ORISSA HMIS Towards an equity based monitoring system Institute of Public Health Bangalore (with the support of DFID, Delhi) July 2007 Objectives of this assignment STATE Rationalisation of the HMIS PERIPHERY 2
Methodology 3 Methodology Level Number State / National level 15 District level 29
PHC / CHC level 13 Subcentre level 7 4 Results status of HMIS Have introduced a comprehensive NRHM reporting format But this a copy of Form 6 with some additions e.g. ASHA, JSY, NLEP, NPCB, IMNCI and details of infant deaths All other reports and registers continue
5 Results status of HMIS Level Number of registers Number of reports Number of variables Sub centre level
32 33 ~ 444 PHC level 20 35 ~ 492 CHC level 43
74 ~ 532 District level 19 46 ~ 680 TOTAL 114
188 ~ 2148 6 NRHM New registers 8, of which 5 are at the block level New reports 22, of which 8 are at the SC level, 10 are at the PHC / CHC level and 4 at the District level. More on the pipeline NRHM GoI apparently wants to monitor the programme, down to SC activities 7 Results status of HMIS
Severe shortage of statistical staff at all levels Quality of data is unsatisfactory Data overload, so very little analysis Feedback is limited - mostly irregular, critical and occurs only when there are problems Validation of data is adhoc, NRHM staff are interested in monitoring, but require capacity building 8 Recommendation I Rationalisation of registers & reports
Comprehensive NRHM is a good first step Not clear what is the use of adding national programmes when they are being monitored separately Reduce duplicate registers and reports. Have already recognised 26 A lot of reduction possible if national programmes can be rationalised, especially malaria Need to start with the GoI and work oneself down Beware of increasing more because of NRHM. 9 Framework of indicators Quarterly analysis at State / district level
Child health 1. % of children fully immunised 2. % of children with malnutrition 3. % of low birth weight babies 4. Number of months that there was stock out of measles vaccine 5. 10 Framework of indicators Quarterly analysis at State / district level Reproductive health 1. Proportion of women how have delivered and who have received full antenatal check up 2. Proportion of deliveries attended by skilled
providers 3. Proportion of deliveries in institutions 4. Proportion of deliveries in government institutions 5. Proportion of BPL mothers who received JSY funds 6. 11 Framework of indicators Quarterly analysis at State / District level Malaria 1. 2. 3. 4. 5.
Incidence rate of malaria Mortality rate due to malaria Case fatality ratio due to malaria Malaria treatment failure rate Proportion of pregnant women who have received full dose of CHQ chemoprophylaxis 6. % of facilities that did not have CHQ / PMQ at least once in the quarter 12 Framework of indicators Quarterly analysis at State / District level TB 1. 2. 3. 4.
Case detection rate NSP case detection rate TB cure rate % of NSP cases put on DOTS within 7 days 13 Framework of indicators Quarterly analysis at State / District level Performance of hospitals 1. 2. 3. 4.
% of Institutions with BOR > 75% Mortality rate in institutions by depts Infection rate in institutions by depts ALOS in institutions by depts 14 Framework of indicators Quarterly analysis at State / District level ASHA 1. % of Gram sabhas that have selected ASHAs 2. % of selected ASHAs who have been trained 3. % of trained ASHAs who have accompanied women for delivery 4. % of trained ASHAs who are DOTS providers 5. % of ASHAs who motivated mothers for the BCG immunisation
15 Framework of indicators Annually at State level 1. 2. 3. 4. 5. 6. 7. 8. Crude Birth rate Crude Death rate Infant mortality rate (by cause of death) Neonate mortality rate
Still birth rate Child mortality rate (by cause of death) Maternal mortality ratio Incidence of near miss events 16 Framework of indicators Annually at State level 9. Total fertility rate 10. Couple protection rate 11. 12. 13. 14.
15. 16. Incidence of TB Mortality rate due to TB Incidence of Malaria Mortality rate due to Malaria Prevalence of leprosy Prevalence of HIV 17 Framework of indicators Annually at State level 17. 18. Outpatient contact rate in government hospitals
Inpatient admission rate in government hospitals (by depts) 19. 20. 21. 22. % of SGDP allocated to health % of health budget on primary care Per capita public health expenditure % of Districts with integrated societies, QA committees and RKS in place % of districts who have submitted UC on time 23.
18 Framework of indicators Annually at State level 24. 25. 26. 27. 28. 29. 30. 31. 32. Ratio of doctor to population Ratio of ANM to population
Vacancy rate (at various levels) % of Directors who were in position for more than 6 months in a year % of District staff who were in position for more than 6 months in a year % of districts with full time DPM in place % of districts that did not having at least one months stock of essential drugs (ATT, measles vaccine, ORS, OC) % of CHCs upgraded to IPHS % of CHCs / SDH / DH providing EmOC 19 Recommendation III Special studies Health seeking behaviour Health expenditure studies
Awareness Patient satisfaction studies Utilisation studies Mortality studies 20 Recommendation IV Strategy for monitoring Not enough to collect information Need to analyse it systematically and regularly Good to have an operational manual detailing on how to interpret the indicators and what action to be taken Important to supervise, triangulate and validate the data also 21
Thank you Dr. N. Devadasan, Dr. Lalnuntlangi Ralte Dr Upendra Bhojani
