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 2
Deptt. 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
Objective
o 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
Odisha
Chhattisgarh
JharkhandMadhya Pradesh
Bihar
AssamRajasthan
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 Coverage
Following 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 NFHS
NFHS 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
Laboratory Testing
• Hb
• HIV
• Malaria
Mortality related
• Maternal Deaths
• Infant deaths
• Adolescent & Adult Deaths
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 Rating
Shared with Data.gov.in

Use of HMIS Data
o 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 & Evaluation
HMIS 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: Indicators
Total of 16 indicators covering 4 stages of lifecycle:

List of Indicators
Sl.
No
Stages of life cycle
Indicators
Association
Proportion of:
1
Pre Pregnancy /
Reproductive age
Post-partum sterilization against total female sterilization
Positive
2 Male sterilization to total sterilization conducted
Positive
3 IUCD insertions to all family planning methods (IUCD plus permanent)
Positive
4
Pregnancy care
1st Trimester registration to total ANC registration
Positive
5 Pregnant women received 3 ANC check-ups to total ANC registration
Positive
6 Pregnant women given 100 IFA to total ANC registration
Positive
7 Cases of pregnant women with Obstetric Complications and attended to reported deliveries
Positive
8 Pregnant women receiving TT2 or Booster to total number of ANC registered
Positive
9
Child Birth
SBA attended home deliveries to total reported home deliveries
Positive
10 Institutional deliveries to total ANC registration
Positive
11 C-Section to reported deliveries
Positive
12
Postnatal maternal&
new born care
Newborns breast fed within 1 hour to live births
Positive
13
Women 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 deliveries
Positive
16 Infants 0 to 11 months old who received Measles to reported live births
Positive

Dashboard & Scorecard: Methodology
1. 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 =
𝑋𝑖𝑑
𝑦
𝑖=1
𝑦

Dashboard & Scorecard: All India across States (2014-15)
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
Overall Index

Scorecard: All India across States (2014-15)
Sikkim 0.6656 0.4678 0.6472 0.7226 0.9188
Kerala 0.627 0.5334 0.695 0.8183 0.3963
Tamil Nadu 0.6225 0.6153 0.6765 0.6747 0.4938
Lakshadweep 0.5812 0.5588 0.4238 0.6857 0.6016
Punjab 0.5705 0.4888 0.6666 0.6782 0.4308
Karnataka 0.5466 0.4943 0.6085 0.7999 0.1495
Assam 0.5291 0.4735 0.4305 0.6772 0.4734
A &N Islands 0.5281 0.6321 0.5937 0.5994 0.1705
Chandigarh 0.5189 0.5183 0.506 0.5325 0.5102
Maharashtra 0.4998 0.3889 0.6503 0.6921 0.2136
Telangana 0.4939 0.4088 0.5562 0.7128 0.2086
Uttarakhand 0.4936 0.3824 0.4086 0.6982 0.423
AndhraPradesh 0.4891 0.4061 0.4978 0.697 0.2722
Mizoram 0.487 0.3789 0.5279 0.6311 0.3862
Gujarat 0.4815 0.407 0.5076 0.6809 0.2472
Manipur 0.4791 0.1737 0.5122 0.6031 0.7485
Chhattisgarh 0.476 0.3924 0.329 0.7327 0.3345
Overall Index Pregnancycare ChildBirth Postnatal maternal
& newborncare
Composite Index( 2014-15)
Pre Pregnancy/
Reproductive age
group
State/UT
Sikkim 0.6656 0.4678 0.6472 0.7226 0.9188
Kerala 0.627 0.5334 0.695 0.8183 0.3963
Tamil Nadu 0.6225 0.6153 0.6765 0.6747 0.4938
Lakshadweep 0.5812 0.5588 0.4238 0.6857 0.6016
Punjab 0.5705 0.4888 0.6666 0.6782 0.4308
Karnataka 0.5466 0.4943 0.6085 0.7999 0.1495
Assam 0.5291 0.4735 0.4305 0.6772 0.4734
A &N Islands 0.5281 0.6321 0.5937 0.5994 0.1705
Chandigarh 0.5189 0.5183 0.506 0.5325 0.5102
Maharashtra 0.4998 0.3889 0.6503 0.6921 0.2136
Telangana 0.4939 0.4088 0.5562 0.7128 0.2086
Uttarakhand 0.4936 0.3824 0.4086 0.6982 0.423
AndhraPradesh 0.4891 0.4061 0.4978 0.697 0.2722
Mizoram 0.487 0.3789 0.5279 0.6311 0.3862
Gujarat 0.4815 0.407 0.5076 0.6809 0.2472
Manipur 0.4791 0.1737 0.5122 0.6031 0.7485
Chhattisgarh 0.476 0.3924 0.329 0.7327 0.3345
Goa 0.47 0.3546 0.5541 0.6121 0.3413
MadhyaPradesh 0.468 0.4015 0.3626 0.7558 0.2046
WestBengal 0.4618 0.4272 0.422 0.6601 0.2286
Haryana 0.4608 0.4312 0.4185 0.5383 0.4233
Himachal Pradesh 0.4595 0.4728 0.3814 0.563 0.3429
Rajasthan 0.4583 0.3644 0.5252 0.636 0.2518
Odisha 0.4575 0.4605 0.393 0.6003 0.279
groupAssam 0.5291 0.4735 0.4305 0.6772 0.4734
A &N Islands 0.5281 0.6321 0.5937 0.5994 0.1705
Chandigarh 0.5189 0.5183 0.506 0.5325 0.5102
Maharashtra 0.4998 0.3889 0.6503 0.6921 0.2136
Telangana 0.4939 0.4088 0.5562 0.7128 0.2086
Uttarakhand 0.4936 0.3824 0.4086 0.6982 0.423
AndhraPradesh 0.4891 0.4061 0.4978 0.697 0.2722
Mizoram 0.487 0.3789 0.5279 0.6311 0.3862
Gujarat 0.4815 0.407 0.5076 0.6809 0.2472
Manipur 0.4791 0.1737 0.5122 0.6031 0.7485
Chhattisgarh 0.476 0.3924 0.329 0.7327 0.3345
Goa 0.47 0.3546 0.5541 0.6121 0.3413
MadhyaPradesh 0.468 0.4015 0.3626 0.7558 0.2046
WestBengal 0.4618 0.4272 0.422 0.6601 0.2286
Haryana 0.4608 0.4312 0.4185 0.5383 0.4233
Rajasthan 0.4583 0.3644 0.5252 0.636 0.2518
Odisha 0.4575 0.4605 0.393 0.6003 0.279
Puducherry 0.4575 0.3093 0.6167 0.5239 0.4346
Tripura 0.4215 0.3181 0.3432 0.7257 0.1648
UttarPradesh 0.4127 0.3254 0.2882 0.5972 0.3752
Nagaland 0.3948 0.0778 0.5107 0.6792 0.3332
Jammu&Kashmir 0.3898 0.2618 0.4253 0.5434 0.3117
Arunachal Pradesh 0.369 0.0885 0.4202 0.6312 0.3486
AndhraPradesh 0.4891 0.4061 0.4978 0.697 0.2722
Mizoram 0.487 0.3789 0.5279 0.6311 0.3862
Gujarat 0.4815 0.407 0.5076 0.6809 0.2472
Manipur 0.4791 0.1737 0.5122 0.6031 0.7485
Chhattisgarh 0.476 0.3924 0.329 0.7327 0.3345
Goa 0.47 0.3546 0.5541 0.6121 0.3413
MadhyaPradesh 0.468 0.4015 0.3626 0.7558 0.2046
WestBengal 0.4618 0.4272 0.422 0.6601 0.2286
Haryana 0.4608 0.4312 0.4185 0.5383 0.4233
Rajasthan 0.4583 0.3644 0.5252 0.636 0.2518
Odisha 0.4575 0.4605 0.393 0.6003 0.279
Puducherry 0.4575 0.3093 0.6167 0.5239 0.4346
Tripura 0.4215 0.3181 0.3432 0.7257 0.1648
UttarPradesh 0.4127 0.3254 0.2882 0.5972 0.3752
Nagaland 0.3948 0.0778 0.5107 0.6792 0.3332
Jammu&Kashmir 0.3898 0.2618 0.4253 0.5434 0.3117
Arunachal Pradesh 0.369 0.0885 0.4202 0.6312 0.3486
Delhi 0.3642 0.1938 0.2972 0.5119 0.469
Jharkhand 0.361 0.2332 0.3246 0.6146 0.1876
Meghalaya 0.3523 0.1845 0.1833 0.5612 0.4529
Bihar 0.3514 0.3046 0.2218 0.613 0.1234
Daman&Diu 0.3316 0.1731 0.2795 0.611 0.1822
Dadra&NagarHaveli 0.2553 0.1819 0.3078 0.3952 0.0921

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

Use of HMIS Data (contd.)
o Publications
HMIS 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

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