample size, different reference period and definition for some of the indicators included in these surveys, people /media tend to compare the results of NFHS and DLHS, leading to different conclusions.

• To avoid / mitigate the problem and to facilitate regular availability of data to assess and monitor performance at more closer interval, the Ministry has decided to conduct one integrated survey in place of different surveys to provide data at the district level and to be named as National Family Health Survey (NFHS).


NFHS-4 Highlights

Coverage of all States/ UTs in two phases.

The first phase covers (17 States / Regions)- Andhra Pradesh & Telangana, Assam, Bihar, Goa, Haryana, Karnataka, Madhya Pradesh (East), Madhya Pradesh (West), Maharashtra, Manipur, Meghalaya, Sikkim, Tamil Nadu, Tripura, Uttar Pradesh (East), Uttarakhand, West Bengal, Andaman & Nicobar Islands and Puducherry.

The second phase will cover (15 States / Regions) - Arunachal Pradesh, Chhattisgarh, Gujarat, Himachal Pradesh, Jharkhand, Jammu & Kashmir, Kerala, Mizoram, Nagaland, Odisha, Punjab, Rajasthan, Uttar Pradesh (Bundelkhand + Central), Uttar Pradesh (West), Chandigarh, Dadra & Nagar Haveli, Daman& Diu, Lakshadweep and NCT of Delhi.

Sample Size under NFHSNFHS Ever-married

women Households

NFHS(1992-93) 89777 (age 13-49) 88562

NFHS(1998-99) 90000 (age 15-49) 91196

NFHS(2005-06) 1,24,385(UM- age 15-24)(M- age 15-49)

109,041

NFHS-4 625,014 women (estimated)

568,200 (estimated)

Levels of Information 1. National 2. State 3. Socio-economic and demographic background


• IIPS (INDIAN INSTITUTE OF POPULATION SCIENCES IS THE NODAL AGENCY

• The periodicity of the survey was 5 – 6 years. Four rounds conducted in 2012-13, 2007-08 (7,20,320 Households), 2002-04, and 1998-99;

• National, State and district level estimates on health and nutrition, performance of reproductive and child health programmes etc. information are made available in these surveys

• The fourth round of District Level Household Survey (2012-13) has since been completed, factsheets containing important indicators for 21 States / UTs (Andhra Pradesh, Arunachal Pradesh, Goa, Haryana, Himachal Pradesh, Karnataka, Kerala, Maharashtra, Manipur, Meghalaya, Mizoram, Nagaland, Punjab, Sikkim, Tamil Nadu, Telangana, Tripura, West Bengal, Andaman and Nicobar Islands, Chandigarh and Puducherry) and 18 State Reports are available on the website of the Ministry “nrhm-mis.nic.in”. Reports of the ‘‘Facility Survey’ component of DLHS-4, for 9 States, is also available and to be uploaded on Ministry’s web site shortly

DISTRICT LEVEL HOUSEHOLD AND FACILITY SURVEY (DLHS)

Health Management Information System (HMIS)

(https://nrhm-mis.nic.in)


Introduction-HMIS

“HMIS is an information system specially designed to assist in the management and planning of health programmes, as opposed to delivery of care”- World Health Organization

A health management information system is an essential management tool to monitor how far we have travelled, and

where the gaps are…


HMIS: Key Features

o Web based MIS where facilities / districts / states are reporting

data on a defined periodicity in pre-defined formats

o Captures data related to service delivery (performance related)

and facility infrastructure

o 1.94 lakh facilities across 672 districts of India uploading

monthly data on performance indicators

o Reports available in public domain


HMIS data is available on Data portal of India under Open Government Data (OGD) Platform India (https://data.gov.in)

Data includes indicators related to:Maternal Health related• ANC related• Delivery care related• Post Natal Care• MTP & Abortion

Child Health related• New born details• Immunization related• Child hood diseases

Family Planning• Male sterilization• Female sterilization• IUCD & other temporary methods

Health Facility services• OPD/ IPD• Surgeries• RKS• Ambulance services

Availability on Data portal of India

https://data.gov.in/

List of reports available on HMIS Public Domain

Standard reports• Data Reporting Status• Data Itemwise• Data Itemwise Comparison • Performance of Key HMIS

Indicators• RCH Reports - Indicator Wise • RCH Reports - State Wise • Min-Max Report • Range wise Report

Analytical reports• Scorecard & Dashboard• Factsheet: State & District• CHC Star RatingShared with Data.gov.in


Use of HMIS Datao Planning

HMIS data is widely used by States in preparing Program

Implementation Plans (PIPs) under NHM.

Indicators from HMIS (like Institutional Deliveries, C -Section

deliveries, Immunization, IPD, OPD, Surgeries, etc.) are used to

evaluate the state performance during National Programme

Coordination Committee (NPCC) meetings

Facility wise data of CHCs is used for rating the facilities. This rating

is also a conditionality for approval of funds under NHM


CHC Star Rating

Based on the available infrastructure at the health facility and the services being provided, the performance of a facility is rated vis-à-vis other facilities.

Data reported by the facilities in Infrastructure and MIS monthly format is used for generating Star rating report.

For Star Rating report the following aspects / categories are considered:• Human Resources available• Infrastructure available• Drugs & Supplies• Service Availability• Client Orientation• Service Utilization

Use of HMIS Data: Planning (contd.)

CHC Star Rating: Karnataka (2014-15)


CHC Star Rating (contd.)

The rating of the facility is done based on the criteria given below:

• If the facility satisfies criteria for HR available & Infrastructure available, facility is eligible for Star Reporting & gets 1 Star.

• Facility gets one star each for satisfying criteria for Drugs & Supplies, Service Availability, Client Orientation and Service Utilization

• If the facility fails to satisfy criteria for HR available or Infrastructure available, facility is not eligible for Star Reporting with status “NE” (Not Eligible)

• If the facility fails to satisfy both of the criteria (i.e. HR available & Infrastructure available) & do not have Drugs and supplies, Service availability and Client Orientation then Star Reporting is not applicable for facility & status of facility will be “NA” (Not Applicable) .

Use of HMIS Data: Planning (contd.)


Use of HMIS Data (contd.)o Monitoring & EvaluationHMIS data is used in various monitoring visits like CRM (Common Review

Mission), Supportive supervision, Mission Indradhanush & various field visits

Calculation of DLIs (Disbursement Linked Indicators) for NUHM- DLI1-

institutional Deliveries, DLI2- Fully immunised children

HMIS data is also used in DMU report (Delivery Monitoring Report of

PMO)- DLI1, DLI2, male & female sterilisations.

HMIS data is used in RFD (Result Framework Document) –Home Deliveries

HMIS scorecards are used for evaluating State/ District/ Sub district

performance for indicators related to RMNCH+A


Use of HMIS Data: Monitoring & Evaluation (contd.)

Dashboard & Scorecard• Visual presentation in the form of ‘Maps’ for depicting status of different components of services delivered under RMNCH+A strategy for states/districts/ blocks

• Compares states/districts/blocks using the Overall Composite Index

• Highlight inequities across states, districts and blocks for focusing on areas lagging behind

• Two types:• Districts across country• Districts within a State


Dashboard & Scorecard: IndicatorsTotal of 16 indicators covering 4 stages of lifecycle:



List of Indicators

Sl. No Stages of life cycle

Indicators Association

Proportion of:

1Pre Pregnancy /

Reproductive age

Post-partum sterilization against total female sterilizationPositive

2 Male sterilization to total sterilization conductedPositive

3 IUCD insertions to all family planning methods (IUCD plus permanent)Positive

4

Pregnancy care

1st Trimester registration to total ANC registrationPositive

5 Pregnant women received 3 ANC check-ups to total ANC registrationPositive

6 Pregnant women given 100 IFA to total ANC registrationPositive

7 Cases of pregnant women with Obstetric Complications and attended to reported deliveriesPositive

8 Pregnant women receiving TT2 or Booster to total number of ANC registered Positive

9Child Birth

SBA attended home deliveries to total reported home deliveriesPositive

10 Institutional deliveries to total ANC registrationPositive

11 C-Section to reported deliveriesPositive

12

Postnatal maternal& new born care

Newborns breast fed within 1 hour to live birthsPositive

13Women discharged under 48 hours of delivery in public institutions to total no. of deliveries in public institutions

Negative

14 Newborns weighing less than 2.5 kg to newborns weighed at birth Negative

15 Newborns visited within 24hrs of home delivery to total reported home deliveriesPositive

16 Infants 0 to 11 months old who received Measles to reported live birthsPositive


Dashboard & Scorecard: Methodology1. Generation of 16 indicators

2. Identification of Max value and Min value

3. Calculation of Index value for each district for each indicator

• Positive indicator:

• Negative indicator:

4. Calculation of Composite index

Xid- Min(Xid)

Index Value, Xid = -----------------------------------

Max(Xid) – Min(Xid)

Max(Xid)- Xid

Index Value, Xid = -----------------------------------

Max(Xid) – Min(Xid)

Composite Index for dth (d=1,2,......,n) district = σ 𝑋𝑖𝑑𝑦𝑖=1𝑦



Dashboard & Scorecard: All India across States (2014-15)Use of HMIS Data: Monitoring & Evaluation (contd.)

Color coding based on quartiles: Green (A) : Quartile 4 – Good performing Yellow (B) : Quartile 3 - Promising

Pink (C) : Quartile 2 – Low performing Red (D) : Quartile 1 – Very low performing

Gujarat Jharkhand

Manipur

Jammu & Kashmir

Andaman & Nicobar Islands

Goa

Andhra Pradesh

Himachal Pradesh

Daman & Diu

Karnataka

Chhattisgarh

Assam

Arunachal Pradesh

Bihar

Haryana

Chandigarh

Dadra & Nagar Haveli

Sikkim

Uttarakhand

PuducherryTamil Nadu

Odisha

Meghalaya

TripuraMadhya Pradesh

Nagaland

Maharashtra

Uttar PradeshRajasthan

Delhi

Punjab

KeralaLakshadweep

West Bengal Mizoram

Overall IndexTotal D 0.0000 - 0.4038C 0.4039 - 0.4690B 0.4691 - 0.5094A 0.5095 - 0.6656


Scorecard: All India across States (2014-15)

Sikkim 0.6656 0.4678 0.6472 0.7226 0.9188Kerala 0.627 0.5334 0.695 0.8183 0.3963

Overall Index Pregnancy care Child Birth Postnatal maternal & new born care

Composite Index ( 2014-15)

Pre Pregnancy/ Reproductive age

group

State/UT

Maharashtra 0.4998 0.3889 0.6503 0.6921 0.2136Telangana 0.4939 0.4088 0.5562 0.7128 0.2086Uttarakhand 0.4936 0.3824 0.4086 0.6982 0.423Madhya Pradesh 0.468 0.4015 0.3626 0.7558 0.2046West Bengal 0.4618 0.4272 0.422 0.6601 0.2286Haryana 0.4608 0.4312 0.4185 0.5383 0.4233Himachal Pradesh 0.4595 0.4728 0.3814 0.563 0.3429Uttar Pradesh 0.4127 0.3254 0.2882 0.5972 0.3752Nagaland 0.3948 0.0778 0.5107 0.6792 0.3332Jammu & Kashmir 0.3898 0.2618 0.4253 0.5434 0.3117Arunachal Pradesh 0.369 0.0885 0.4202 0.6312 0.3486


Dashboard: District across India / State -Bihar

Dash Board: Districts across India Dash Board: Districts within a State

Color coding based on quartiles: Green (A) : Quartile 4 – Good performing Yellow (B) : Quartile 3 - Promising

Pink (C) : Quartile 2 – Low performing Red (D) : Quartile 1 – Very low

performing

Based on HMIS data for 2014-15

Purnia

Pashchim Champaran

Saran

Siwan

Gopalganj

Muzaffarpur Darbhanga

SaharsaSamastipur

Katihar

Begusarai

Kishanganj

ArariaSupaul

Madhubani

Sitamarhi

SheoharPurba Champaran

Madhepura

Patna

JamuiNawada

GayaAurangabad

Jehanabad

RohtasKaimur (Bhabua)

Vaishali

Bhojpur

ArwalNalanda

SheikhpuraLakhisarai Munger

Banka

Bhagalpur

Khagaria

Buxar

Purnia

Pashchim Champaran

Saran

Siwan

Gopalganj

Muzaffarpur Darbhanga

SaharsaSamastipur

Katihar

Begusarai

Kishanganj

ArariaSupaul

Madhubani

Sitamarhi

SheoharPurba Champaran

Madhepura

Patna

JamuiNawada

GayaAurangabad

Jehanabad

RohtasKaimur (Bhabua)

Vaishali

Bhojpur

ArwalNalanda

SheikhpuraLakhisarai

Munger

Banka

Bhagalpur

Khagaria

Buxar


Use of HMIS Data (contd.)o PublicationsHMIS data is used in various National & State level publications

National level: Health and Family Welfare Statistics in India.

State level: HMIS Bulletin (State UP) Swasthank (State Chhattisgarh)

State & district level “Fact Sheets” are prepared by triangulating data

from HMIS, Population Census and various published surveys.

oParliament Questions & RTI Queries


Thank you

Data Driven Decision Making in Ministry of Health and Family Welfare

Data & Analytics

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