Transcript FP-C2 Use of DHS data for influencing FP/MNCH Programs

Use of DHS Data to Influence FP/MNCH
Programs & Policies: India National
Family Health Survey
Sheena Chhabra
Chief, Health Systems Division,
USAID/India
Reconvening Bangkok
March 9, 2010
India’s National Family Health Survey (NFHS):
A key data-base for promoting data-based
decision-making in health
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National Five Year Plans
National Population Policy
National Nutrition Policy
State Health & Population Policies
Reproductive and Child Health (RCH)-1 & -2 designs
Integrated Child Development Scheme design
National Urban Health Mission design
Development Partners PHN Strategies & Programs- USAID,
UNICEF, DFID, World Bank, UNFPA, EC, etc.
• Designing & tracking program progress
• Monitoring MDGs
NFHS data were instrumental in revitalizing
routine immunization
Key Findings
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100
Percentage of children age 12-23 months
78
80
DPT 1: 76%
DPT 2: 67%
DPT 3: 55%
78
72
63
62
60
59
54
51
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55 55
42
40
20
30
14
5
0
None
BCG
Polio3
Measles
NFHS-1 NFHS-2 NFHS-3
DPT3
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Immunization coverage stagnant
for DPT
Health system is reaching vast
majority of children at least once
Substantial decrease in full
vaccination coverage among
children in better-performing states
Response
• Strategies for Routine
Immunization
• Community mobilization through
Village Health & Nutrition Days
• Improved program monitoring
NFHS reiterated the need to focus on proven &
simple child health interventions
Key findings
• Basic package of child health
services is not being delivered
– Stagnant ORS use
– 69% of the children with ARI
symptoms sought treatment
Percentage of children age with diarrhoea in
the past 2 weeks
100
NFHS-2
80
60
40
Response
• Newborn & Child Health Policy
• Strategies for home-based as
well as institutional care
NFHS-3
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33
25
20
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Urban
Rural
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NFHS highlighted the need for focused attention on
malnutrition
Key Findings
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Percent
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60
51
50
45
43
40
40
30
20
23
20
10
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Stunted
Underweight
NFHS-2
NFHS-3
Wasted
No significant improvements in
nutrition status among children
under age 3.
Anemia among children age 635 months has increased over
the past 7 years.
Response
• Prime Minister’s letter to Chief
Minister urging action to
address malnutrition especially
among children under six.
• Establishment of the Coalition
for Sustainable Nutrition
Security in India under
chairmanship of Prof. M.S
Swaminathan.
NFHS-3 informed programs for improving nutritional
status
Key Findings
• Only a third of the eligible
children receive any service
from an Anganwadi Centre
(AWC) under the ICDS
Percent of age-eligible children in
areas with an AWC
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70
60
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33
30
26
23
20
20
18
16
10
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Response
• Strategic shift in the design of
Integrated Child Development
Services Scheme (ICDS)-3
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NFHS data influenced design of JSY
Janani Suraksha Yojana
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NFHS data helped in
improving program focus on
coverage and quality of
antenatal care & institutional
deliveries.
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National Maternity Benefit
Scheme modified (JSY) from
nutrition-improving scheme to
one of addressing all aspects
of maternal health.
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Janani Suraksha Yojana
designed for promoting
institutional deliveries.
Report on the Working Group on Health of Women &
Children for the 11th 5 year plan (2007-2012)
NFHS data helped improve focus on birth spacing
Key Findings
• Contraceptive use increased
steadily with vast majority
continuing to rely on female
sterilization.
• Some gains in modern spacing
method use but use of IUDs
remained static.
Percent of currently married women age 15-49
56
NFHS-1
NFHS-2
NFHS-3
49
48
43
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37
37
34
Response
• Shift of the family welfare program
to target-free approach.
• Strategy for repositioning IUDs.
• Enhanced commitment to expand
basket of contraceptive methods.
• Standard Days method introduced
in National program.
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Any method Any modern Female
Male
method sterilization sterilization
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IUD
2
1
2
Pill
3
2
3
5
Condom
NFHS data helped to evolve strategies for healthy
timing and spacing of births
Deaths in the first year of life per 1000 live births
PREVIOUS BIRTH INTERVAL
< 2 years
2 years
3 years
4 years or more
86
50
30
37
BIRTH ORDER
1
2-3
4-6
7 or more
64
47
62
80
MOTHER'S AGE AT BIRTH
< 20
20-29
30-39
40-49
77
50
56
72
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20
30
40
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60
70
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NFHS-3 helped devise appropriate strategies
for vulnerable population groups
Key Findings
Response
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Health conditions of urban poor are
similar to or worse than rural
population and far worse than urban
averages.
27% of teenage women and 21% of
women age 20-24 have unmet need
for family planning.
Child mortality rate is 61% higher
for girls than for boys.
Two in five currently married women
age 15-49 have ever experienced
spousal violence in their current
marriage.
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Design of the draft National Urban
Health Mission highlighting need
for programming resources for
urban poor.
Adolescent Reproductive and
Sexual Health Strategy (ARSH).
Improved commitment for gender
programming including genderbased budgeting.
Inputs for the Domestic Violence
Act 2005.
NFHS-3 Key Data Source for RCH-2 Performance Review
of States
Segmentation of States based on RCH-2 Performance
Top Guns
High Achievers
Movers and Shakers
Promising
Goa
Kerala
Sikkim
Uttaranchal
Himachal Pradesh
Karnataka
Maharashtra
Tamil Nadu
Manipur
Chhattisgarh
Madhya Pradesh
Orissa
Andhra Pradesh
Gujarat
Haryana
Jammu & Kashmir
Punjab
West Bengal
Meghalaya
Mizoram, Tripura
Bihar
Jharkhand
Rajasthan
Uttar Pradesh
Arunachal Pradesh
Assam
Nagaland
Source: RCH-2 – Program Management Support Group (PMSG), Donor Coordination Division
Key Learnings
• Government stewardship essential from design stage
• Involve various government departments on Steering &
Technical Committees
• Widen ownership by engaging multiple stakeholders
early on
• Provide adequate funding
• Build various data quality checks
…Key Learnings
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Provide world-class technical assistance
Engage premier local institutions
Anticipate barriers for acceptance of data and plan appropriately
Disseminate data widely at all levels
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2 National & 29 State NFHS-3 fact-sheets
National and 29 state reports
27 dissemination seminars at national and state level
4 subject reports & 5 subject factsheets
Estimated 2000 media reports including over 500 wholly or largely
based on NFHS-3 results
– 124 peer-reviewed journals using NFHS data
• Make data-sets available in public domain (wwwnfhsindia.org)