User guideline on MIES reporting Format Statistics Division, MoHFW, New Delhi The objectives of user guideline To ensure uniformity and consistency in understanding of the monitoring indicators across States and Districts; To facilitate standardized compilation and calculation of the various indicators at various levels of health care system; To facilitate the programme managers and other stake-holders in tracking monitoring indicators through use of standardized definition of indicators. To facilitate peripheral staff who are engaged in the data collection to clearly fill the information without any ambiguity. Contd.. The guideline will help in compiling good and robust data arriving at reasonable estimates of monitoring indicators and comparisons between different points in time. National and State programme Managers, Demographers, Mission Directors, CMOs etc .can also use these guidelines for monitoring the performance, making comparisons across states and districts and, provide insight to taking recourse to mid term corrections in the health programmes. Organisation of the User Guideline CHAPTER - 1 Monthly reporting format from state to centre CHAPTER – 2 Quarterly reporting format CHAPTER – 3 Annual reporting format CHAPTER – 4 General concepts and definitions CHAPTER – 5 Indicators for local level health planning List of references Important links / websites Chapter -1 monthly reporting format from state to centre The Monthly reporting format of the MIES contains data relating to : The special information on CHC and PHC up-gradation, Reproductive and Child Health indicators and Inventory status. These suggested indicators should be tracked on a monthly basis. This Chapter has three main sections: Section 1A covers “Special Information on NRHM agreed indicators” given in items M100 to M400 of the MIES monthly format. Section 1B provides information on “Reproductive Health” related information covered in M1 to M16 and Section 1C provides information on “Monthly Inventory Status” covered in items M17 to M19 of the MIES Monthly format. 1A. art A. Special Information Part A of the monthly format contains some special information with regard to the performance of the public facilities such as CHC upgraded as FRUs PHCs functioning as 24 hrs RCH services Total number of FRUs, CHCs and 24 hrs PHCs that are conducting at least 10 Wet mount tests per month and stock certain critical items. M-100 Performance of CHCs upgraded as FRUs This section deals with capturing information on the performance of CHCs that have been upgraded as FRUs. As this is a separate compilation, there would be a certain level of duplication on a few items like the no. of deliveries, C-Section etc. being captured in item no M2 (2.2) & M3 (3.1) which is for all the CHCs whether they are FRUs or not. This duplication is intentional. First Referral Unit (FRU) An existing facility (district hospital, sub-divisional hospital, community health centre etc.) can be declared a fully operational First Referral Unit (FRU) only if it is equipped to provide round-the-clock services for Emergency Obstetric and New- born Care, in addition to all emergencies that any hospital is required to provide. Minimum services to be provided by a fully functional FRU 24-hour delivery services including normal and assisted deliveries Emergency Obstetric Care including surgical interventions like Caesarean Sections(*) and other medical interventions New-born Care(*) Emergency Care of sick children Full range of family planning services including Laproscopic Services Safe Abortion Services Treatment of STI / RTI Blood Storage Facility (*) Essential Laboratory Services Referral (transport) Services (*): Critical determinants of functionality M-200.Performance of PHCs functioning as 24 hr RCH centres This section deals with capturing information on the performance of PHCs that are functioning as 24 hr RCH Centre. This is a separate compilation, there would be a certain level of duplication on a few items like the no. of deliveries, C-Section etc. being captured in item no M2 (2.2) & M3 (3.1) which is for all the PHCs whether they are functioning as 24 hr. RCH Centre or not. 24 x 7 PHC NRHM envisages that all the Primary Health Centres should function as a 24x7 centre in a phased manner to improve the availability of health care services and also promotes the conduct of institutional deliveries at these centres. Contd.. A 24 hour PHC :provides Basic Essential Obstetric Care and reproductive health services which includes (i)24 hour delivery services (assisted +normal), (ii)Essential new born care, (iii)Referral for emergency (iv)Routine ANC (v)PNC and (vi)Safe Abortion services (vii)Family planning (viii)Prevention and management of RTIs/STIs. (ix)Essential lab services. The steps that may be needed are as follows: Conduct an institution specific facility survey and identify the gaps. In order to make the PHC 24x7 delivery of services, There should be at least 4 Staff Nurses (to perform rotation duties round the clock. ) To improve the institutional deliveries, appointment of at least three Staff Nurses may be recruited on contractual basis to fill the gaps. A labour room with appropriate equipments and drugs with Round the clock referral transport support either managed by the PHC or by the NGOs / CBOs for referring patients in case of emergency is essential. Appointment of two Medical Officers (MBBS) preferably one lady MO), and one AYUSH practitioner, either by relocation or on contractual basis. All effort should be made to see that all the PHCs have the Medical Officers. Contd.. PHC buildings should be made environment friendly, disabled friendly, with a good source of water supply, electricity / solar power / other alternative energy sources and telephone. Utilization of untied fund for strengthening the functioning of PHCs. Utilization of Annual Maintenance Grant for strengthening the infrastructure and basic necessities Each PHC must have a Rogi Kalyan Samiti (RKS) and display of the Citizens’ Charter that should spell out the details of the health services available at the centre. Once a specific PHC has achieved the 24x7 / IPHS status, the district authority / state authority should declare the institution as 24x7 / IPHS and continuously monitor that these standards are being maintained on a regular basis. M -300. M -300. Total number of FRUs, CHCs and 24 hrs PHCs that conducted at least 10 wet mount test (Refer 4.21 Chapter 4) per month is to be recorded (This is one of the agreed indicators that are to be monitored monthly.) M-400. This provides Monthly Stock of Critical items (viz. Injection Oxytoxin, Gloves, MVA Syringes, Tab. Fluconazole, Blood transfusion sets, Tubal rings, Gluteraldehyde 2%, Oral pills, Measles vaccine, Vitamin A Solution, Ad Syringes etc.). The Logistic Management Information System has to be need-based and a mechanism of buffer stock management has to be in place at all levels of the health system. Number of Districts having stock-outs(Refer 4.22 Chapter 4) for these critical items (400.1 to 400.11) at any time during the month to be recorded 4.22 Stock-outs Sufficient stock is defined as the quantity required meeting estimated consumption needs for the following period (month/quarter/year). No facility can afford to keep sufficient stock to meet every demand. Inability to meet a demand due to lack of inventory is called Stock-out. Unit of measurement : Stock out percentage It is calculated as the % of number of orders which could not be satisfied to the total number of orders. For items (400.1 to 400.11) take the monthly stock average of an item during last financial year. Thus if Stock available at the time of recording is less than one-third of the monthly average it should be considered as Stock-out. 1B. Part B: Reproductive Health Disaggregated data by SC, ST and Others to be recorded for the reporting month for item M1 to M16 M1 ANTE NATAL CARE SERVICES M2 DELIVERIES M3 NUMBER OF CAESAREAN (C-SECTION) DELIVERIES PERFORMED M4 PREGNANCY OUTCOME M5 NUMBER OF CASES OF PREGNANT WOMEN IDENTIFIED WITH OBSTETRIC COMPLICATIONS AND ATTENDED M6 MATERNAL DEATHS / DEATHS OF WOMEN (NUMBERS) M7 POST PARTUM CARE M8 MEDICAL TERMINATION OF PREGNANCY (MTP) Contd.. 1B. Part B: Reproductive Health ......Contd.. M9 RTI/STI CASES M 10 CONTRACEPTION M11 NUMBER OF ELIGIBLE COUPLES ACCEPTING PERMANENT METHODS FOR CONTRACEPTION M12. JANANI SURAKSHA YOJANA (JSY) M13 CHILD IMMUNIZATION M14 NUMBER OF VITAMIN A DOSES ADMINISTERED BETWEEN 9 MONTHS AND 3 YEARS M 15 NUMBER OF CHILD HOOD DISEASES REPORTED DURING THE MONTH M 16 NUMBER OF INFANT/CHILD DEATHS IDENTIFIED 1C. PART C : Monthly Inventory Status Part C of the monthly format provides information on the inventory status of certain critical items. M17 This provides information on Vaccine Stock Position during the month. One of the objectives of the UIP multi year strategic plan is to ensure an efficient and vaccine and injection equipment and management logistics 17.1 to 17.6 Record the stock position of DPT, OPV, TT, DT, BCG & Measles vaccine in the respective column M 18 Stock position of other drugs such as Vitamin A solution, ORS Packets, Vaccine Carriers are to be provided in 18.1, 18.2 and 18.3. M 19 Stock of AD syringes (0.1 ml, 0.5 ml and 5 ml) is to be recorded in 19.1, 19.2 and 19.3. CHAPTER -2 QUARTERLY REPORTING FORMAT The Quarterly format contains data relating to the status of • health infrastructure, • manpower, • logistics and • institutional reforms under NRHM. This format is basically for assessing the progress of various initiatives under NRHM. Contd.. The strategy under NRHM involves wide ranging sectoral and systematic reforms in the health sector, like Intersectoral convergence, Pooling of funds /Societies of Health and Family Welfare programmes under National/State/District Mission, Strengthening of public health infrastructure by involving the Panchayat Raj Institutions, Increased accountability of doctors and paramedical staff at distrct/sub- distrct level, Constitution of Hospital Committee empowered to levy user free, involvement of private sector in the health delivery , Strengthening of village health delivery by providing additional manpower etc. Thus, it is paramount to track progress of NRHM for every quarter. The quarterly format provides a brief summary of the progress achieved under NRHM during the four quarters. Contd.. This Chapter has Six main sections: Part A of this format is related the status of health infrastructure such as Community Health Centers (CHC), Primary Health Centre (PHC), Sub-Centers (SC), District Hospitals, Medical Colleges etc. NRHM envisages bringing up the services of all health facilities to the Level of Indian Public Health Standards. Part B of this format deals with status of human resource availability- staffing status of some selected positions, Part C gives information on Training of Programme managers and various categories of staff members. Information on the type of training programme, the number of trainees identified and the number actually trained should be recorded. Part D provides information on Details of Camps Held. Part E Indicate status of equipments. Part F provides information on Additional NRHM Components viz. State/District Health Missions, Health Societies, Rogi Kalyan Samitis, ASHAs and Functioning of VHC etc. Part G provides information on the National Health Programmes. This data is already being collected by the respective nodal health officers and no fresh data collection is necessary. These officers have already been instructed to share this information with the State/District mission Director for NRHM. CHAPTER –3 ANNUAL REPORTING FORMAT This annual reporting format is to be submitted every year by the state to GOI and status of the data to be recorded is as on 1st of April every year. This gives a summary of health profile of the state and has following Sections: 3A. : DEMOGRAPHIC (A1 to A7) 3B. : FROM THE ELIGIBLE COUPLE REGISTER (ECR)(A8 to A10) 3C. : SELECTED INDICATORS (A11 to A15) 3D. : URBAN HEALTH (A16 ) CHAPTER – 4 GENERAL CONCEPTS AND DEFINITIONS This chapter provides brief discussion on general concepts and definitions applied throughout the Guidelines. These definitions are given in bullets 4.1 to 4.28 of the user guideline. A care has been taken to follow latest definitions as per MoHFW/NRHM CHAPTER –5 INDICATORS FOR LOCAL LEVEL HEALTH PLANNING This chapter provides discussion on various health and family planning indicators to enable readers and district level health programme managers to understand the concept that are used to monitor and evaluate health programmes and translate these concepts into local level health planning. (Page 62) Methodology for Monthly Performance Report on FW Statistics I. Sterilization: a. Total No. of Eligible Couples @ in the beginning of year: (EC = Projected population during the year X Rate*) (* Rate = estimated eligible couples per 1000 population On the basis of 2001 census) @ = Eligible couples are those couples whose wife is in the age group 15-45 years. Females are not eligible for sterilization after 45 years of age. b. Unsterilized couples are calculated: (Total no. of estimated eligible couples minus Estimated Sterilized Couples $ as per NFHS II/III) $ Estimated Sterilized Couples are Calculated: Contd.. (Estimated eligible couples multiplied by %age current users of Ster.) Sterilization (Contd..) c. Current Year performance : As per the monthly report received from States/UTs about the total number of operations done d. Last year performance of corresponding month for which report is prepared. e. % change in current month performance over corresponding month. f. Estimated Unsterilized Couples exposed to higher order births 3 & 3+: (Estimated No. of EC Unsterilized multiplied by %age no. of Couples who have 3 or more children Source NFHS II/II) g. Sterilization per 10,000 unsterilized couples exposed to higher order of birth 3 & 3+ = (Current Sterilization divided by Est. unsterilized couples exposed to higher order of birth multiplied by 10000) Contd.. II. IUD Insertions: a. Total No. of eligible couples unsterilized in the beginning of year as taken in Sterilization statement b. Performance of particular month during current year c. Performance of particular corresponding month during last year % Change d. Current IUDs divided by Est. unsterilized couples exposed to higher order of births multiplied by 10,000) Contd.. III. Eq. Condom Users: a. Total No. of eligible couples unsterilized in the beginning of year as taken in Sterilization statement b. Performance of particular month during current year. Condom users are calculated : (No. of Condom pieces (Net) / 72 ) X (12 / 1..2..3 for April, May, June) c. Performance of particular corresponding month during last year……same methodology as above d. % Change e. Current Condom users divided by Est. unsterilized couples exposed to higher order of births multiplied by 10,000) f. Note: Eq. Condom users are cumulative users as one beneficiary who uses 72 condoms pieces in a year is counted one user. Contd.. IV. Eq. Oral Pill Users: a. Total No. of eligible couples unsterilized in the beginning of year as taken in Sterilization statement b. Performance of particular month during current year. Oral Pill users are calculated : (No. of OP Cycles/ 13 ) X (12 / 1..2..3 for April, May, June) c. Performance of particular corresponding month during last year……same methodology as above d. % Change e. Oral Pill Users per 10,000 unsterilized couples during current year f. Note: Eq. Oral pill users are cumulative users as one beneficiary who uses 13 cycles in a year is counted one user. Contd.. Methodology for Monthly Performance Report on Immunization Statistics I. DPT Immunisation for children (0-1 Years) 3rd Dose: a. Prop. Need Assessed during the current financial year : Prop. Need assessed are calculated: i. Live Birth = (Projected mid-year population X Crude Birth Rate) ii. Children 0-1 years = (Live Births – (Live Birth X IMR)/1000 b. Cumulative performance upto the month during current year c. Cumulative performance upto month of last year d. % Change II. POLIO (3rd Dose) 0-1 Years children: (same as per DPT above) III. B.C.G. (One Dose) 0-1 year children: - do – IV. Measles (One Dose) 9-12 months: - do – Contd.. V. D.T. (Diptheria Tetanus) 5 Years Dose a. Prop. Need Assessed during the current financial year : Prop. Need assessed are calculated: i. Projected mid-year population X proportion of children in the age of 5 years as per SRS Bulletin) b. Cumulative performance upto the month during current year c. Cumulative performance upto month of last year d. % Change e. % Achievement of prop. Need assessed VI/VII. T.T. 10/16 Years Dose a. Prop. Need Assessed during the current financial year : Prop. Need assessed are calculated: i. Projected mid-year population X proportion of children in the age of 10/16 years as per SRS Bulletin) b. Cumulative performance upto the month during current year c. Cumulative performance upto month of last year d. % Change e. % Achievement of prop. Need assessed Contd.. VIII. Vitamin ‘A’ (Prophylaxis against blindness due to Vit ‘A’ deficiency) Ist dose and 2nd-5th dose IST DOSE (0-1 YEARS) a. Annual Need Assessed (Total No. of Infants during current year) b. Achievement Cumulative (Ist Dose) during current year) c. Achievement of the same period during last year d. % Change e. % Achievement of Need assessed 2-5th DOSE (1-3 YEARS) a. Annual Need Assessed (Total No. of Children aged 1-3 Years during current year) b. Achievement Cumulative (2-5th Dose) during current year) c. Achievement of the same period during last year d. % Change e. % Achievement of Need assessed of Vit „A‟ (2-5 dose) worked out by taking (2 X 1.9 times) of Children (1-2 years) * Earlier half of doses initiated, continuing and completed were taken to get the total no. of beneficiaries.