STENTHENING OF M

1
STENTHENING OF ME IN TAMIL NADU

• Multidisciplinary workshop

2
ME FRAMEWORK
INPUT ? PROCESS ? OUTPUT ? OUTCOME ?
IMPACT
NRHM support State resources External factors
Functional outputs Service outputs Service
utilization
Long term Impact (reduction in burden of
disease)
Planning Implementation
Immediate Outcomes (reduction in morbidity)
Programme Based
Population Based
3
Formal ME System in Tamil Nadu

• The concept of ME is well known and understood
  in the organization
• There is specific ME mandate with elaborate
  procedures, functions and activities
• There is a specific section of staff assigned to
  carry out the ME mandate
• A set of ME tools and techniques is available
  for use

4
Contd.

• Regular reporting is done and feedback received
• Information synthesized and disseminated to cross
  section in and outside
• Information and analysis is ploughed back into
  the planning regularly
• A functional MIS (manual and computerized) exists
• Financial support is made available by the State
  and NRHM

5
MONITORING SYSTEM IN TAMIL NADU
GOI
State Health Society Tamil Nadu Health System
Project State Bureau of Health Intelligence
State
Monthly reports compiled by Assistant Director
(Statistics) and Statistical officers of
district hospitals and respective programmes
District
Weekly reports compiled by VHN, SHN, CHN, Block
health statistician
Primary Health Centres
Health Sub Centres
Basic registers of maternal and neonatal
consultations
6
INNOVATIVE MONITORING TOOLS
7
PHC online reporting system

• List of information collected online
• Health Mela / Varumun Kappom Thittam - already
  operational
• Mobile medical units Outreach Camps- already
  operational
• Muthulakshmi Reddy Maternity Scheme/JSY- already
  operational
• Effective Disease Surveillance Information
  System-trials in place
• PHC OP Morbidity- trials in place
• Immunisation- trials in place
• Pregnancy and Infant Cohort Monitoring-trials
  started in April
• Integrated Management of Neonatal and Childhood
  Illness-to be started
• Civil Registration-to be started

8
PHC Online monitoring

• New initiatives- Infrastructure report of the
  PHCs now collected through OMR sheets will also
  be converted to online reporting
• Family Welfare and RCH reports now collected
  through email are being converted to online
  reporting directly from the PHCs.
• Financial reporting for NRHM/RCH to be integrated
  into the online reporting
• Data to be entered at the PHC level using PHC
  staff. VHNs to make the data available during
  weekly meetings
• Other alternatives such as simputers for the
  VHNs, smart card systems for pregnancy and child
  tracking to be explored on pilot basis.

9
Pregnancy Cohort Monitoring
10
Imnci
11
PHC morbidity data
12
MMU outreach camps
13
VERBAL AUTOPSY

• Maternal death review is a state wide initiative
• Maternal death notification protocol in place
• Multiple source reporting of maternal deaths eg.
  Field functionaries of Health Nutrition Dept,
  PHCs Hospitals and urban local bodies

14
COMMUNITY BASED MATERNAL DEATH REVIEW

• Notification by telegram / fax to Commissioner
  of health within 24 hours of occurrence
• Notification includes all pregnancy related
  deaths including suicides, accidents
• Investigation of maternal deaths within 15 days
  using a structured format
• Investigation of maternal deaths using semi
  structured verbal autopsy format to conduct
  community based audit and facility based review
  of each maternal death by PHC Medical Officer
• Almost 100 reporting data analysis since 2001

15
FACILITY BASED MATERNAL DEATH REVIEW

• All district health managers conduct regular
  monthly maternal death audit
• Concurrent medical audit done
• Case sheets of all maternal deaths reviewed by
  CMOs and district officers
• Regular reports with minutes of the audit meeting
  sent to Commissioner MCH welfare

16
Community based Maternal death Review Facility
based Maternal Death Audit by Collector

• District collectors conduct the meeting once in a
  month
• All Maternal deaths occurred during previous
  month are reviewed
• All the service providers including the private
  service providers, district health managers and
  the relatives of the deceased participate in
  the verbal autopsy meeting
• Findings of the verbal autopsy format discussed
  in the meeting
• All the contributory factors for each maternal
  death are analysed
• Common factors are identified and informed to
  state level for policy changes
• Relatives narrate the events leading to the death

17
(No Transcript)
18
(No Transcript)
19
CAUSES OF MATERNAL DEATHS (2004-05)
20
Key findings from Investigation of Maternal
Deaths (Verbal Autopsy)

• Misdistribution of FRUs shortage of specialists
• Sub standard care in the institutions
• Unnecessary referrals
• Majority of the patients visited more than two
  institutions before death
• Delay in accessing Emergency Transport
• Under utilization of PHCs resulted in the
  overcrowding of FRUs for normal deliveries
• Unmet need for MTP/tubectomy services
• Obstetric first aid not provided before referral
• No birth preparedness

21
Solutions

• CEmONC centres with contractual appointments
• Emergency transportation (EMS)
• Blood storage facilities in 385 PHCs
• Capacity building of SN and VHN
• Emergency obstetric management protocols in place
• Strengthening of FRUs
• Marketing of PHC services

22
COMPREHENSIVE HMIS SYSTEM(TNHSP)
23
Tamil Nadu-Monitoring and Evaluation- Issues

• Multiple, uncoordinated data systems
• Under-used data (even when good quality)
• Disconnect between planning and budgeting
• Lack of validation of data from multiple sources
• ME often supply-driven

24
Tamil Nadu ? Next Steps

• Streamlining of institutional framework
• Data collection take it to the lowest level
  possible
• Collation of data in state and national Database
• Meta-Analysis of data from different sources
• Identification of Lessons Learned, Gaps and
  Priorities

25
Contd

• Development of Targeted Information products,
  tailored to info needs of specific stakeholders
• Strategic Use of Info in Policy development
• Achieve greater integration with other national
  programmes
• Validation of data using research institutions
  and medical colleges

26
THANK YOU