e-mamta: gujarat past, present & future€¦ · e-mamta: gujarat past, present & future ......

e-Mamta: Gujarat

Past, Present & Future

Department of Health & Family Welfare,

Govt. of Gujarat

3/16/2015 E- Mamta: Mother and Child Tracking 2

Gujrat – Ek Najar

Population(2011 Census) 60.4 million

Birth Rate (SRS 2014) 20.8 / 1000

Death Rate (SRS 2014) 6.5 / 1000

IMR (SRS 2014) 36 / 1000 live birth

MMR (SRS 2010-12) 112 / 1 lakh live birth

Yearly Estimated Pregnancies: 1,402,805

Yearly Estimated Live Births: 1,275,278

No. of CHCs 296

No. of PHCs 1208

Number of Sub centres 8121

No. of Blocks 248

3

Health & Family Welfare Dept, Govt of Gujarat

www.gujhealth.gov.in

Institutional Delivery Trend Gujarat

Source: HMIS

55.9 57 63.2

67.6 77.8 82

89.4 91.8 93.7 95.1 96.4

44.1 43 36.8

32.4 22.2 18

10.6 8.2 6.3 4.9 3.6

20

03

-04

20

04

-05

20

05

-06

20

06

-07

20

07

-08

20

08

-09

20

09

-10

20

10

-11

20

11

-12

20

12

-13

20

13

-14

Institutional Deliveries Home Deliveries

4



54 53 5250

4844

4138

36

29

24

0

10

20

30

40

50

60

2005 2006 2007 2008 2009 2010 2011 2012 2013 2015 2017

IMR

@ 1 per year i.e.

1.9%@ 2 per year i.e. 2.8 & 4 %

@ 4 per year i.e.

8.3 %

@ 3 per year i.e. 6.8 % & 7.3

%

NRHM

Chiranjeevi

108

NirogiBal BalSakha

@ 2 per year i.e. 5.2%

Source: SRS Infant Mortality Estimates

Infant Mortality Rate in Gujarat

5



Maternal Mortality Ratio Gujarat

5

172 160 148

122 112

100

2001 to 03 2004 to 06 2007 to 09 2010 to 12 2011 to 13 2013 to 15

6.9% Decline 7.5 %

Decline 18 %

Decline 8.1 % Decline

Target 18 %

Decline

Target to Achieve

90

47

49

41 31

IMR as per NSS Natural Division: Table -11

SRS 2013

DRY AREA

4.1.1 KACHCHH

4.1.2 BANAS KANTHA

4.1.3 SURENDRANAGAR

SOUTH EASTERN

4.2.1 PANCH MAHALS

4.2.2 DOHAD

4.2.3 VADODARA

4.2.4 NARMADA

4.2.5 BHARUCH

4.2.6 SURAT

4.2.7 THE DANGS

4.2.8 NAVSARI

4.2.9 VALSAD

PLAIN NORTHERN

4.3.1 PATAN

4.3.2 MAHESANA

4.3.3 SABAR KANTHA

4.3.4 GANDHINAGAR

4.3.5 AHMADABAD

4.3.6 ANAND

4.3.7 KHEDA

SOURASHTRA

4.4.1 RAJKOT

4.4.2 JAMNAGAR

4.4.3 PORBANDAR

4.4.4 JUNAGADH

4.4.5 AMRELI

4.4.6 BHAVNAGAR

7



• High left out rates, inadequate quality of services, inability to track beneficiaries especially pregnant women and children leading to high Maternal Mortality Ratio (MMR) & Infant Mortality Rate (IMR).

• Despite the availability of abundance of information in health sector, there was a need to build capacity to find, communicate or use the information effectively and link it to individual beneficiaries.

Challenges

8



• HMIS:

• Monitors through numbers. • No Attention to services provided to individual

beneficiaries

• Migration: • Health services delayed or missed • Improper reporting system

• Better Communication required between service providers and beneficiaries to ensure service delivery

Challenges

January 8, 2013 Health & Family Welfare Department 9 Health & Family Welfare Department

e-Mamta - Introduction

“Matrutva or Mamta” means “love of Mother for her Child”

Initiated by H & FW Dept and NIC in 2010

Name based Tracking web application. Comprehensive Family Health Survey Database with AADHAR card & Bank account number.

UID Compatibility & Family search options.

Coverage

Almost entire population of state

Special emphasis – Rural, Urban Slum and slum like

Health detail of 1.1 crore Families, 5.3 crore individuals

> 85% of populations

http://e-mamta.gujarat.gov.in/




1. To Develop Management tools

• Provide quality MCH services,

• Track drop outs and

• Ensure complete service delivery.

Thus reducing IMR and MMR

NAME BASED TRACKING : RATIONALE

3/16/2015 10 E- Mamta: Mother and Child Tracking

2. HMIS -

About numbers

No attention is given to individuals- name based tracking system

Doesn’t ensure service delivery to every individual

3. To establish a credible monitoring system for MCH services.

4. To increase the quality of service delivery.

NAME BASED TRACKING : RATIONALE


12



1. Most of the analysis of data in the Public Health system

Focus on post mortem of the historical data

Establishing trends for policy analysis and planning.


NAME BASED TRACKING :PRINCIPLE

2. E-Mamta for the first time processes the

available data to generate

Denominator based work plans that determine

the entire gamut of beneficiaries

Provides the detailed schedule of beneficiaries

to be targeted – name wise

13



3. This facilitates concentration on

• Individual beneficiaries and

• Determining the left outs of service delivery during a certain period of time.

4. The analyzed historical data is also available on Dash Board.


NAME BASED TRACKING :PRINCIPLE

Stake holders and their responsibilities

DEO ANM

FHS

MO

THO

THV

M & E Assis CDHO PO e Mamta

Help Desk

NIC

AD(FW)

MD-NHM

Com. Of Health

Beneficiary


Data entry Operator

– Data entry • Family Health Survey

• Registration

• Services

– Generate • Reports for review

• Work plan

• Family Health Survey verification

ANM – Family Health Survey Update/Verification

– Work plan – receive in timely manner and submit duly filled

– Record: e-Mamta generated unique ID in Register 4 & 5, Mamta Card

– Provide: e Mamta generated ID to beneficiaries

– Counselling : to keep Mamta card and ID when attending facilities

Taluka level: (THO/THV/M&E) • Ensure availability of network

connection, hardware, operator for data entry

• Ensure correct mapping in e Mamta

• Performance review PHC wise

• Ensure updated information : mobile no. staff info. Etc

• Coordination & solution of PHC level issues

• Cross verification of sample size


MO/FHS • Family Health Survey : ensure

completeness and verification • Registration: ensure completeness

for ANC and child • Coordination: between staff for data

entry and work plan • Validation/Verification : e Mamta Vs

HMIS • Migration: updated information,

services & data entry • Performance review: Sub centre

wise • Ensure updated information: mobile

no. and staff info • Cross verification of sample

District Level ( DPC/CDHO) • Overall implementation of program in district

• Solve issues: HR, Technical & Other as per guidance from state

• Training and guidance to taluka and PHC

• Timely feedback to state for improvement

• Data : monitoring review, cross verification, validation


State level {AD(FW), AD(VS), PO-e Mamta, PA} • Administrative & Financial matters – AD(FW)

• Technical – AD(VS)

• Over all Implementation in state

• Review of District: data entry ( registration and services)

• Provide data during CDHO Review meeting

• Receive feedback from district and coordinate with NIC for solution

1. District Family Health survey

2. Verification & Validation of the data

3. Registration of mother and child

4. Tracking & Service provision

Four Basic Components of Implementation



District Family Health Survey

Mother and Child

registration

Monthly workplans for grassroot level

workers

Service delivery and left out

tracking

E-Mamta: Process

Financial implications

As such no extra financial implications

– HR already available at all level ( except State level posts PO e Mamta, PA, Operator for help desk )

– Logistics – Already available at all level

– Space – already available at all level

– Printing cost from contingency

– Training cost from training budget

Other Resource requirements - in terms of physical infrastructure, man power, time required

State

• Project Officer ( PO e – Mamta)

• 24 X 7 Help Desk – 2 operator

• 2 Program Assistant

• Sitting space

• Server & Technical support - NIC

District • District Nodal Officer(DPM)

• District Program Assistant

• Logistics

Taluka • Taluka M & E Assistant

• Logistics

PHC

• Data Entry Operator

• Logistics

• 8 to 10 days/month ( Vs advantage of not preparing manual report, ppt for review etc..)

• Data collection by ANM during VHND sessions

Steps for Successful implementation of Programme

• Annual update of Family Health Survey

• Validation, Cross verification of Family Health Survey

• Removal Of Duplicate Data

• Timely Registration of pregnant mother

• Printing of Unique Health ID on Mamta Card and Register 4 & 5

• Generation of work plan(weekly) – ANC, PNC, Delivery & Immunization services etc…

• Real time data entry based on work plan

• Timely data entry of delivery services by institutes.

• Monthly review of pending services after registration

• Technologically empowered ANM

• Regular training

• Regular recruitment of staff

• 24 X 7 Help desk to solve issues e.g. ID, PW

• Constant update of websites

• Review of RCH services only based on e-Mamta ( Top to bottom)

• Very high level of commitment

Steps for Successful implementation of Programme

Challenges faced and lesson learnt

Challenges faced

• Need of orientation/Training

• vacancy of HR & unavailable Logistics

• Data(Collection, data entry)

• Poor data entry

Lesson learnt

• Arranged at all level(Training ongoing)

• Guideline created (Guj)

• Ensured at all level through regular recruitment and supply

• Work plan generation and direct data entry from work plan

• Regular review at all level

Challenges faced

• Verification/validation of data

• Duplication of data

• Technical issues

• Communication issues

Lesson learnt

• FHS verification forms

• Report for duplicate data entry generated and verified

• 24 X & Help Desk at state, PO e Mamta

• Regular feedback from field through email and improvement

Challenges faced and lesson learnt

Comprehensive service

delivery

Reduced IMR, MMR and TFR

Universal coverage of immunization

Reduction in anemia and malnutrition

POTENTIAL OUTCOMES OF E-MAMTA



Scenario Before & After e-Mamta


e-Mamta – Impact on Stakeholders

• Better Service Delivery

• Awareness about due services to be received

• Continuity in service delivery in case of migration Beneficiary

• Work -Plans with ready list of beneficiaries to be targeted

• Dynamic reports available for day to day monitoring

• Better communication

Service

Provider

• Quality data for better budget planning

• Real time online reports for performance monitoring

• Better reporting of Maternal & Infant deaths

Program

Manager


e-Mamta Success Journey……

e-Mamta –Features

17th Dec. 2013 Health and Family Welfare Department, Government of Gujarat 6

• Family search options available from AADHAR card number

• Multiple Search Option for Mother and Child

Search Options

e-Mamta –Features


Immunization Record

e-Mamta –Features


24 X 7 Help Desk with

tool free number

Dash Board

Help Desk & Dash Board

e-Mamta –Features


Growth Chart

e-Mamta –Features


Hb and Weight Chart

e-Mamta –Features


Coverage • 1158 Public Health Centers • 7274 Sub centers • 314 Community Health

Centers • 54 Sub-District & District

Hospitals • 6 Major Hospitals • 8 Corporations • All Villages of Gujarat • Tel nos of 32,000 ASHA,

7200 Female Health Workers, who are now technologically empowered

Online health record

Interdepartmental Co-ordination

Women & Child, Education etc

State Verification Cell – Quality Check

• Details of various incentives paid

• Individual records for the benefits of JSY, BSY and CY schemes

• Online health record of individuals.

• Integration with HMIS

• Interdepartmental coordination - ICDS, Education Department, RSBY

OTHER FEATURES


37

Sr No. Location Name

Delivery of Beneficiary

Home Delivery

of JSY Benefici

ary

Institutional Delivery of JSY

Beneficiary

% of Home Delivery of

JSY Beneficiary

% of Institutional

Delivery of JSY Beneficiary

1 Abdasa 8 0 8 00.00 100.00

3 Bhachau 76 0 76 00.00 100.00

4 Bhuj 4 0 4 00.00 100.00

6 Lakhpat 41 0 41 00.00 100.00

10 Rapar 58 0 58 00.00 100.00

11 District 187 0 187 00.00 100.00

Details of various incentives paid under JSY, BSY and CY schemes

38

Pregnant Mother Details for 108 Services Sr

No. Family Id Health

UID Name Age Social

Status Delivery is Expected at which Address

Mobile No

EDD (MM/DD/

YYYY)

Service Given Govt.

Facility

Medical Officer

(Name/MobNo)

FHW(Name/Mob

No)

Asha (Name/M

obNo)

District : KACHCHH Taluka : Bhuj

PHC : Kukma Subcentre : Madhapar-3 Village : Madhapar (OG) - Ward No.15 PPU : UHC :

2 FM/2012/42215

A049593198

ઉષા લખન મહશે્વરી

22 ST માધાપર ૩

8901740765

01/15/2015

PHC :Kukm

a

Dr.Kirtikumar

Siju/990994933

5

chandrikaben C Vaghela/972773

4426

Abedaben G.

Sumra/7567878

189 5 FM/201

4/587646

A057190038

નનલમ દિનેશ બલરામ ચાવડા

24 OBC/SEBC

જુનાવાસ 8866325686

01/14/2015

PHC :Kukm

a

Dr.Kirtikumar

Siju/990994933

5

chandrikaben C Vaghela/972773

4426

Abedaben G.

Sumra/7567878

189

OTHER FEATURES

Pregnant Mother Detail for 108 Services

SMS to beneficiaries

“Apni Matru ane bal kalyan sewao

mate najikna arogya kendra ni

athava to Mamta divas ni mulakat

levi. Mulakat lidhel hoy to aabhar”

Meaning………..

‘Please visit your nearest PHC or

Mamta Diwas for ANC service. Kindly

ignore if already taken’

Customized SMS Vernacular SMS

e Mamta

CDR

MDR

JSY

BSY

CY

ICDS School Health

RNTCP

Leprosy

HMIS

RSBY

40

Integration of National Health Programmes

E-mamta vis a vis other mother and Child

tracking programs

• Work Plans to provide list of targeted beneficiaries and ensure no left outs

• Full Integration of Service delivery and Reporting: Starts from DFHS to store back end data and culminates in HMIS reports.

• No duplication of mothers: Individual is the unit. All pregnancies of a single mother are recorded together.

• Complete life cycle approach: Data of an individual is recorded form Birth to Death.


E-mamta vis a vis other mother and Child

tracking programs

• Citizen service features.

• SMS alerts to beneficiaries and service providers.

• Complete integration of Health Record of an individual

• Not only data management tool but service delivery management tool.

• Access to private providers.

• Convergence with other Health Programs and Nutrition.

• Data base of all service providers and communication platform(Including Pvt).


Health record of individual

43


WORKPLAN For ANC

Progress so far..


No. of families entered 118.52 lakh AS ON TODAY

No. of members entered 5.52 crore (91.39% of Gujarat’s Pop.)

On-line NAME BASED TRACKING

# Service Registered In 2012-13 (in lakh) In 2013-14 (in lakh)

1 No. of PW registered during the year

( % against Est.)

12.12 ( 82.71%) 13.28 (94%)

2 Total Children Registered (0-1 year)

( % against Est.)

99.89 (74.97%) 11.32 (88%)

Percentage achievement against Child Registration

3 BCG given 91.1% 85.22%

4 DPT-3/Penta -3 85.5% 77.77%

5 Measles Dose 81.0% 79.87%

6 Fully immunized children 79.10% 78.65%

Value Added Features


• Dash board

• Notice board

• Immunization record

• Growth chart

• Hb., weight chart for Pregnant

woman

• Mother tracking report with LMP

• Child tracking report with Date Of

Birth

• Line list available of children

dropout after delivery of registered

mother

• Mother search option by Mobile

number

e-Mamta – Sustainability and Scalability


Sustainable

Institutionalized and integrated with the state health system

Training Saturated up to grass root level workers

Minimal recurring expenditure

UID Compatibility( ADD IN IMPACT ONLY IN ONE LINE )

Scalable

Already replicated at National level as Mother and Child Tracking System (MCTS)

Modular design which enables newer application for the various programs.

Unicode font used to ensure customization in various languages

Developed by NIC – A Government Organization


1. e-Mamta Helpdesk having Toll

Free Number (18002331044) for

all assistance related to e-Mamta

2. Introduction of RCH Portal in place

of MCTS (Mother & Child Tracking

System) which integrates register

number 3,4,5 and based on

eligible couple UID.

e-Mamta – Future


Innovative Mobile Phone Technology for Community Health Operation

(ImTeCHO) for improvement in performance of ASHA which is facilitated by

SEWA Rural organization.

e-Mamta – Future


USSD service has to be started for online entry of e-Mamta data through

ASHA/FHW for which Vodafone Gujarat will provide service..

e-Mamta – Future


1. Voice Messages to all the beneficiaries registered in e-Mamta for which

application is developed by C-DAC Hyderabad.

e-Mamta – Future

Replication : Jharkhand Context

• Already replicated at national level in the form of MCTS

• Generate work plan on regular basis

• Mechanism for dissemination & Collection of work plan – (as no PHC structure available)

• Connectivity –E gram ( Just like Gujarat)

• RCH review based only on MCTS – as done in Gujarat

• Vernacular SMS/Voice messages alert to beneficiaries for due services

• Regular review of data entry

• Add more points

Questions &

Suggestions

e-mamta: gujarat past, present & future€¦ · e-mamta: gujarat past, present & future ......

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