Post on 12-Jan-2017
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
Ministry of Health and Family Welfare
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
Ministry of Health and Family Welfare
.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
Ministry of Health and Family Welfare
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
Ministry of Health and Family Welfare
Geographical Coverage : Annual Health Survey
OdishaChhattisgarh
J harkhandMadhya Pradesh
BiharAssamRajasthan Uttar Pradesh
Uttarakhand
Ministry of Health and Family Welfare
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.
Ministry of Health and Family Welfare
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
Ministry of Health and Family Welfare
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
Ministry of Health and Family Welfare
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.
Ministry of Health and Family Welfare
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…
Ministry of Health and Family Welfare
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…
Ministry of Health and Family Welfare
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
Ministry of Health and Family Welfare
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).
Ministry of Health and Family Welfare
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
Ministry of Health and Family Welfare
• 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)
Ministry of Health and Family Welfare
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…
Ministry of Health and Family Welfare
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
Ministry of Health and Family Welfare
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
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
Ministry of Health and Family Welfare
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
Ministry of Health and Family Welfare
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)
Ministry of Health and Family Welfare
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.)
Ministry of Health and Family Welfare
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
Ministry of Health and Family Welfare
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
Ministry of Health and Family Welfare
Dashboard & Scorecard: IndicatorsTotal of 16 indicators covering 4 stages of lifecycle:
Use of HMIS Data: Monitoring & Evaluation (contd.)
Ministry of Health and Family Welfare
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
Ministry of Health and Family Welfare
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
Use of HMIS Data: Monitoring & Evaluation (contd.)
Ministry of Health and Family Welfare
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
Ministry of Health and Family Welfare
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
Ministry of Health and Family Welfare
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
Ministry of Health and Family Welfare
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
Ministry of Health and Family Welfare
Thank you