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NEWS
24 Dec 2010
JICA-MP-RHP - Reproductive Health Project - JICA TQM Consultant invited as Guest Speaker for the Seminar on Bio Medical Waste Management in Gwalior (24th December 2010)

JICA TQM Consultant invited as Guest Speaker for the Seminar on Bio Medical Waste Management in Gwalior (24th December 2010) .. .....Details


16 Dec 2010
JICA-MP-RHP - Reproductive Health Project - The Common Review Mission visits Damoh district (16th 22nd December 2010)

The Common Review Mission visits Damoh district (16th - 22nd December 2010) .. .....Details


6 Dec 2010
JICA-MP-RHP - Reproductive Health Project - National Dissemination Seminar of JICA MP RH Project held at NIHFW, New Delhi

National Dissemination Seminar of JICA MP RH Project held at NIHFW, New Delhi .. .....Details


19 Nov 2010
JICA-MP-RHP - Reproductive Health Project - JICA Consultants oriented the Data Officers of DoHFW on use of GIS

JICA Consultants oriented the Data Officers of DoHFW on use of GIS .. .....Details


13 Nov 2010
JICA team invited for the Partners Forum on Womens and Childrens Health, New Delhi

JICA team invited for the Partners Forum on Womens and Childrens Health, New Delhi .. .....Details


19 Oct 2010
JICA TQM Consultant invited to present a paper at the Asian Network for Quality Congress Delhi 2010

JICA TQM Consultant invited to present a paper at the Asian Network for Quality Congress Delhi 2010 .. .....Details


12 Oct 2010
Dr. Kiran Ambwani, Deputy Commissioner (FP), MoHFW, GoI, visits Tikamgarh for the District level planning for MCH centres of Sagar division

Dr. Kiran Ambwani, Deputy Commissioner (FP), MoHFW, GoI, visits Tikamgarh for the District level planning for MCH centres of Sagar division .. .....Details


9 Sept 2010
Dissemination Seminar held to share the findings of the Terminal Evaluation Mission

Dissemination Seminar held to share the findings of the Terminal Evaluation Mission .. .....Details


8 Sept 2010
Joint Review Meeting of JICA Project held on 8th September 2010

Joint Review Meeting of JICA Project held on 8th September 2010 .. .....Details


30 August 2010
JICA Consultant presented a poster at the Global Maternal Health Conference

JICA TQM Consultant presented a poster at the Global Maternal Health Conference .. .....Details


17 August 2010
Madhya Pradesh becomes the first State to start the Public Health Management course at State owned Health Institute (SIHMC), Gwalior

Madhya Pradesh becomes the first State to start the Public Health Management course at State owned Health Institute (SIHMC), Gwalior .. .....Details


14 June 2010
JICA Consultant invited to present paper at Lal Bahadur Shastri National Academy of Administration, Mussoorie

JICA TQM Consultant invited to present paper at Lal Bahadur Shastri National Academy of Administration, Mussoorie .. .....Details


15 June 2010
Chief Representative, JICA India Office visited Project site

Chief Representative, JICA India Office visited Project site .. .....Details


24 May 2010
JICA Consultant nominated by DoHFW, GOMP, for Training of Master Trainers on BEmONC at New Delhi

JICA Consultant nominated by DoHFW, GOMP, for Training of Master Trainers on BEmONC at New Delhi .. .....Details


News Archives
 
Abbreviations
 

COUNTERPARTS
JICA - Counterparts
Ministry of Health & Family Welfare
 
Department of Health & Family Welfare
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ADVOCACY NOTES


GUIDELINES FOR BLOCK LEVEL ORIENTATION ON BMW

Core Competency Orientation Methodology

MH Card Orientation Methodology

JICA/MP-RHP TA for NRHM reporting formats
 
Briefing Memo to Department of Health & Family Welfare
Government of Madhya Pradesh

Briefing Memo to DoHFW on Information Management at the SHC level

Issues & Concerns on State HMIS: based on JICA field experiences

Recommended Information Flow



GUIDELINES FOR BLOCK LEVEL ORIENTATION ON BMW


Preparation

  1. The BMO should be first intimated about the purpose and need to orient the whole CHC staff on BMW.

  2. The preferred timing is after OPD hours.

  3. The BEE/BPM could be given the responsibility to gather the whole staff.

  4. Sitting arrangement should be identified and should be able to house on an average 30 people.

  5. Possible participants could be BMO, BPM, BEE, any other MO, if present, Staff nurse, ANM/LHV, Sweeper, Ayah, Ward boys, Lab assistants, Dresser, Compounder, Pharmacist, Peon.


Materials Required

  1. Model of colour coded bins.

  2. Posters and stickers for segregation of wastes. (for block) 2 sets

  3. Flip chart with markers. 1 set

  4. Laminated diagram of deep burial and sharp pit specification. 1

  5. Matrix on area wise bin requirement. 1

  6. Infection Prevention booklet. 1

  7. FAQ (to be handed over to the BMO/BPM/BEE) 1

  8. CD of Hindi dubbed movie on BMW (to be handed over to the BMO) 1

  9. Copy of Gazette of GoI (CPCB)

  10. Set of protective gears


Objective

To familiarize the participants with the following:

  • What is Bio medical waste and its types

  • Points of waste generation

  • How to segregate the wastes

  • Treatment of the segregated waste

  • Disposal of the treated waste

  • Roles and Responsibilities of the CHC staff for the above mentioned actions.


Process

Step 1 Introduction of participants and setting the stage

  • During the round of introduction, facilitator should try to build rapport with the participants.

  • Facilitator should ensure participation of all the participants, specially the lower wrung workers.

  • Facilitator should use this platform to build the team for BMW management within the facility staff.

  • Facilitator should build the understanding of the participants from BMW as “nobody’s business” to everybody’s responsibility” (Who log nahi hum log)


Step 2 What is Bio Medical Waste

  • What is bio medical waste?

  • What is infectious waste and non infectious waste? (make it participatory and let the participants state the two categories)

  • Example of Balwan kachra – infectious waste because it immediately infects and Kamzor kachra because after it rots, it infects.

  • The Balwan kachra is infectious and constitutes 15% of the waste generated in the hospital. Essential to segregate it. Use example of bad and good milk.

  • Why is BMW management so important and required- affects the health of the people working in the hospital first- several examples used including skin infections etc. Occupational hazard for health workers (Vyavasaya sambhandhi khatra)

  • Brief mention of CPCB and EPA Act and Authorization form and Fee calculation.


Step 3 Types of wastes generated and their segregation

  • Types of wastes generated in the hospital – interactive and participatory session

  • Discussion on what wastes generated from various points like Lab, Labor room, dressing room etc. This is a key session and all the participants should be involved in this.

  • The following table can be used as a template for guiding the discussion. Please note that this table should not be shared with the participants. It is just for the use of the facilitator and it is advisable that the facilitator should memorize this table.


Table 1 Types of waste generated and its segregation at source


Sections Black bins Red bins Yellow bins Blue bins /white puncture proof polybag or bin
Registration Papers      
Observation & LR Medicine foil, medicine packet, Spoiled medicines Gauze, Swabs, blood stained cotton, blood stained cloths, sanitary pad Placenta Needles, syringes,
Urobag, Gloves, broken bottles, IV set, IV bottles, Catheters, Blood transfusion bag, mucus extractor, enema set, venflon.
Post natal ward Medicine foil, medicine packet, Spoiled medicines, food packets, plastic carry bags, fruit peels, waste food items, paper cups Gauze, Swabs, blood stained cotton, blood stained cloths, sanitary pad, baby nappies, pus stained gauze Umbilical cord shedding Needles, syringes, Urobag, Blood transfusion bag,
broken bottles, IV set, IV bottles, Catheters, mucus extractor, cord clamp, enema set, venflon
Dressing room and Injection room Medicine foil, medicine packet, Spoiled medicines , paper cups Gauze, Swabs, blood stained cotton, blood stained clothes, Plaster , pus stained gauze Tissues Needles, syringes
Gloves, broken bottles
Laboratory Laboratory Reagents, paper cups Gauze, Swabs, blood stained cotton, Blood, urine ,stool, sputum sample, used uristiks, pus stained gauze Biopsy material Needles, syringes
broken bottles, Tubes, pipette , glass slides, lancets
Store Paper, medicine foils, packing material, expired medicine, paper cups     Broken injection vials, medicine bottles, pre-sterilised disposable items where the packaging is tampered

 

  • Revision of waste segregation according to colour codes should be done using a participatory game e.g. quiz, use of stickers and posters


Step 4 Treatment & Disposal of segregated wastes

  • The segregated waste form all the bins (except Yellow bin) should be treated before disposal.

  • The treated waste should be disposed off according to the categories.


The following table details how to treat the waste generated from each bin before it is disposed.


Table 2 BMW Segregation, Treatment and Disposal



Step 5 Role Distribution - (The BMO should be present during this session)

  • Facilitate discussion on role distribution related to BMW management.

  • It is important to be specific on the names/persons taking the role and responsibility and just not the designations.

  • The following table can be customized by name for each facility. Please note that this table should not be shared with the participants. It is just for the use of the facilitator and it is advisable that the facilitator should memorize this table.



Table 3 Proposed Roles & Responsibility of staff for BMW Management

Places of Waste Generation Who generates Waste Who should Segregate Treatment done by Who should Dispose
Labour Room LMO, SN, LHV, ANM SN, LHV, ANM, Dai, Sweeper (male or female) None Dai, Sweeper
Dressing Room Dresser Dresser   Sweeper
Laboratory Lab Technician Lab Technician   Sweeper
Store Room Store keeper Store keeper   Sweeper
Injection Room SN,LHV,ANM SN,LHV,ANM   Sweeper
ANC clinic LMO, SN, LHV, ANM SN, LHV, ANM   Sweeper
Minor / major OT MO,SN OT attendant   Sweeper
Wards SN, LHV, ANM, patients and relatives ward boy, sweeper, attendant   Sweeper
OPD MO, SN Peon   Sweeper
Medicine Distribution Compounder or medicine distributor Compounder or medicine distributor   Sweeper

 
Step 6 Plan for Supply

For ensuring implementation of BMW, availability of supplies like bins, gloves, tub for treatment with hypochlorite, aprons, etc. is essential. Therefore discussions on this should be ensured with the BMO.

  • Lime (chuna)

  • Funnel (chungi)

  • Dustbin with pores

  • Large scissors to cut plastic waste

  • Tub, bucket

  • Utility gloves for sweepers

  • Apron , mask

  • Coloured dust bins and bags

  • Bleaching powder to make 1% hypochlorite solution

  • Autoclave with electric supply


Core Competency Orientation Methodology


GUIDELINES FOR BLOCK LEVEL ORIENTATION ON CORE COMPETENCY

Preparation


  1.  The BMO should be informed about the purpose and need to orient the field staff on Core Competency skills.
  2.  Since it is a two days activity, preferred days should be Wednesday and Thursday, so as to the routine work is not disturbed.
  3.  BEE/BPM could be given the responsibility of ensure participation of the field staff at the block level.
  4.  The venue of orientation should have the capacity to house on an average 80 participants.
  5.  2-3 rooms are available for the participants to do skill practice in smaller groups.
  6.  The participants would include all the ANMs, MPWm, LHVs and MPS from the field, ANMs and LHVs posted at PHC and CHC in the block.
  7.  A minimum of 4 facilitators are required for each batch.
  8.  MPW-Ms /MPS are called only for Day 1.
  9.  Day-wise skill practice: Day 1- Measuring of height & weight, Recording of pulse and BP, Hb estimation, Urine examination for albumin & Sugar.
  10.  Antenatal cases (second trimester) are to be arranged for demonstration and practice session on Day 2. It should be in ratio of 1:2 (participant: ANC case)

 

Materials required
Participants’ kit (1 for each participant)

  1. ANC training module (Part I)
  2. ANC skill checklist
  3. MH card - 2
  4. Set of Posters
  5. Note pad and pen

SHC kit (1 for each SHC team)

  1. ANM bag
  2. BP apparatus
  3. Stethoscope
  4. Hb kit
  5. Spirit
  6. Glycerine


Facilitators’ kit (1 for each facilitator)

  1. ANC training module (Part I)
  2. ANC skill checklist
  3. MH card - 2
  4. Set of Posters
  5. Note pad and pen
  6. Core competency flip chart
  7. BP apparatus
  8. Teaching Stethoscope
  9. Hb kit
  10.  Spirit
  11. Glycerine
  12. Uristix (Urine test kit)
  13. Lancets
  14. Cotton swabs
  15. Empty bottles for urine samples Inch tape
  16. Adult weighing scale
  17. Flip chart and markers


Objective

  • To orient the field staff on core competency skills required for a complete antenatal checkup.
  • To facilitate hands-on practice of these skills on ANC cases.


Process


Day 1 (11 am to 5 pm) Participants are ANM, MPW-M, LHV and MPS
Step 1 Introduction of participants and ice breaking

  • During the introduction, the facilitator should try to build rapport with the participants.
  • Facilitator should ensure participation of all the participants.
  • Facilitator should build the understanding of the participants on the importance and need of core competency skills for ANC checkup.
  • Participants should express their expectations from the training.
  • Facilitate team spirit amongst the SHC group.
  • Involve the MPW-M in discussion of their roles in antenatal checkups in the field.


Step 2 Current status of ANC checkups

  • In a participatory mode, start discussion on what are the parameters for antenatal checkup.
  • List down the most common parameters practiced by workers within the group
  • Try to assess the constraints faced by the workers to carry out complete antenatal check up.
  • Participants should share in which skills they are confident and which one they need more practice.

Step 3 Setting the ground for Day 1

  • Distribute the training kits to each participant and explain use of each item in it.
  • With the help of Core competency flip chart, explain theory part of some of the antenatal care topics. These are- Abdominal palpation, Anaemia in pregnancy, Pregnancy induced hypertension (PIH), Antepartum haemorrhage (APH),.
  • Explain day-wise skill practice plan to the participants.
  • Divide the participants into 4 smaller groups and make one facilitator in-charge of each one.


Step 4 Demonstration of skills of ANC checkup

  • The facilitator should demonstrate the following skills on the first day – Measuring height, recording weight, pulse monitoring, blood pressure recording, urine estimation for albumin and sugar, hemoglobin estimation.
  • The facilitator should introduce all the instruments and materials required for the above mentioned checkups. The facilitator should explain in detail the various parts of the instruments and how to use them.
  • ANC skill checklist must be used to demonstrate each skill.

    Step 5 Skill practice
  • The facilitator should ensure that separate rooms or areas are available for group work
  • The facilitator should then ask the participants to practice the skills on each other. The minimum number of practice for each skill should be as under:
    • Measuring height - 2
    • Recording weight - 5
    • Pulse monitoring - 2
    • Blood Pressure recording - 12
    • Urine Albumin estimation - 2
    • Urine Sugar estimation - 2
    • Hemoglobin estimation - 10
  •  Facilitator should monitor skill practice of each participant and also help them when needed.
  • Each participant should write down details of each skill practice i.e. name of the case, reading of the chekup etc.
  • Pay more attention to the skill practice by MPW-Ms as they would not be attending the Day 2 session.
  • At the end of session, assess how many times each skill is practiced by each one.
  • Get feed back of the day’s session from the participants before they are dispersed.


Day 2 (11 am to 5 pm) Participants are ANM and LHV

Step 6 Setting the ground for Day 2

  • The facilitator should start the session by taking the feedback of the previous day from the participants.
  • Introduce to the day’s proceedings and expectations from the participants.
  • Each participant should try to do
    • Abdominal palpation 5
    • FHS monitoring 5
  • Facilitator should also encourage them to practice BP recording and Hb/urine testing if they haven’t gained enough confidence.

Step 7 Case demo

  • Form 4 smaller groups with 1 Facilitator in-charge of each one.
  • The ANC cases invited on the second day should be equally divided as per the number of groups formed.
  • The facilitator should explain the participants again about anemia in pregnancy, PIH/Eclampsia and APH .
  • The facilitator should then demonstrate how to do abdominal palpation for measuring fundal height and how to monitor FHS (Foetal Heart Sound) on one of the ANC cases.
    Step 8 Skill practice
  • Ensure that the groups have smaller rooms or enclosed area for Antenatal examination.
  • ANC cases and their attendants should be made comfortable during the sessions by explaining them the process and offering them refreshments and water.
  • The facilitator should then ask the participants to practice the skills on the ANC cases.
  • The facilitator should ask the participants to fill up the MH card simultaneously during the practice session
  • Facilitator should monitor skill practice of each participant and also help them when needed.
  • Each participant should write down details of each skill practice i.e. name of the case, reading of the chekup etc.


Step 9 Discussion

  • The facilitator should take feedback from the participants about the skill practice.
  • The facilitator should then try to take the commitment from the ANMs for initiating and conducting regular ANC clinics in their respective duty stations. The facilitator should stress upon having a fixed day for holding ANC clinics.
  • The facilitator should initiate discussion about the availability of materials for conducting ANC checkups. The BMO should be asked to provide probable solutions on the spot.


Step 10 Distribution of kits and TA/DA

  • The facilitators should then ask the BMO to distribute the kits to the SHC team. A receipt of the same should be taken.
  • The kits can be distributed either at the end of Day1 or starting of Day 2- depending upon the availability of the BMO.
  • The facilitator should also ask the BMO to get the kits entered into the block level stock register for further actions.
  • The workers should be instructed to take the kit on stock books. These kits are to be used by them during VHNDs and clinic days.
  • In the end, the travel and daily allowances of the participants should be distributed.



MH Card Orientation Methodology

Background

The Department of Health & Family Welfare (DoHFW) has committed for the usage of MH card in the Jabalpur and Sagar division in the State PIP of 2007-08. Going by the quality of JICA implementation standards, a structured orientation is required for the frontline workers before the distribution and initiation of recording on the MH card. Although from the Project Implementation Strategy point of view, the focus is mainly on the Sagar division, yet there is a pertinent need to develop a standardized methodology for the MH card orientation, considering the number of blocks left in Sagar division itself.



Training Load

The training load is of 8+5 districts, of which within Sagar, there are 37 blocks. Thirteen blocks of Damoh and Tikamgarh have already been oriented during the Core Competency skill training in 2006-07.



Need for Innovation in Methodology


Uptil now, the ANMs had been oriented on the MH card on the 5th day of the Core competency Training. The benefit of this approach was the established rapport and skill enhancement during the first four days. Therefore the MH card was viewed as a tool to record whatever the participants had learnt during the training. It was never viewed as an additional burden. However, the limitation in virgin blocks where ANC trainings has not taken place is the lack of rapport and skills related to data elements mentioned in the MH card. Given this limitation, the methodology was improvised and has been detailed below.



Duration of Orientation

  •  1 day

 


Participants

  •  ANMs, MPW, LHV and Male Supervisors from all SHCs. MPWm were also called because it has been observed that field level recording and reporting is usually done by the MPWs. The assumption is that if MPWm are involved then the quality of data recording might improve, which currently is posing a big challenge to the Project Implementation.



Preparation Required

  •  Fixing of block wise date of orientation with the DPM and CMHO.



Materials to be taken

  •  MH Cards and guidelines.

  •  Sets of 20 cards to be given to each SHC initially and then to be replenished after review of data quality and precision of recording in the first 20 cards.



Resource Persons


Facilitators from JICA Project Staff



Methodology


Step 1: Address and set the objectives by BMO/local block official

Step 2:Introduction within participants and Resource team.

Step 3:Introduction about JICA and its functioning

Step 4: Discussion on the Maternal Health services being provided by the workers in the field and gauging the quality of ANC services being currently provided by the workers.

Step 5: Interactive session on available mechanism/recording tools available for Maternal health. Objectively pointing out the shortcomings/problems existing in the currently available registers. Simultaneously building the need to have a more structured recording system which can track each case.

Step 6: Introducing the concept and design of MH Card (purpose, need etc.) and facilitating discussion on the benefits from it for the service provider as well as the client.

Step 7: Cell by cell orientation using the MH Card guideline. Encourage all queries pertaining to the actual collection of each data element.

Step 8:Mock session on MH card filling. Groups to be divided sector wise and within each group, roles to be played of 1 ANM, 1 MPW, 1 Supervisor and 1 ANC case.
Tips for facilitation of mock session:

  •  Let the group decide who plays what role.

  •  Don’t hint on who should fill the card. Observe what the group does, it’s a reflection of the field scenario.

  •  Encourage the ANC case role player to pose actual field like situations.

  •  Ensure the participation of other workers also.

  •  Coach the Supervisor on his/her probable role.



Step 9:Agreement on when to start filling of the new cards. Usually, this is for fresh cases coming from the next month onward.

Step 10:Consensus on role distribution for MH Card. The roles could be as follows:

  •  Skill practice and telling the reading by ANM. The MPW can also perform most of the check ups except abdominal palpation.

  •  Actual recording and data entry by MPWm.

  •  Supervisor validates the cards – including data quality checks.



Expected Outputs:

  •  Front line workers get oriented on how to fill the MH card

  •  Role Clarity for MH card
     Go to Top




JICA/MP-RHP TA for NRHM reporting formats


The new NRHM reporting formats were rolled out to the States from MoHFW in September 2008. The State of M.P. has taken the initiative to take these formats to the district level and JICA/MP RHP has been constantly providing TA for this purpose to the DoHFW.

Despite continuous TA by JICA and repeated seminars/workshops at the State level in the past one year, the new reporting formats have not been operationalised yet. The purpose of this paper is to review JICA’s contribution to this topic since 2007, as a Technical Collaborator to NHSRC, and a Facilitator of the implementation at the State level.

Jan 2007- HMIS Consultant had participated in the National level brain storming session held at NHSRC to streamline the data elements.

Feb 2007 – The proposed NHRM reporting formats and the relevance of the data elements were field tested in Damoh. The NHSRC HMIS Expert had come for the same.

June 2008 – NHSRC HMIS team visited JICA Project office to finalise the data elements and the definitions given in the data dictionary.

Nov 2008 - The Hindi translations of the finalized NRHM reporting formats were done by the JICA/MP RHP team and shared at the National level. These were well appreciated by the M&E division at MoHFW. The DoHFW introduced the same formats throughout the State.

March 2009 - (1) JICA/MP RHP team was invited by the state to take the session on orientation of the Reporting formats to all the divisions and districts. The participants included the DPM/ASO and DEA from each district. The participants were oriented on each data element. During the orientation, many issues came up which required state specific decisions.

(2) JICA/MP RHP partnered with NHSRC to prepare the Data dictionary in Hindi for the data elements in the reporting formats. This dictionary is now being used by the state and has been circulated to all the districts during the state level Orientation.

10 April 2009 – A small consultation was held in the DoHFW with Dr. Archana Mishra (Deputy Director- MH), Dr. Jayshree Chandra, Dr. Ashwin Bhagwat and the State Data Officers to review each data element in detail. This was the second time this exercise was being undertaken. JICA team deliberated on all the data elements and others to be included. The output of this meeting was more a consensus on the new formats and familiarization with the new formats.

22 April 2009 – JICA team met the JD (RCH) to chalk out a plan for rolling out the NRHM formats at all levels in the State. The main decisions reached, with the TA of JICA, were to allow the districts to print the formats at their level for the first three months since large scale printing from State would have some procedural delays. Considering that this was a transition phase for HMIS reforms, it was also decided to retain the old reporting formats till the new system is perfectly implemented.

28 April 2009 - The JD RCH, Dr. S.K.Shrivastava, had called a special meeting of all the Program division heads to discuss each data element and reach a consensus for State level customization, if required, of the reporting formats. JICA/MP RHP facilitated the discussion on each data element. The suggested changes were incorporated and shared with the JD (RCH). However, the changes were not taken up and it was decided that the original formats proposed by the National level only be retained.

Aug 2009 – It came to the notice of the Project office that most of the districts have not yet operationalised the formats. Field visits to Damoh and Panna revealed several operational hitches. Despite the fact that the letter for printing the formats at local level had been sent on 28 April 2009 but most of the districts had not acted upon it. As is usual the case, it needed more follow-ups to actually get it operationalised at the district level. This situation was discussed in detail with the SDOs. Taking cognizance of all these situations, the SDOs had already planned a state wide orientation. The DoHFW requested JICA team to be one of the core facilitators. This workshop spaced over 6 weeks will be carried out in all divisions including Bhopal, Indore, Ujjain, Jabalpur, Sagar and Gwalior.

The contributions of JICA for the first divisional training held on 3-4 August at Bhopal has been mentioned as under:

  •  Rechalking the agenda with a logical flow

  •  Giving the design for Capacity building of the NRHM formats at various levels, this is going to be followed for all districts.

  •  Explaining to the district teams the difference between the old and new information flow for State HMIS.

  •  Matching the source of information between old and the new NRHM formats as well as for other programs like immunization, blindness control etc.

  •  Roles and responsibilities for reporting at SHC, PHC, CHC and DH level.

  •  Usage of GIS for health systems management and monitoring.


Through these experiences, JICA concludes that so far the efforts done by the State for the Capacity building of Data Managers (district level) did not materialize the regular input of data. Retrospectively, there was a need to synchronise the introduction of the software, capacity of the data managers, capacity of the data collectors and the proper printed formats in order that the State takes initiative in proper reporting and in accordance with the NRHM norms. The most delayed part, namely printing of formats, should be accelerated.

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Briefing Memo to Department of Health & Family Welfare
Government of Madhya Pradesh

COMMENTS ON HMIS STRATEGY WITH PARTICULAR
REFERENCE TO THE ROLE OF DEO

At the outset, JICA would like to appreciate the State on the decision to appoint DEOs at block and district level. While welcoming this decision, JICA would like to reiterate that the post of DEO has high potential which can be capitalized for effective implementation of the RCH II and NRHM Programs. It also would be helpful in meeting the objectives of the HMIS component of JICA which stresses on:

  1. Authentic data generation

  2. Data validation

  3. Use of information for evidence based planning and monitoring.
     (Performance rewardal forms an innate part of the component.)

The DEOs can be the main catalysts for actualizing the shared vision of the State and JICA.

A three day training (17 to 19 April, 2007) for the Data Entry Operators (DEO) of Damoh had been organized by JICA (Annex 1- Training Session Plan). This training was designed and conceptualized to meet the requirements of the district level health administration. One of the main outputs of the training was to clarify the potential role of DEOs (Box 1) in ensuring better implementation of the RCH II and NRHM.

Box 1 Potentials of DEOs
  • Computerizing all manual records (including reporting formats), schemes status, stock inventory etc.
  • Acting as catalysts for undertaking Data validation through computerized auto checks.
  • Ensuring timely upward and downward flow of information
  • Ensuring easy data retrieval systems
  • Providing summary reports to BMOs before monthly meeting for Section/Worker wise appraisal and performance of other National Health Programs.
  • Keeping track of stock situation.
  •  Sending the MIES of NRHM electronically.

During the course of the training, the session on the various formats existing at the field level brought to light the need to review the formats being filled by the ANM and the multiplicity of information being generated through the various formats. Alleviation of the work load used for the generation of un-used information at the first level of data inputting is required. JICA, with the expertise and guidance from the State, proposes to undertake a systematic analysis of the formats at the field level.

Computerization of the data being generated currently will help in better and timely flow of information and the systematic use of this information for promoting evidence based planning and management. Table 1 highlights the areas of Capacity Building that are currently being undertaken by JICA to improve the HMIS. The Center may consider the possibility of taking Damoh as a pilot district for operationalisation of HMIS.

Table 1 Multi level intervention of JICA at various stages of HMIS

HMIS
stage		 Recording Reporting Planning Monitoring
ANM Authentic data generation.Systematic filling of Form 6.      
Super-visor Scientific data compilation for preparing Form 7. Data validation through Consultative Supervision.    
Computer post   Timely collection of all forms, with the cooperation from BEE.    
DEO   --Sending Computerized data (Form 6 & 7) to district headquarters.
- Ensuring timely reporting.
-Assisting the BMO in data validation thus ensuring the quality of data generated.
-Sending the monthly MIES.
- Preparing reports of meetings including follow ups.		 Providing analytical summary of performance of RCH II, NRHM and other National Health Programs to BMO.

Providing the status of stock for timely reorder levels.
Ensuring timely and easy data retrieval.
Ensuring follow ups planned during monthly meetings.		 Generating monthly summary of Section wise/worker wise performance.
BMO     Based on report provided, plan the implementation strategy and area of focus. Evidence based performance rewardal.
DPM (CMHO office)     Based on report provided, plan the implementation strategy and area of focus. Monitoring block wise performance.

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Briefing Memo to DoHFW on Information Management at the SHC level

DUPLICATION OF INFORMATION AT SHC LEVEL

 

Duplication of information generated at the SHC level has become a challenge for the frontline health workers especially the ANMs, to maintain a useful and comprehensive data base which can be used as a ready-reckoner. The need of the hour, therefore, is to make a thorough survey of the existing registers, reports, channels of flow of information and the utility of the existing recording system at the SHC level. The following table is an attempt to summarise the existing information system at the SHC level. Based on the findings, a set of recommendations to streamline the information system at the SHC level has also been given.

Register No. Name of Register Corresponding entry in Village Health Register Corresponding Entry in Form 6
1 Village Health Register    
Duplication between Village Health Register & Independent Register
2 Depot Holder Register Depot holder  
3 DOTS Register Details of DOTS provider 13.2
4 Pregnancy Registration Pregnancy Registration 1
5 Mother & Child Care Register ANC Services & Outcome of pregnancy 2, 3, 4, 5, 6, 2.1, 2.2, 2.3, 2.4, 3.1,3.2
6 PNC Register Services provided to lactating mothers 4.1,4.2, 3.3,
7 SHC Immunisation register Immunisation 7, 7.1, 7.2,7.3, 7.4, 7.5, 7.6, 8
8 Eligible Couple Register    
9 VT Register    
10 Copper T Register Eligible Couples and their details 11, 11.1, 11.2, 11.3, 11.4, 11.5, 11.6
11 Nirodh Register    
12 Oral Pills Register    
13 Birth Register Birth Registration  
14 Marriage Register Marriage Registration  
15 Death Register Death Registration  
16 Slide Register Malaria  
17 Cataract Register Blindness Registration  
18 School Health Register School health  
19 Leprosy Register Leprosy  
Other Relevant Entries in Village Health Register
    Referral Cases 10
    Details of Communicable diseases 9.4, 9.2
    Malnourished Children 7.3
    Deen Dayal Antyodaya Scheme  
    Prasav hetu Parivahan  
    Blindness Registration  
Other Suggested Entries in Village Health Register (which are not being registered systematically)
    High risk Infants referred to PHC/FRU 3.4
    Details of when maternal death took place 5, 5.1 to 5.3
    RTI/STD cases 6
    Diphtheria cases 9.1
    Polio cases 9.1
    Neonatal Tetanus 9.2
    ARI 9.3
    Abortion details 12
    Time of infant death 10
Other Registers
20 Stock Register


Can be clubbed into one Register


Monthly Stock position
21 Vaccine stock Register
22 Medicine stock Register
23 JSY Register Can go into Village Health Register
  
24 Mahila Mandal Register
All IEC/BCC activities can be clubbed into one Register		  
25 Village Health Committee Register  
26 Attendance Register


Can be clubbed into one Register		  
27 Daily Diary  
28 ANM Work Register  
29 Survey Comment Register  
30 Rough Register  
       

Therefore, Proposed Registers and Reports at SHC level:

Register No. 1
Village Health Register (with some proposed new entries)

Register No. 2
Maternal Health Card (by JICA) (ANC, INC, PNC details, as per requirements of the Annex 3B of the RCH PIP II)

Register No. 3
Stock Register

Register No. 4
IEC/BCC Register

Register No. 5
ANM’s working records (ANM Karya Pustika / Daily diary)

Some relevant suggestions for Village Health Register:

  • Colour coding

  • Matching data inputs with Annex 3B

  • Having a detailed guideline to enter the data (like ANC card guideline)

Report
Form 6 with the following modifications

  • caste desegregation

  • including some other entries (as per the requirements of the MIES of NRHM and entries required in Annex 3B)

  • including scheme details

  • the columns on past years could be deleted

  • there could be a column/comment provision for source of information

  • the quality of paper should be improved

  • colour coding could be adopted for some entries

  • All NHP should be included

  • Using self carbon sheets.

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ISSUES & CONCERNS ON STATE HMIS: BASED ON JICA FIELD EXPERIENCES

SHC level

1. ANMs are overwhelmed by the burden of reporting

  • A total of about 30 Registers, 4 records, 7 lists and some other reports are being filled by the ANMs.

  • Most of the records/reports just reflect the working efficiency of the ANMs. There is no reflection of the work of the MPWm.

  • The role of MPWm in reporting has not been stressed leading to a unipolar division of work.

  • There is a lot of multiplicity of information being generated at the field level.

2. Lack of clear guidelines leads to inconsistency in reporting and generation of
(sometimes) non authentic and irrelevant data.

  • At the field level, the ANMs differ with each other in the information related to the formats they are filling. Thus pointing to the fact that there is no uniformity of the formats at field level.

  • The anatomy of source of information for the various parameters being reported is also not clear.

3. Form 6 is the most accepted and comprehensive reporting format at the SHC level

  • Form 6 is the major form being used for reporting RCH & FP Programs; however, some of the shortcomings of the Form include issues like absence of caste disaggregation, inability to do case monitoring of ANC cases, anomaly in reporting versus recording formats etc.

4. Capacity Building needs

  • At the sector level, the Supervisors need to be oriented on validation skills.

  • There is no supervision of quality of data being generated by the ANMs or any feedbacks given to them.

  • The ANMs lack orientation on the way to fill the various formats, the implication of each entry, source of information for each entry in the reports, taking correct readings, recording timely data, units of measurement, correlation between various parameters etc. They need to be oriented clearly on each format they are filling.

  • Reorientation of all health workers on vital health indices, their calculations, their demographic significance needs to be undertaken as a priority.

  • Demystified version of the recent data like NFHS needs to be shared with the frontline health workers.

Block level

1. Reporting Mechanism

  • There is no uniformity in the formats being sent from the block to the district level. For example, in some districts, the blocks are sending the P1 & P2 forms; some are sending the main information in Form 7 & 8 etc.

  • Efficient usage of computers needs to be promoted at the block level.

  • Proper orientation (each entry) on the MIES (NRHM) format needs to be done for the block level officials. The source of information for each entry needs to be clearly spelt out to establish uniformity.

  • The monthly data needs to be consolidated section wise and used for evidence based monitoring, management and planning (being promoted in Damoh).

  • The information needs to be sent in a computerized format from the blocks to the district.

2. Human Resource Organisation

  • There needs to be clearly defined roles and responsibilities between the BEE, Computer and DEO cadre.

District Level

1. Reporting Mechanism

  • The DEOs have a lot of potential and they can be utilized for facilitating evidence based health planning, management and monitoring (Please refer to Briefing memo dated 27 April 2007).

  • In context of Family Planning & RCH Programs, 3 basic reports (apart from the Maternity benefit scheme reports) are being sent from the District to the state. They are the MIES (NRHM) report, Family Planning Welfare Report and the RCH Management Report. However, the basic information sources for most of these reports are the Forms 6, 7 and 8 from lower levels.

  • The MIES is a new format and requires caste desegregation of data which is not generated at the lower levels.

  • There are other reports like the Chief Minister’s report, other scheme reports, institutional deliveries report etc. All these need to be scrutinized  and uniformity established with just one reporting format through the State.

  • The rural urban desegregation of data seems to be conspicuous in its absence. (Urban health is emerging as a major cause of concern).

  • The reporting format for block and district are not in similar format for many parameters. Therefore compilation at district level becomes a very time taking process since it requires data transfer and compilation from one format to another.

State level

  • The flow of information from SHC up to the State needs to be worked out in detail. There seems to be ambiguity at various levels. A preliminary attempt depicting the current mechanism of flow of information has been given in Fig 1.

  • New reporting formats are being introduced without discontinuing the older formats. In consequence---------- see ‘SHC level’.

  • The information of discontinuation of older systems of reporting is not there at the lower levels leading to confusion and burdening the frontline workers with duplication in reporting.

  • Focal point for receiving, collation and analysis of the monthly reports is totally missing at the State level. Therefore there is discrepancy in frequency of submitting monthly reports by the districts.
    It is required to give the MIES format in a bilingual form for the ease of the DEOs.

  • Field testing of formats needs to be undertaken before introducing them to the workers in all the States.

Suggestions

Capacity Building Needs

  • The front line workers need to be given clear guidelines on filling formats, source of information for each entry, taking and recording correct readings, units of measurement and implication of each entry.

  • The health workers need to be oriented on the basics of vital health indices, their importance as health indicators etc. and subsequent importance of their reports.

  • The BEE and Supervisors need to be taught skills of data validation and feedback mechanisms.

  • The DEOs need to be appointed and their potentials used for timely data entry for efficient data usage by BMOs through the reports generated by the DEOs.

  • Capacity building of block and district level officials for Evidence based planning and management.

Human Resource Organisation

  • Clear role division needs to be spelt out for the responsibility of filling the reporting formats.

  • There needs to be clearly defined roles and responsibilities between the BEE, Computer and DEO cadre.

Usage of information generated through HMIS

  • Timely analysis of information generated at one focal point is essential. Information storage should be such as to promote easy data retrieval.

  • Usage of this information for evidence based planning, management and monitoring at various levels (state, district, block and supervisor) needs to be promoted.

  • This information should be used for rewarding/recognizing good workers and taking to task the less or non- performers.

Reporting Mechanism

  • Universalizing the reporting formats at each level to avoid ambiguity.

  • Discontinuing older formats and standardizing the formats to avoid duplication of information generated. This will also reduce the work load of ANMs.

  • Having standard time lines to ensure smooth flow of information.

  • Field testing any formats before introducing them at scale.

  • Computerized flow of information from block level and upward should be encouraged.

  • Any computerized format should be bilingual nature, for the ease of the DEOs and other block level officials.

  • Establishing mechanism for feedback.

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