Agency : Directorate of health Services, Government of Madhya Pradesh

In order to improve the performance of the health sector and achieve the MDGs, the State Government will have to do a better job of tracking its performance on key indicators. Tracking performance more effectively will require that: (i) the quality of data collected is improved and that weaknesses in data quality are understood; and (ii) the resulting data is being used for making decisions. Currently, in India, there are serious issues of quality affecting many of the sources of data. Unfortunately, even when reasonably good data are available, they are not always used for decision-aking, policy improvement, and program implementation.

In view of the above, a study was carried out in Guna district of Madhya Pradesh to strengthen the existing information system. Village and subhealth center level records and registers for the health workers were redesigned so that they could understand the utility of data they were submitting to the stakeholders or to the government. Process documentation of piloting the new tools was also described.

To strengthen maintenance of sub-center level health records and registers in Madhya Pradesh, IhMR worked closely with the Department of Public health and Family Welfare, Government of Madhya Pradesh. Guna district of Madhya Pradesh was selected for piloting the project within a period of six months.

The overall objective of the pilot study was to review all records and reports generated under various programmes at different levels in consultation with different stakeholders to design the requisite records and report formats, which ensured ease of data capture and its use by the concerned functionarie

Key findings of the record review were as follows:

Based on the findings of the record review, the research team designed a 'Daily Service Diary' with supportive reporting format and a 'Village Register'. A three-tier training programme was designed and implemented for the district officers, supervisors and health workers. Logistics were provided to the health workers for four months through the Block Medical Officer. To build the capacity of the health workers regarding new tools, monitoring and supervisions were made for three consecutive months.

• The extent of physical closeness and sexual relationship between adolescent boys and girls living in rural areas was as large as observed in metros or other large cities in India. In most cases, such sexual relationships were unsafe. The community was not against the initiatives to build awareness for reproductive and sexual health among the adolescents. It provided ample space for interventions.
• Risk behaviour related to unsafe sex and substance abuse was quite significant in the youth in the study area
• There was little communication between the parents and children on issues related to future, marriage, health etc. There was a need to bridge these gaps.
  • To determine the effectiveness and impact of NCLP by carrying out a quick assessment of the functioning of project societies and special schools working under NCLP
  • To capture the perception of various stakeholders: the children, parents of the beneficiaries, implementing agencies, community etc
  • To study the impact of various components of the project, mapping their focus, their coverage and reported impacts of these interventions on child labour elimination
  • To focus on the termination of the NCLP projects where targets have been achieved
  • To examine the degree of involvement of the state government in the implementation and monitoring of NCLP
  • To understand the impact of additional components assessing the strengths and limitations of the partners and the types of interventions undertaken
  • Ensuring availability of health managers
  • Strengthening competency of health service managers
  • Improving health workforce management
  • Improving management of health care service delivery
  • Creating an enabling working environment for good management
  • Assess the operational status of the designated/functional First Referral Units in keeping with the critical parameters as prescribed in the guidelines issued by GOI.
  • Assess the operational status of the designated/functional 24x7 ChCs and PhCs in keeping with the critical parameters as prescribed in the guidelines issued by GOI.
  • Identify gaps in operationalization in those FRUs and PhCs which do not qualify as functional facilities.
  • Review of the Medical Manual of the Department of Public health & Family Welfare, GoMP in the backdrop of current policies, programmes and priorities and identify the changes that need to be effected in its structure and content.
  • Propose a revised version of the Medical Manual.
  • Assist the Department in the dissemination of the revised Medical Manual.
  • To overview the system of quality assurance followed in the the hospitals.
  • To assess quality of services from the perspective of patients at the health facilities.
  • To assess quality of services from the perspective of the health care providers.
  • To identify factors influencing poor quality of care and providing recommendations for improving the quality of services offered by the hospitals.
  • Improving the infrastructure including building and other basic amenities
  • Improving skilled manpower in the public health facilities
  • Proper equipment and furniture in the health facilities
  • Improving the quality of OPD, IPD and investigating services
  • Capacity building of MOIC/hospital superintendents
  • BCC training to the medical and para-medical staff
  • Reducing the work load from technical and nursing staff
  • Internal quality measurement mechanism for taking care of the hospital performance and patient satisfaction at regular interval.
  • The infant mortality rate was 38 per 1000 live births in the area. It declined significantly from 54 per 1000 live births in 2005. The infant mortality rate was lower than the state average.
  • Birth registration for children from zero to six months was 60%
  • As many as 90% of the children received colostrum and nearly half of them were breast fed within half an hour of their birth
  • Nearly two-thirds of the children between 0-6 months were weighed during the last one month and none of the children was in grade III/ IV of malnutrition. Nearly 65% of the children were fully immunized and only 3 per cent were not immunized.
  • As many as three-fourths of the pregnant women were registered for ANC check up and half of them got three or more ANC check-ups.
  • Institutional deliveries constituted only two-thirds of the total deliveries.
  • location, type, ownership, operational timings and contact details of the health facilities;
  • availability of services, types of wards and beds;
  • availability of infrastructure facilities;
  • diagnostic and investigating services; availability of major equipment;
  • availability of full-time and part-time human resources including medical professionals, para-medical and support staff;
  • utilization data for the last one year;
  • and fees structure and charges
  • Nearly 22 types of registers were maintained at sub-health center level whereas at the PhC level village health registers, but daily diaries were not maintained.
  • health workers were specifically maintaining a working register to record activities during field visits
  • Working registers mainly focused on MCh related information but also had columns on different registers provided by GoMP.
  • Information columns in service registers and frequency of reports generated varied from ANM to ANM.
  • All these led to overburden workload among health workers.
  • Further multiple reporting of the same information by the workers resulted in occasional submission of incomplete /inconsistent and incorrect reports.
  • There was no system of supportive supervision and feedback on registers.
  • It was also found that there was no mechanism for removal of obsolete and useless records after the completion of a programme.
  • Lack of continuous supply of printed registers and records and when supply of printed records got exhausted, workers tended to prepare handmade records and registers with different columns.
  • The following was the feedback on the pilot test of daily service diary and village health registers The simple language and systematic tabular form of daily service diary helped them to get the information faster, so the ANM did not need to put the data in the register once again for preparing the monthly report.
  • It was easier for the health workers to find out any data from DSD and for crosschecking for future reference.
  • Classification of data was much easier in the new diary as compared to the earlier one.
  • New modified NRhM Form 6 had solved the problem by keeping provision for every programme in one common format. As a result, paper work was also reduced.