Ministry of Health & Family Welfare
(Statistics Division)
Monitoring and Evaluation System
1. Introduction: The National Health Mission (NHM) has quantifiable goals to be achieved through specific road maps with appropriate linkages and financial allocations for strengthening the health infrastructure. A continuous flow of good quality information on inputs, outputs and outcome indicators is essential for monitoring the progress of NHM at closer intervals. Integral to this process is using information for decentralized planning where the States prepare Integrated District Health Action Plans (IDHAP) culminating to the State Health Action Plans or Programme Implementation Plans (PIP) through which resource allocation takes place.
The salient features of monitoring and evaluation system under NHM are given below.
2. M&E Strategy: The strength of the monitoring systems for various national health programmes varied across states/programmes and was dependent on the keenness and availability of independent personnel for monitoring. The Empowered Programme committee (EPC) of NRHM decided in 2008 that a Nodal Information Officer may be identified at various levels - the State, District, block and facility levels and a notification issued by states so that s/he becomes the focal point for submission and dissemination of information. Norms were also laid down for strengthening the IT infrastructure in the States. The States were requested to synergise the monitoring and IT infrastructure across health programmes to minimise redundancy. The States/UTs have been proposing requirements of funds accordingly in their PIPs.
3. HMIS Web Portal: For capturing information on the service statistics from the peripheral institutions, an exercise was undertaken to rationalize the data capturing formats by removing redundant information, reducing the number of forms and with a focus on facility based reporting. The revised forms were finalized in September 2008 and disseminated to the States. A web based Health MIS (HMIS) portal was launched in October, 2008 to facilitate data capturing at District and lower levels. The HMIS portal has led to faster flow of information and almost all districts in the country are now reporting data on a regular basis.
The HMIS portal has also been rolled out to capture information at the facility level. As on 01.11.2013, 540 districts (out of 661) are reporting facility wise information for about 1,41,000 facilities every month. The remaining districts (121) are reporting consolidated district information.
HMIS data is regularly checked to identify outliers, invalid, inconsistent and irrelevant data entries. Automated standard reports highlighting validation errors and outliers are available for use by States / UTs / districts. National HMIS team remain in constant touch with States / UTs and follow up for ensuring data quality.
To promote use of HMIS data, standard ready to use reports giving national, state and district level key indicators are being generated and refreshed on daily / weekly basis. Efforts are on to provide sub-district and facility level reports. Further, to improve quality of HMIS data, score cards and dash-boards have been developed and these are being used at the state and district level consultations to highlight the poor performing regions and the programme areas which need more attention
4. Large Scale Surveys: The Ministry has been conducting large scale surveys periodically to assess the level and impact of health interventions. These surveys include National family Health Survey (NFHS), District level Household Survey (DLHS), Annual Health Survey (AHS) etc. The main aim of these surveys is to assess the impact of the health programmes and to generate various health related indicators at the District, State and National level.
The details of the existing Surveys related to health are summarised below:
Sl No / Name / Nodal Agency / Periodicity(Year of Surveys) / Availability of Information /
1. / National Family Health Survey (NFHS),
MoHFW
Coordinated by IIPS, Mumbai / IIPS, Mumbai / 5 – 7 years
(Three rounds conducted in
2005-06, 1998-99,
1992-93) / National and State level indicators relating population, health, nutrition, reproductive and child health, health seeking behavior etc. HIV/AIDS estimates provided for the first time in 2005-06
2. / District level Household Survey (DLHS),
MoHFW
Coordinated by IIPS, Mumbai / IIPS Mumbai / 5 – 6 years
(Three rounds conducted in
2007-08, 2002-04,
and 1998-99) / National, State and district level estimates on health and nutrition, performance of reproductive and child health programmes etc
3. / Sample Registration System (SRS),
Registrar General of India, Ministry of Home Affairs / RGI / Annual / State wise estimates on CBR, CDR, IMR. U5MR, TFR etc
4. / Annual Health Survey / RGI / Annual
(Three rounds) / Demographic and health Indicators at the State and District level for 8 EAG States and Assam
The latest status is as under:
4.1 National Family Health Survey: National Family Health Survey (NFHS-3) conducted in 2005-06 was the third in a series preceded by earlier NFHS surveys carried out in 1992-93 (NFHS-1) and 1998-99 (NFHS-2) with the objective to provide essential data on health and family welfare needed by the Ministry of Health and Family Welfare and other agencies for policy and programme purposes, and to provide information on important emerging health and family welfare issues.
Preparatory work for the fourth round of National Family Health Survey (NFHS-4) to be launched in 2014 is in progress. Sample design and Questionnaires have been finalized in a series of meetings of the Technical Advisory Committee and its sub- committees comprising various stakeholders. IIPS, Mumbai has been designated as the nodal agency. In the meeting of Steering Committee of NFHS-4 taken by Secretary (H&FW) on 19.08.2013, the proposal for conducting NFHS-4 has been approved. A presentation on NFHS-4 was also made to the National Statistical Commission on 13.09.2013 which had given advice on certain issues.
4.2 District level Household Survey: The District Level Household and Facility Surveys (DLHS) were initiated in 1997 with a view to assess the utilization of services provided by health facilities and people’s perception about the quality of services. The District Level household and Facility Survey (DLHS -3), the third in the series of the district surveys was preceded by DLHS-1 in 1998-99 and DLHS 2 in 2002-04. DLHS is designed to provide district level estimates on important indicators on maternal and child health, family planning and other reproductive health services and important interventions of National Rural Health Mission (NRHM).
The fourth round of DLHS has been taken up with the objective of estimating reliable indicators of population, maternal & child health and family planning at District and National Level. As part of the Survey, a number of Clinical Anthropometric and Biochemical (CAB) tests are carried out to produce district level estimates for nutritional status and prevalence of certain life style disorders. The major constituents of the CAB component are height, weight, and blood pressure, estimation of hemoglobin (Hb), blood sugar and test for iodine content in the salt used by households. The survey results are expected to be available during 2014.
4.3 Annual Health Survey: The Ministry is undertaking Annual Health Survey (AHS) through the Office of Registrar General of India (ORGI) in 284 districts of 9 States namely Assam, Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttar Pradesh and Uttarakhand. The first round of AHS was conducted during 2010-11 and the preliminary results covering key indicators and the detailed State wise factsheets based on first round of AHS have been brought out. State-wise Bulletin of 1st updation round of AHS was released in 1st week of May, 2013. Field work of 2nd updation Round of AHS has been completed and the Survey on measurement of height, weight, blood pressure, blood glucose, hemoglobin etc. is in progress.
5. Regional Evaluation Teams (RETs): The system of sample check of family planning acceptors was introduced in the year, 1972 by the State Demographic and Evaluation Cell followed by the Regional Health Offices in 1974-75. At present there are 7 Regional Evaluation Teams (RETs) located in the Regional Offices of the Ministry which undertake evaluation of the NRHM activities including Reproductive and Child Health Programme (RCH) on a sample basis by visiting the selected Districts and interviewing the beneficiaries. Reports of the RETs are sent to the States and programme divisions for taking corrective measures on issues highlighted in the reports. During 2012-13, 94 districts were visited by RETs.
6. Population Research centres: The Ministry of Health and Family Welfare has established a network of 18 Population Research Centres (PRCs) scattered in 17 major States. These PRCs are located in various Universities (12) and other Institutions (6) of national repute. The PRCs are responsible for carrying out research on various topics of population stabilization, demographic, socio-demographic surveys and communication aspects of population and family welfare programme. During the year 2011-12, 103 studies were completed by the Population Research Centres (PRCs) on some of the important topics of research including the studies assigned by the Ministry. At present PRCs are also involved in analysis of district-wise data captured through HMIS portal and evaluation of quality of data on regular basis. Services of PRCs are also utilized in monitoring DLHS-4 field work and monitoring of State Programme Implementation Plans.
7. Other Monitoring and Evaluation Activities: In pursuant to a decision taken by the Empowered Programme Committee (EPC) of NRHM, Concurrent evaluation of NRHM was undertaken by the Ministry in 187 districts of all States/UTs except Himachal Pradesh and Meghalaya during 2009-10 covering activities and programmes initiated under the NRHM through the International Institute of Population Science (IIPS), Mumbai. The IIPS acted as the nodal agency for conducting the Concurrent Evaluation and outsourced the field work to independent agencies having experience in conducting surveys / research studies. The district-wise facts sheets and State reports are available in public domain at HMIS portal (https://nrhm-mis.nic.in).
Various development partners carry out evaluations to assess the impact of health interventions. For example, UNICEF conducted Coverage Evaluation Survey in 2009.
The officers of the Ministry, PRCs, RET, NHSRC visit various states/districts/facilities/beneficiaries regularly. It has been decided by AS & MD that all reports will be sent to NHSRC for consolidation and for putting up draft DO letters to States/UTs for taking necessary action.
8. Triangulation of Data: The Ministry is undertaking Triangulation of Data from various sources (HMIS, Surveys, Evaluation etc.) so as to improve the quality and validity of data. Accordingly, data from various sources is presented in the national, state and district factsheets which are available on the HMIS Portal for use by national, state and district level users.
9. Enhanced role of Statistics Division: It has been decided by the Ministry in October 2013 to place Central Bureau of Health Intelligence (CBHI) under the Statistics Division of the Ministry to ensure that the requirement of entire data and statistical reports is addressed by the Statistics Division. Statistics Division would essentially be a resource centre for the collection and dissemination of all statistics relating to Health and Family Welfare and also for coordination of all statistical activities in the Ministry.
*****
5