Integration of Monitoring and Evaluation Systems for National Rural Health Mission

1. Ministry of Health & Family WelfareMonitoring & Evaluation (M&E)under National Rural Health Mission Issues for Third Common Review Mission, 3rd November, 2009

2. National Rural Health Mission Integration of Health Care delivery systems … necessitating An integration of Monitoring of Information and Evaluation Systems (MIES)

3. Ministry’s Requirement of Data • Performance Monitoring • Physical Monitoring • Financial Monitoring Emphasis on • Outcomes, Impact, Convergence • Reach - sub-district, community, household • Equity - gender, vulnerable groups • Performance based funding in programs • Now Results Framework Document • Giving quantifiable and measurable goals

4. Monitoring and Evaluation activities • Health Management Information System (HMIS) • NRHM - operational • NDCPs in pipeline • Surveys • Large scale household surveys – NFHS, DLHS • Annual Health Survey – District Health Profile for 284 Districts • Evaluation • Concurrent Evaluation of NRHM • Regional Evaluation Teams • Population Research Centres • Clearing House for Information

5. Legacies in Health Information • Similar data sets for various Central Agencies • Respondent Burden on Data Provider • Data load on the system – Manpower x Time matrix • Affects consistency and reliability of information • Lack of involvement and ownership • Delays, integrity, quality aspects etc • Information Flow - an upward bias • Data viewed as a by-product • Increased participation of Private Sector, PPP • Challenge for collecting information • Evaluation systems primarily project based

6. HMIS Challenges • Integrating/consolidating information needs of various agencies • Rationalising formats for data capture • Reducing frequency of data capture • An evolving and dynamic concept - not static • Technology solutions to reduce manual processes and improve quality of analysis

7. HMIS Challenges - cont’d • Infrastructural strengthening at the Centre, State and District • Facilitate / motivate data flow • IT readiness of the data reporting machinery in States and Districts

8. MIES System Model Working Group on M&E Program Planning & Service Delivery Validation Community Monitoring & Triangulation Monitoring Format & guidelines MIES Programme Mgmt Review Launched • Evaluation • Surveys, RETs • Concurrent evaluation Quality Assessment Pilot being expanded

9. Multi-pronged M&E strategy • Identifying Nodal (M&E) Information Officer at all levels • Structuring the Information flows • Infrastructural strengthening- IT, Networking, Manpower • Improving the quality of information • Earmarking 2-3% of the Budget on M&E • Strengthening evaluation work and improving validation and use of data.

10. Developments in HMIS ..(1) • Rationalisation of Formats - 2008 • Final Formats sent to States in September, 2008 • Soft copy on MoHFW’s Website • HMIS portal launched on 21st October, 2008 • Web-based Software Application Developed • Dedicated Portal for HMIS http://nrhm-mis.nic.in • All State Prl Secy (HFW) and MD (NRHM) provided with dedicated e-mails

11. Developments in HMIS ..(2)Data Details in Formats • Monthly: Performance/Service statistics (Form-9, RIMS, Patient Services, Lab Tests, Cause-wise listing of deaths) • Quarterly: Training and NRHM additionalities • Annual: Infrastructure and Manpower • FMRs: Quarterly – to be made monthly

12. Developments in HMIS ..(3) • Web-based Data capturing system • Physical performance captured at District level (M,Q,A) • Includes District Level FMRs • Facility based performance • Data validation - identifying Probable Outliers, consistency checks • Automatic aggregation, Export facility to Excel • Financial Performance at District level • Standard and Custom Reports • National, State and District Fact Sheets • Key indicators for NRHM and RCH • Discontinuation of paper reports under NRHM

13. HMIS Portal – Information Available • Customized Reports – Data Item Wise Report • All/Selective Items • Across Periods, Districts, States • Across States/Districts/Sub-Districts and Periods • Periodic Reports/Publication sections being continuously enhanced • DLHS III Reports • MMR Report • NFHS III Factsheet • SRS Bulletin • Time Series data on CBR, CDR, IMR & TFR – India • Demographic Indicators

14. www.nrhm-mis.nic.in

15. Flow of Data–Data Aggregation Unit DAU

16. Modes of Data District Draft Mode

17. Modes of Data State Draft Mode

18. Modes of Data State Forward Mode

19. HMIS – Steps taken • Interaction with State Governments • Provisional Reports for • NRHM and RCH - 2008-09 • NRHM and RCH – Apr-September, 2009 • Discussion on Outliers • Validation Checks • Sensitisation through Workshops and discussions • Training of State and District Users

20. Data Uploading Status - Monthly

24. Data Uploading Status – Quarterly 2008-09

27. RCH Reports - Data Entered Status

28. Road Ahead • Involve State Institutes for training State/District/Sub-District Users on: • Formats and Instructions – physical and financial • Uploading data and checking quality • Generating reports and analysis for local action and onward transmission • Levels of Training • Medical Officers • Data and Finance Officers • Paramedics, ANMs • HMIS R&D Group in these Training Institutes • Feed inputs to Clearing House • Help Desk • Mother (ANC) and Child Immunisation name-based Tracking

29. Next Steps • Fast Track training to the States, Districts, Blocks • Capitalising on NICNET, DIT and other networks • Propagation of “Using Data for Action” • Regular MIS • Evidence Based Planning (IDHAP) • Expanding HMIS beyond Districts, Helpline, GIS etc

30. Expectations from State/District Users • Portal provides complete flexibility to authorised Users • Data Discipline & Protocols to be inculcated • Data Capture on time at District level • Prepare Provisional Reports – detect outliers • Recheck and verify data • Forward/Commit Data onto system • District/State Level Necessary for Final Reports

31. Key issues to be seen by CRM... (1) 1. State/District Level • Have the Nodal Information (M&E) Officers been notified – State/District/Block • Efforts to integrate M&E activities across health programmes (NRHM, RCH, RNTCP, NVBDCP etc) • Do they have Meetings for reviewing progress of Districts, Blocks • Who checks validity (completeness/consistency) of data • State Demographer/ PMU? • Periodicity - Regular/adhoc • Is review analytical or target based • Do they rely on HMIS Portal data or other sources • Frequency of Feedback to Districts/Blocks

32. Key issues to be seen by CRM... (2) 2. District/Block/Facility level • IT infratructure (manpower, IT eqpmt, connectivity, electricity etc) • Are the HMIS forms available at the block/facility • see last few months data • Is the performance being reviewed at any level – Block upwards 3. State’s Capacity for training for State/ District/Sub-District level users on HMIS

33. Key issues to be seen by CRM... (3) 4. PIP Preparation for 2010-11 • Budget for M&E Activities • HMIS, Printing of forms, Training • IT enhancement • Quality Assurance, Community Monitoring • Provision for mobility to improve data quality 5. M&E Related queries be sent on hmis-nrhm@nic.in

34. Thanks Pravin Srivastava Director (Statistics) Ministry of Health & Family Welfare Government of India dirstat-mohfw@nic.in pravin.srivastava@nic.in