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1
Monitoring & Evaluation (M&E)
- - an integral component of NRHM PIPs
Parameters of Health Care
AwarenessAvailableAccessible - equityAffordable
Quality
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Monitoring & Evaluation
Requirements under the Logical Framework
Approach of the National PIP
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Agreed Indicators … (1)
13 Process Indicators – 6 monthly review
1. % of ANM positions filled
2. % of states and districts having full time program manager for
RCH with financial and administrative powers delegated
3. % of sampled state and district program managers aware of
their responsibilities
1. % of sampled state and district program
managers whose performance was reviewed
during the past six months5. % of districts not having at least one month
stocks of (a)Measles vaccine, (b)Oral Contraceptive Pills and (c)Gloves
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Agreed Indicators … (2) 13 Process Indicators – 6 monthly review (cont’d)
6. % of districts reporting quarterly financial performance in time
7. % of district plans with specific activities to reach vulnerable communities
8. % of sampled districts that were able to implement M&E triangulation involving communities
9. % of sampled outreach sessions where guidelines for AD syringe use and safe disposal are followed
10. % of sampled FRUs following agreed infection control and health care waste disposal procedures
11. % of 24 hrs PHCs conducting minimum of 10 deliveries/month
12. % of upgraded FRUs offering 24 hr. emergency obstetric care services
13. % of sampled health facilities offering RTI/STI facilities as per agreed protocols
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Agreed Indicators … (3)
Output Indicators from Mid & End-line SurveysOutput Indicators from Mid & End-line Surveys
The states are to The states are to set levels of achievement based based on their on their own assessmentsown assessments..
1. 1. Contraceptive prevalence rateContraceptive prevalence rate2. % eligible couples using any spacing method for 2. % eligible couples using any spacing method for
> 6 months> 6 months3. % of women delivered during past one year who 3. % of women delivered during past one year who
received 100 IFA tabletsreceived 100 IFA tablets4. % deliveries conducted by skilled providers 4. % deliveries conducted by skilled providers
(doctors, nurses or ANMs) (doctors, nurses or ANMs) 5. % of 24 hrs PHCs conducting minimum of 10 5. % of 24 hrs PHCs conducting minimum of 10
deliveries/monthdeliveries/month
Agreed Indicators … (4)
66. % of upgraded FRUs offering 24 hr. emergency obstetric care
services
7. % of 12-23 months children fully immunized
8. % of mothers and newborn children visited within 2 weeks of delivery
by a trained community level health provider/AWW or health staff
(ANM/Nurse/Doctor)
9. % of children suffering from diarrhea during past 2 weeks received
Oral Rehydration Solution
10. Polio free status achieved since
Details of numerator and denominator and sources of information given in Appendix IV of National PIP
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Program Planning & Service Delivery
MIES System Model in NRHM
MIES
Validation
EvaluationQuality Assessment
Monitoring
MIES
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M&E Activities:–(1)
A - Surveys
3.1 Improve DLHS-3 (Mid-line Survey) to reflect Equity & Access
3.4 Equity Indicators for large national surveys like NFHS
Actions & Current Status
NFHS-III: – Key results out, Detailed results in August, 2007
DLHS-III: – Pilot Work to begin in July, 2007
Annual Health Survey (AHS) – being conceived with the RGI– District Health Profile
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M&E Activities:–(3)
B. MIS3.23.2 Guidelines for local data to prepare & monitor
plans
3.5 CNAA Manual to be revised with field test3.6 Simplified MIES proforma
Actions & Current Status
• MIES Format developed and sent to State Govts in August, 2006.
• Key Indicators for Health Programmes integrated and sent to States in November, 2006
• Data on revised formats have been received from 13 States o Andaman & Nicobar Isles, Chhattisgarh, Delhi, Goa, Gujarat, Himachal
Pradesh, Jharkhand, Madhya Pradesh, Maharashtra, Manipur, Meghalaya, Puducherry, Rajasthan
• User Guidelines for MIES Format finalised.
o Contains information on use of MIES data for local needs
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3.7 Analytical reporting for outputs
Actions & Current Status.
• A web based information and communication system to be implemented in two phases.
– The first phase would essentially be a Bulletin Board for the NRHM/RCH.
– The second phase is to take care of the data ware housing requirement of MIES.
• In-house software being developed for routine MIS reports
M&E Activities:–(5) B. MIS
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3.9 Concurrent evaluation studies through common format
Actions & Current Status
Evaluation presently being done through RETs – Max 168 (7x2x12) districts per annum– Needs reinforcement and realignment
PRCs undertake adhoc evaluation studies
Several Institutions approached for Concurrent Evaluation of NRHM• Workshop held in Feb, 2007• A Committee formed to evaluate the proposals • Framework for Evaluation being worked out
M&E Activities:–(6) B. MIS
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3.10 Quality Assurance Surveys
Actions & Current Status
Monitoring tools, check lists, operational manual for QA finalized
Six States identified for piloting of QA and launched in December, 2006
- UP, Uttaranchal, West Bengal, Assam , Maharashtra, Karnataka
(1 Dist each, 2 in UP)
- Duration of QA piloting would be of 24 months
M&E Activities:–(7) B. MIS
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3.11 Programme Management Reviews (Assessment of Management Capacity)
Actions & Current Status
Study by IIM-A completed and Tools prepared and circulated to StatesBased on feedback, the Tools were refined and up-scaled country-wide in January, 2007.Each State to canvas the Tool and report findings annually
M&E Activities:–(8) B. MIS
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3.12 Community Monitoring & Triangulation
Actions & Current Status
Plan of action
1. Experts on Community Monitoring approached for a Concept Note on Triangulation
2. Based on the feedback from the experts, a Triangulation framework would be prepared and piloted
M&E Activities:–(9) B. MIS
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Program Planning & Service Delivery
Status of MIES System Model
MIES
ValidationCommunity Monitoring & Triangulation
Evaluation•Surveys, RETs
•Concurrent evaluation Quality AssessmentPilot on
MonitoringFormat & guidelines
Programme Mgmt Review
Launched
Working Group on
M&E
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The ten Steps to building a performance – The ten Steps to building a performance – based M&E Systembased M&E System
1.1. Conducting a Readiness AssessmentConducting a Readiness Assessment
2.2. Identifying & agreeing on Performance Outcomes to Identifying & agreeing on Performance Outcomes to Monitor and EvaluateMonitor and Evaluate
3.3. Selecting Key Indicators to Monitor OutcomesSelecting Key Indicators to Monitor Outcomes
4.4. Baseline Data on Indicators to Monitor OutcomesBaseline Data on Indicators to Monitor Outcomes
5.5. Planning for Improvement-Setting Realistic TargetsPlanning for Improvement-Setting Realistic Targets
6.6. A Monitoring and Evaluation System (HMIS, Web-based A Monitoring and Evaluation System (HMIS, Web-based ???)???)
7.7. The Role of EvaluationThe Role of Evaluation
8.8. Reporting the FindingsReporting the Findings
9.9. Using Own/Other’s FindingsUsing Own/Other’s Findings
10.10. Sustaining the M&E SystemSustaining the M&E System
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M&E Plan: MDG goals achievement plan
1. Map information sources and flows– Performance data – Monthly, Qtrly, Annual– Surveys - NFHS, DLHS, NSSO, Other agencies– Evaluation Studies – RET, PRC, NGOs, Communities
2. Map M&E requirements• Household surveys• IT infrastructure mapping
Hardware, Software, Network, HMIS application, People – existing skills vs training needsState, District, Blocks
• Printing of Registers at SC, PHC, CHC etc• Map institutions (public & private) – by service, strength etc• Address vulnerable groups in IDHAP
3. Report on MIES format only• Don’t change the reporting format• Form 9 No longer required
4. Plan for sustainability of M&E
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What we expect from the State Governments …(1)…(1)
Prepare a State-Logical Framework Approach (LFA) on the lines of the
National PIP to monitor the M&E Activities
Reporting Monthly Performance data on Revised MIES format.
Assess management capacity - Programme Management Tool
Undertake Household Surveys – to be updated annually
Revising and fresh printing of the primary registers from the Sub-centre
level onwards – capture data for SC/ST
Training of manpower on data collection, flow and relevance
Upgrading/modifying the hardware and software for States having an
HMIS.
For States not having an HMIS efforts are to be made for establishing one
The State Govts may revisit and revise their State PIPs to take the above aspects into consideration.
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What we expect from the State Governments …(2)
Challenges
Getting the primary registers from the Sub-centre level onwards in position to capture data for vulnerable groups
Institutionalising the data flow mechanism for timley and quality data
Leveraging the advances in IT for expediting data flow Capturing information from private sector Have an inclusive Distt Action Plan to cover M&E requirements at
the Distt level and aggregated at State level
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Triangulation – an emerging concept
Triangulation
Monitoring/ Performance data
Survey Data/ Evaluation studies
Community Monitoring
Concurrent Evaluation