Transcript Document

Nutrition Surveillance System
(NSS) in ICDS
The need for
Nutrition Surveillance in ICDS
Reduction of malnutrition in India between
1998-99(NFHS-2) and 2005-06 (NFHS-3)
% of Underweight Children (0-3 years)
INDIA
Less than 30%
NFHS-2 1998-99)
NFHS-3 2005-06)
30% - 40%
More than 40%
29.2
24.0
36.5
31.1
24.7
36.3
27
15.5
31.7
(21.5)
29.7
17.3
(35.3)
48.1
46.7
52.2
51.5
50.8
41.6
53.2
(28.6)
18.8
54.9
19.8
45.3
Tripura
(37.3)
50.3
47.8
32.7
34.2
29.8
21.3
38.6
33.3
31.5
21.7
54.6)
57.9
41.6
44.8
21.3
35.8
41.6
36.8
20.1
25.9
21.2
42.9
19.5
14.2
37.6
Tripura
(35.2)
39.5
23.7
% reduction in malnutrition between NFHS-2 and NFHS-3
NFHS-3 results on the Nutritional Status of children have some surprises in store
for the discerning observer. Chart indicates that the reduction in incidence of
malnutrition underweight) on an all–India basis was hardly about 2.3% between
NFHS-2 (1998-99) and NFHS-3 (2005-06), while in Tripura, the same was 2.1%
45
42.7
40.4
40
37.3
35.2
35
30
India
Tripura
NFHS-2
NFHS-3
% reduction in malnutrition between NFHS-2 and NFHS-3
During the same period, the
states which focused to
expose malnutrition, the
silent
killer,
reduced
malnutrition
by
highest
percentage.
Percentage of under-3 yrs.
underweight children
Reduction Rate %)
55
2.3%
12.1%
10.2%
50
50.3
45
The reduction was as high as
12.1%
in
Maharashtra
followed by 10.2 % in Orissa.
Both the states had adopted
strategies
to
tackle
malnutrition after nutrition
surveillance revealed pockets
of high malnutrition.
44.8
40
42.7
40.4
39.5
35
32.7
30
India
Maharashtra
NFHS-2
NFHS-3
Orissa
21.2
25.9
32.7
33.3
35.2
37.6
40.4
41.1
41.6
54.6
29.8
30
39.5
40
47.8
50
54.9
60
57.9
NFHS-3 (2005-06) revealed that more than 40% children of
India are malnourished
20
10
0
Regular ICDS Monthly Progress Report MPR) gave no indication of
this scenario
Existing ICDS monitoring system
Data Flow in ICDS
Data Capture and Data Flow for Process Monitoring
Project
Sector
Project Level
Compilation
Nation
Sector Level
Compilation
State
District
Anganwadi Centre
Data captured at AWC level
Data once again manually compiled at Supervisor level for individual
AWC
Supervisor’s compilation report for a Sector
Project level compilation..
The data is further compiled
in the MPR forms in 5 copies
manually within a very short
time span of (5-7days) by the
CDPO
office
staff
or
Supervisor and flows to the
higher levels.
CDPO’s compiled report
for a Project.
Limitation of the System
 A lot of time is wasted in capturing the data at AWC level and then
again at Supervisor level manually and thereby incurring huge Paper
works and considerable man-hours.
 Pockets of malnutrition within an ICDS Project remain un-seen.
 Severely malnourished children, needing urgent therapeutic
intervention are sometimes left unattended by health care system.
 In the present system current month's data can't be compared with
the previous months' figures. So, progress cannot be measured.
 Chances of error increase as the compilation is done within a very
short time span.
 Many valuable information is lost as the data is collated at Project
level.
Loss of valuable Data…
Data lost ………… as it moves up
Child Population ….
Project
CDPO)
MPR
Below 6 mnths
6mnths – 1 yr
1 yr – 3 yrs
3 yrs – 6 yrs
Sector
Supervisor)
Below 6 mnths (Male & Female)
6mnths – 1 yr (Male & Female)
1 yr – 3 yrs (Male & Female)
3 yrs – 6 yrs (Male & Female)
Anganwadi Centers
AWW)
Below 6 mnths (Male & Female)
6mnths – 1 yr (Male & Female)
1 yr – 2 yrs (Male & Female)
2 yrs – 3 yrs (Male & Female)
3 yrs – 4yrs (Male & Female)
4 yrs – 5 yrs (Male & Female)
5 yrs – 6 yrs (Male & Female)
Government of India
(Format-II)
0 - 6 yrs
West Tripura Initiative..
West Tripura Initiative..
 AWC
level
data
capturing
rural/tribal/urban AWCs of the State.
from
1771
 The data has started revealing pockets of malnutrition
along with age/sex break-up, this is leading to focussed
intervention by the functionaries and communities.
Activities completed…
• Design and development of NSS version 1.0 with old GoI
MPR by Riddhi

• Training of CDPOs and Supervisors on above system

• Design and development of NSS version 2.0 with new GoI
MPR by Riddhi

• Training of CDPOs and Supervisors on above system

• Data Entry by CDPOs in the new system

What AWC level Data reveals ?
Nutrition Surveillance System
West Tripura
www.westtripura.nutritiongis.org
District level MPR
Nutritional Status of children out of children weighed)
GoI 78 column Report Generation
Generates monthly report for submitting to
GoI
All AWCs are visible in the web
All AWCs are visible in the web
Data Analysis
• Graphical
• Spatial
Project wise Percentage Normal Children
(May 2013)
105
100
100
95
90
88.75
87.06
85
83.19
82.32
82.16
80
77.3
75
70
Ranirbazar
Agartala II
Agartala I
Hezamara
Mohanpur
Mandwih
Dukli
Project wise Percentage Moderate Underweight Children
(May 2013)
25
20
20.04
17.61
17.34
16.81
15
12.89
11.01
10
5
0
0
Dukli
Mohanpur
Mandwih
Hezamara
Agartala I
Agartala II Ranirbazar
Project wise Percentage Severe Underweight Children
(May 2013)
3
2.66
2.5
2
1.5
1
0.5
0.5
0.24
0.07
0.05
0
0
Mohanpur
Agartala I
Hezamara
Ranirbazar
0
Dukli
Mandwih
Agartala II
Spatial Analysis
Motivated functionaries have taken charge of
the new system
District map showing ICDS projects
Hezamara
Mohanpur
Mandwih
Agartala-II
Agartala-II
Jirania
Dukli
District map showing 1771 Anganwadi Centres
Individual AWCs are now
visible along with
nutritional status of
children
%age of moderately underweight children (0-5 yrs.), May, 2013
Hezamara 17.3)
Mohanpur 16.4)
Mandwih 16.8)
Agartala-II 11.3)
Less than 15%
Agartala-II13)
Jirania Data yet to be
received)
Dukli 20.45)
Between 15% to 20%
Above 20%
%age of severely underweight children (0-5 yrs.), May, 2013
0%
Between 0% to 1%
Above 1%
Hezamara 0)
Mohanpur 0.09)
Mandwih 0.46)
Agartala-II 0)
Agartala-II0.08)
Jirania Data yet to be
received)
Dukli 2.83)
Disaggregated data analysis through
Project level system
ICDS Project : Mandwih, West Tripura
Project Mandwih: Dashboard on AWC reporting status
Project Mandwih showing Anganwadi Centres
AWCs having more than 5 moderately underweight
children (0-5 yrs.)
Pockets of malnutrition are now
visible
AWCs having 1 or more severely underweight children
(0-5 yrs.)
Severely underweight children are now visible
through the system
Focused action plan will now lead to
rapid reduction of malnutrition
2nd phase of Nutrition Surveillance:
Tracking every child by name for
Scaling Up Nutrition (SUN)
The Janani initiative:
1000 Days Care for every child
(-9 months to 2 years of age)
Why?
Improper care during first 1,000 days -9 months
to 2 years) of the child i.e. the period from
pregnancy upto a child’s 2 years after birth, leads
to...
High morbidity, Stunting and Poor Survival
Addressing
needs
of
mothers/children
necessitates an innovative approach that calls for
convergence and collaboration of different
departments, as well as community awareness.
A look at one such initiative..
“e-Janani”
A Mother-Child Dyad Care Initiative by the
Government of Tripura
Mandwih
e-Janani
A combination of Mobile Telephony and Server
based computer program
Real Time Tracking of all
Pregnant Mothers and Children
Bringing Focus to those at RISK
From Registration to Delivery
110 data fields are collected for a mother
over a period of 1 year
ANC 1
Registration
ANC 3
PNC
Delivery
ANC 2
ANC 4
ANC 5
Proper capturing, storing and timely access
to this information can save many lives
e-Janani
Helping frontline health workers MPWs and
Anganwadi workers) to deliver timely and
quality services to pregnant Women and
children
e-Janani helps in converging H & FW and ICDS
initiatives
Data flow from MPWs
Data flow system in Health
Voice Data capturing by MPWs of Mandwih Block
Data flow from AWWs
Data flow system in ICDS
AWC Register Entry by
Worker
Monthly data entry from
CDPO office to NIC
Server
Server at NIC
Analysis of Health & ICDS Data
Server at Riddhi
Converging data through e-Janani
Activities completed…
• Design and development of new format for Health and ICDS
data capturing

• Survey and geo-referencing of Health & ICDS facilities by
Riddhi

• Development of data entry system for Health & ICDS by NIC

• Procurement and distribution of Android mobile phone to
ANMs by H&FW

• Installation and training on real time mobile application by
Riddhi

• Training of data transcriber at PHC level by Riddhi

• Development of online analysis tool by Riddhi

• Linkage between mother-child and health & ICDS

Analysis of Data received so far….
Common linking field (e-RoR) is being worked out by
individual departments. Till that time, instead of
COHORT tracking, individual mother and child
tracking has already started
Analysis on following dataset:
Mother’s data received
from Health System
Pregnant Mother’s data
received from
ICDS System
Child’s data received
from Health System
Nursing Mother’s data
received from
ICDS System
Child’s data received
from ICDS System
Data received from NIC’s server
As on 5th July 2013
Health
Mother
2091
Child
5830
Child with Mother MCTS ID
20
ICDS
Pregnant Mother
946
Nursing Mother
176
Child
Child with Mother ID
4363
2
Dashboard analysis of Mother’s ANC
in Mandwih Block as on 5th July 2013
ANC 1
ANC 2
71
34
1
76
12
108
Services in time
Services Awaited
Services delayed or not taken
List of 12 Mothers who missed their second ANC
Mother Code
Mother's name
PHC Name
Sub Center Name
Date Range
160100300311300004
Babita Debbarma
Borakha PHC
Patni Sub-centre)
03-01-2013 - 27-03-2013
160100300511300010
Sabita Debbarma
Borakha PHC
Rajchantai Sub-centre)
07-02-2013 - 01-05-2013
160100300811300001
Swarnalaxmi
Debbarma
Mandai PHC
Ashigarsh Sub-centre)
03-06-2012 - 25-08-2012
160100301011300009 Rebika Debbarmma
Mandai PHC
Brigudas Bari Sub-centre)
30-12-2012 - 23-03-2013
160100301011300013 Kalpana Rupini Saha)
Mandai PHC
Brigudas Bari Sub-centre)
05-11-2012 - 27-01-2013
160100301211300003
Malani Debbarma
Mandai PHC
Laxmipur Sub-centre)
14-12-2012 - 07-03-2013
160100301211300007
Dipali Debbarmma
Mandai PHC
Laxmipur Sub-centre)
12-02-2013 - 06-05-2013
160100301211300008
Biswarani
Debbarmma
Mandai PHC
Laxmipur Sub-centre)
28-12-2012 - 21-03-2013
160100301711300013 Pratima Debbarma
Borakha PHC
Kathiram Sub-centre)
18-01-2013 - 11-04-2013
160100301811300002
Namita Debbarma
Borakha PHC
Binankobra Sub-centre)
04-02-2013 - 28-04-2013
160100301811300005
Anjana Debbarma
Borakha PHC
Binankobra Sub-centre)
08-01-2013 - 01-04-2013
160100301911300003
Khajani Debbarma
Borakha PHC
Borakha MCH Sub-centre)
16-12-2012 - 09-03-2013
Dashboard analysis of individual Mothers of
Mandwih Sub Centre
Total Mothers: 40 mothers
Suchitra Debbarma
Suchitra Debbarma’s dashboard showing delayed ANCs
High-Risk Factor
Dashboard analysis of individual child on Immunization
Wakhinagar Sub Centre
MCISID ID
Child Name
1601002102120013
Sunita Debbarma
1601002102120014
Sanjoy Debbarma
1601002102120029
Sunita Debbarma
1601002102120030
Sanjoy Debbarma
160100300621300004
Anjuman Aktar
160100300621300005
Tanbir Ahammad
160100300621300006
Imran Hussain
160100301721200283
kuhina Debbarma
160100301821300001
Pitor Debbarma
160100301821300005
Kokthai Debbarma
Services in time
BCG
Status
Polio 0
Status
Hep B1
Dose
Services Awaited
DPT 1st
Dose
Polio
1st
Dose
HepB1
Dose
DPT 2
Dose
Polio 2
Dose
Services delayed or not taken
Work Plan
List of services fall due from 1-7-2013 to 8-7-2013
Mandwih Sub-Centre
Sl.
No
ALERT
ALARM
Mother Id
Mother Name
ANC 2
ANC 3
Expected
Delivery Date
Address
1
160100300711300001
Baijanti Debbarma
01-04-2013 23-06-2013
24-06-2013 15-09-2013
10-10-2013
Mandai
2
160100300711300002
Sumita Debbarma
03-02-2013 27-04-2013
28-04-2013 20-07-2013
14-08-2013
Baludhum Para
3
160100300711300003
Lucy Debbarma
20-03-2013 11-06-2013
12-06-2013 03-09-2013
28-09-2013
Nakshirai Para
4
160100300711300004
Lilata Debbarma
18-02-2013 12-05-2013
13-05-2013 04-08-2013
29-08-2013
Deb Charan Para
5
160100300711300005
Reshmi Debbarma
15-04-2013 07-07-2013
24-10-2013
Mandai
6
160100300711300006
Patal Debbarma
27-02-2013 21-05-2013
07-09-2013
Mandai
22-05-2013 13-08-2013
Analysis on Mother’s age registered in MCTS
Below 18 Years
Between 18 to 35 Years
Above 35 Years
95.5
0.6 3.9
Age Group
Below 18 Years
Between 18 to 35 Years
Above 35 Years
% Mothers
0.6
95.5
3.9
Analysis on Delivery Place
Indicator
29.2
(%)
Home Delivery
29.2
Institution
70.8
70.8
Home Delivery
Institution
Child’s data received from ICDS System
Analysis on Gender wise number of Children
Indicator
Female
(%)
47.5
47.5
52.5
Male
52.5
Sex Ratio
905
Female
Male
Analysis on Birth Weight of Children
Indicator
Weight Information
Received
Absolute
2165
(%)
49.6
50.4
Weight Information yet
to be Received
2198
50.4
Low Birth Weight
Children out of Weighed
children
180
8.3
49.6
Weight Information Received
Weight Information not Received
Analysis on Nutrition Status of Children
Indicator
Absolut
e
Children Weighed
(%)
88.1
1023
Normal
901
88.1
Moderate
112
10.9
10
1.0
Severe
ICDS Data as on May 2013
1
Normal
10.9
Moderate
Severe
Gram Panchayats having Severe Malnourished children
May 2013
Borakha 5)
Mandainagar 17)
Kai Rai 3)
Vrigudasbari 2)
Analysis on Disability observed in the children
3.9
Indicator
Absolute
(%)
No
4194
96.1
Yes
170
3.9
96.1
No
Yes
Thank You