ORISSA HMISTowards an equity based

monitoring system

Institute of Public Health

Bangalore(with the support of DFID, Delhi)

July 2007

2

Objectives of this assignment

• Rationalisation of the HMIS

STATE

PERIPHERY

3

Methodology

4

Methodology

Level Number

State / National level 15

District level 29

PHC / CHC level 13

Subcentre level 7

5

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

6

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

7

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

8

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

9

Recommendation – IRationalisation 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.

10

Framework of indicators

Quarterly analysis – at State / district level

Child health1. % of children fully immunised

2. % of children with malnutrition

3. % of low birth weight babies4. Number of months that there was stock out of

measles vaccine

5. ……

11

Framework of indicators

Quarterly analysis – at State / district level

Reproductive health1. 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. ……

12

Framework of indicators

Quarterly analysis at State / District level

Malaria1. Incidence rate of malaria2. Mortality rate due to malaria3. Case fatality ratio due to malaria4. Malaria treatment failure rate5. Proportion of pregnant women who have received

full dose of CHQ chemoprophylaxis6. % of facilities that did not have CHQ / PMQ at least

once in the quarter

13

Framework of indicators

Quarterly analysis at State / District level

TB1. Case detection rate

2. NSP case detection rate

3. TB cure rate

4. % of NSP cases put on DOTS within 7 days

14

Framework of indicators

Quarterly analysis – at State / District level

Performance of hospitals1. % of Institutions with BOR > 75%

2. Mortality rate in institutions by depts

3. Infection rate in institutions by depts

4. ALOS in institutions by depts

15

Framework of indicators

Quarterly analysis at State / District level

ASHA1. % 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

16

Framework of indicators

Annually at State level1. Crude Birth rate

2. Crude Death rate

3. Infant mortality rate (by cause of death)

4. Neonate mortality rate

5. Still birth rate

6. Child mortality rate (by cause of death)

7. Maternal mortality ratio

8. Incidence of near miss events

17

Framework of indicators

Annually at State level9. Total fertility rate

10. Couple protection rate11. Incidence of TB

12. Mortality rate due to TB

13. Incidence of Malaria

14. Mortality rate due to Malaria

15. Prevalence of leprosy

16. Prevalence of HIV

18

Framework of indicatorsAnnually at State level17. Outpatient contact rate in government hospitals18. Inpatient admission rate in government hospitals (by

depts)

19. % of SGDP allocated to health20. % of health budget on primary care21. Per capita public health expenditure22. % of Districts with integrated societies, QA

committees and RKS in place23. % of districts who have submitted UC on

time

19

Framework of indicatorsAnnually at State level24. Ratio of doctor to population25. Ratio of ANM to population26. Vacancy rate (at various levels)27. % of Directors who were in position for more than 6

months in a year28. % of District staff who were in position for more than

6 months in a year29. % of districts with full time DPM in place30. % of districts that did not having at least one month’s

stock of essential drugs (ATT, measles vaccine, ORS, OC)

31. % of CHCs upgraded to IPHS32. % of CHCs / SDH / DH providing EmOC

20

Recommendation – III Special studies

• Health seeking behaviour

• Health expenditure studies

• Awareness

• Patient satisfaction studies

• Utilisation studies

• Mortality studies

21

Recommendation – IVStrategy 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

Thank you

Dr. N. Devadasan,

Dr. Lalnuntlangi Ralte

Dr Upendra Bhojani