Department of Health & Family Welfare, Govt. of Gujarat e-mamta: Gujarat Past, Present & Future
Gujrat Ek Najar Population(2011 Census) 60.4 million Birth Rate (SRS 2014) 20.8 / 1000 Death Rate (SRS 2014) 6.5 / 1000 IMR (SRS 2014) 36 / 1000 live birth MMR (SRS 2010-12) 112 / 1 lakh live birth Yearly Estimated Pregnancies: 1,402,805 Yearly Estimated Live Births: 1,275,278 No. of CHCs 296 No. of PHCs 1208 Number of Sub centres 8121 No. of Blocks 248 3/16/2015 E- Mamta: Mother and Child Tracking 2
2003-04 2004-05 2005-06 Institutional Delivery Trend Gujarat 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 55.9 57 44.1 43 63.2 36.8 67.6 32.4 77.8 22.2 82 18 89.4 91.8 93.7 95.1 96.4 10.6 8.2 6.3 4.9 3.6 Institutional Deliveries Home Deliveries Source: HMIS www.gujhealth. Health & Family Welfare Dept,
IMR Infant Mortality Rate in Gujarat 60 50 40 30 20 54 53 52 @ 1 per year i.e. 1.9% 50 48 @ 2 per year i.e. 2.8 & 4 % 44 @ 4 per year i.e. 8.3 % 41 @ 3 per year i.e. 6.8 % & 7.3 % 38 36 @ 2 per year i.e. 5.2% 29 24 10 0 NRHM Chiranjeevi 108 Nirogi Bal BalSakha Source: SRS Infant Mortality Estima 2005 2006 2007 2008 2009 2010 2011 2012 2013 2015 2017 www.gujhealth. Health & Family Welfare Dept,
Maternal Mortality Ratio Gujarat 172 160 148 122 112 Target to Achieve 100 6.9% Decline 7.5 % Decline 18 % Decline 8.1 % Decline Target 18 % Decline 2001 to 03 2004 to 06 2007 to 09 2010 to 12 2011 to 13 2013 to 15 90 www.gujhealth. Health & Family Welfare Dept, 5
SRS 2013 DRY AREA 4.1.1 KACHCHH 4.1.2 BANAS KANTHA 4.1.3 SURENDRANAGAR 49 4.2.1 PANCH MAHALS 4.2.2 DOHAD 4.2.3 VADODARA SOUTH 4.2.4 NARMADA EASTE 4.2.5 BHARUCH RN 4.2.6 SURAT 4.2.7 THE DANGS 4.2.8 NAVSARI 4.2.9 VALSAD PLAIN NORT HERN 4.3.1 PATAN 4.3.2 MAHESANA 4.3.3 SABAR KANTHA 4.3.4 GANDHINAGAR 4.3.5 AHMADABAD 4.3.6 ANAND 4.3.7 KHEDA 4.4.1 RAJKOT 4.4.2 JAMNAGAR SOURA 4.4.3 PORBANDAR SHTRA 4.4.4 JUNAGADH 4.4.5 AMRELI 4.4.6 BHAVNAGAR IMR as per NSS Natural Division: Table -11 31 47 41
Challenges High left out rates, inadequate quality of services, inability to track beneficiaries especially pregnant women and children leading to high Maternal Mortality Ratio (MMR) & Infant Mortality Rate (IMR). Despite the availability of abundance of information in health sector, there was a need to build capacity to find, communicate or use the information effectively and link it to individual beneficiaries. www.gujhealth. Health & Family Welfare Dept,
Challenges HMIS: Monitors through numbers. No Attention to services provided to individual beneficiaries Migration: Health services delayed or missed Improper reporting system Better Communication required between service providers and beneficiaries to ensure service delivery www.gujhealth. Health & Family Welfare Dept,
e-mamta - Introduction Matrutva or Mamta means love of Mother for her Child Initiated by H & FW Dept and NIC in 2010 http://e-mamta.gujarat.gov.in/ Name based Tracking web application. Comprehensive Family Health Survey Database with AADHAR card & Bank account number. UID Compatibility & Family search options. Coverage Almost entire population of state Special emphasis Rural, Urban Slum and slum like Health detail of 1.1 crore Families, 5.3 crore individuals > 85% of populations January 8, 2013 Health & Family Welfare Department 9 Health & Family Welfare Department
NAME BASED TRACKING : RATIONALE 1. To Develop Management tools Provide quality MCH services, Track drop outs and Ensure complete service delivery. Thus reducing IMR and MMR 3/16/2015 E- Mamta: Mother and Child Tracking 10
NAME BASED TRACKING : RATIONALE 2. HMIS - About numbers No attention is given to individuals- name based tracking system Doesn t ensure service delivery to every individual 3. To establish a credible monitoring system for MCH services. 4. To increase the quality of service delivery. 3/16/2015 E- Mamta: Mother and Child Tracking 11
NAME BASED TRACKING :PRINCIPLE 1. Most of the analysis of data in the Public Health system Focus on post mortem of the historical data Establishing trends for policy analysis and planning. 2. E-Mamta for the first time processes the available data to generate Denominator based work plans that determine the entire gamut of beneficiaries Provides the detailed schedule of beneficiaries to be targeted name wise 3/16/2015 E- Mamta: Mother and Child Tracking 12 www.gujhealth. Health & Family Welfare Dept,
NAME BASED TRACKING :PRINCIPLE 3. This facilitates concentration on Individual beneficiaries and Determining the left outs of service delivery during a certain period of time. 4. The analyzed historical data is also available on Dash Board. 3/16/2015 E- Mamta: Mother and Child Tracking 13 www.gujhealth. Health & Family Welfare Dept,
Stake holders and their responsibilities Help Desk PO e Mamta CDHO M & E Assis THV NIC AD(FW) Beneficiary THO MD-NHM MO Com. Of Health DEO ANM FHS
Stake holders and their responsibilities Data entry Operator ANM Data entry Family Health Survey Registration Services Family Health Survey Update/Verification Generate Reports for review Work plan Family Health Survey verification Work plan receive in timely manner and submit duly filled Record: e-mamta generated unique ID in Register 4 & 5, Mamta Card Provide: e Mamta generated ID to beneficiaries Counselling : to keep Mamta card and ID when attending facilities
Stake holders and their responsibilities MO/FHS Family Health Survey : ensure completeness and verification Registration: ensure completeness for ANC and child Coordination: between staff for data entry and work plan Validation/Verification : e Mamta Vs HMIS Migration: updated information, services & data entry Performance review: Sub centre wise Ensure updated information: mobile no. and staff info Cross verification of sample Taluka level: (THO/THV/M&E) Ensure availability of network connection, hardware, operator for data entry Ensure correct mapping in e Mamta Performance review PHC wise Ensure updated information : mobile no. staff info. Etc Coordination & solution of PHC level issues Cross verification of sample size
Stake holders and their responsibilities District Level ( DPC/CDHO) Overall implementation of program in district Solve issues: HR, Technical & Other as per guidance from state Training and guidance to taluka and PHC Timely feedback to state for improvement Data : monitoring review, cross verification, validation State level {AD(FW), AD(VS), PO-e Mamta, PA} Administrative & Financial matters AD(FW) Technical AD(VS) Over all Implementation in state Review of District: data entry ( registration and services) Provide data during CDHO Review meeting Receive feedback from district and coordinate with NIC for solution
Four Basic Components of Implementation 1. District Family Health survey 2. Verification & Validation of the data 3. Registration of mother and child 4. Tracking & Service provision 3/16/2015 E- Mamta: Mother and Child Tracking 18
E-Mamta: Process District Family Health Survey Mother and Child registration Service delivery and left out tracking Monthly workplans for grassroot level workers 3/16/2015 E- Mamta: Mother and Child Tracking 19
Financial implications As such no extra financial implications HR already available at all level ( except State level posts PO e Mamta, PA, Operator for help desk ) Logistics Already available at all level Space already available at all level Printing cost from contingency Training cost from training budget
Other Resource requirements - in terms of physical infrastructure, man power, time required State District Project Officer ( PO e Mamta) 24 X 7 Help Desk 2 operator 2 Program Assistant Sitting space Server & Technical support - NIC District Nodal Officer(DPM) District Program Assistant Logistics Taluka PHC Taluka M & E Assistant Logistics Data Entry Operator Logistics 8 to 10 days/month ( Vs advantage of not preparing manual report, ppt for review etc..) Data collection by ANM during VHND sessions
Steps for Successful implementation of Programme Annual update of Family Health Survey Validation, Cross verification of Family Health Survey Removal Of Duplicate Data Timely Registration of pregnant mother Printing of Unique Health ID on Mamta Card and Register 4 & 5 Generation of work plan(weekly) ANC, PNC, Delivery & Immunization services etc Real time data entry based on work plan Timely data entry of delivery services by institutes. Monthly review of pending services after registration
Steps for Successful implementation of Programme Technologically empowered ANM Regular training Regular recruitment of staff 24 X 7 Help desk to solve issues e.g. ID, PW Constant update of websites Review of RCH services only based on e-mamta ( Top to bottom) Very high level of commitment
Challenges faced and lesson learnt Challenges faced Need of orientation/training vacancy of HR & unavailable Logistics Data(Collection, data entry) Poor data entry Lesson learnt Arranged at all level(training ongoing) Guideline created (Guj) Ensured at all level through regular recruitment and supply Work plan generation and direct data entry from work plan Regular review at all level
Challenges faced and lesson learnt Challenges faced Verification/validation of data Duplication of data Technical issues Communication issues Lesson learnt FHS verification forms Report for duplicate data entry generated and verified 24 X & Help Desk at state, PO e Mamta Regular feedback from field through email and improvement
POTENTIAL OUTCOMES OF E-MAMTA Comprehensive service delivery Reduced IMR, MMR and TFR Universal coverage of immunization Reduction in anemia and malnutrition 3/16/2015 E- Mamta: Mother and Child Tracking 26
Scenario Before & After e-mamta January 8, 2013 Health & Family Welfare Department 27 Health & Family Welfare Department
e-mamta Impact on Stakeholders Beneficiary Better Service Delivery Awareness about due services to be received Continuity in service delivery in case of migration Service Provider Work -Plans with ready list of beneficiaries to be targeted Dynamic reports available for day to day monitoring Better communication Program Manager Quality data for better budget planning Real time online reports for performance monitoring Better reporting of Maternal & Infant deaths January 8, 2013 Health & Family Welfare Department 28 Health & Family Welfare Department
e-mamta Success Journey January 8, 2013 Health & Family Welfare Department 29 Health & Family Welfare Department
e-mamta Features Search Options Family search options available from AADHAR card number Multiple Search Option for Mother and Child 17 th Dec. 2013 Health and Family Welfare Department, Government of Gujarat 6
e-mamta Features Immunization Record 17 th Dec. 2013 Health and Family Welfare Department, Government of Gujarat 6
e-mamta Features Help Desk & Dash Board 24 X 7 Help Desk with tool free number Dash Board 17 th Dec. 2013 Health and Family Welfare Department, Government of Gujarat 6
e-mamta Features Growth Chart 17 th Dec. 2013 Health and Family Welfare Department, Government of Gujarat 6
e-mamta Features Hb and Weight Chart 17 th Dec. 2013 Health and Family Welfare Department, Government of Gujarat 6
e-mamta Features Online health record Interdepartmental Co-ordination Women & Child, Education etc State Verification Cell Quality Check Coverage 1158 Public Health Centers 7274 Sub centers 314 Community Health Centers 54 Sub-District & District Hospitals 6 Major Hospitals 8 Corporations All Villages of Gujarat Tel nos of 32,000 ASHA, 7200 Female Health Workers, who are now technologically empowered 17 th Dec. 2013 Health and Family Welfare Department, Government of Gujarat 6
OTHER FEATURES Details of various incentives paid Individual records for the benefits of JSY, BSY and CY schemes Online health record of individuals. Integration with HMIS Interdepartmental coordination - ICDS, Education Department, RSBY 3/16/2015 E- Mamta: Mother and Child Tracking 36
Details of various incentives paid under JSY, BSY and CY schemes Sr No. Location Name Delivery of Beneficiary Home Delivery of JSY Benefici ary Institutional Delivery of JSY Beneficiary % of Home Delivery of JSY Beneficiary % of Institutional Delivery of JSY Beneficiary 1 Abdasa 8 0 8 00.00 100.00 3 Bhachau 76 0 76 00.00 100.00 4 Bhuj 4 0 4 00.00 100.00 6 Lakhpat 41 0 41 00.00 100.00 10 Rapar 58 0 58 00.00 100.00 11 District 187 0 187 00.00 100.00 37
OTHER FEATURES Pregnant Mother Detail for 108 Services Sr No. Family Id Health UID Pregnant Mother Details for 108 Services Name Age Social Status Delivery is Expected at which Address Mobile No EDD (MM/DD/ YYYY) Service Given Govt. Facility Medical Officer (Name/M obno) District : KACHCHH Taluka : Bhuj PHC : Kukma Subcentre : Madhapar-3 Village : Madhapar (OG) - Ward No.15 PPU : UHC : 2 FM/201 A04959 ઉષ લખન 22 ST મ ધ પર 89017 01/15/2 2/42215 3198 મહ શ વર ૩ 40765 015 5 FM/201 4/58764 6 A05719 0038 નનલમ દ ન શ બલર મ ચ વડ 24 OBC/ SEBC જ ન વ સ 88663 25686 01/14/2 015 PHC :Kukm a PHC :Kukm a Dr.Kirtik umar Siju/990 994933 5 Dr.Kirtik umar Siju/990 994933 5 FHW(Na me/mob No) chandrik aben C Vaghela /972773 4426 chandrik aben C Vaghela /972773 4426 Asha (Name/M obno) Abedab en G. Sumra/7 567878 189 Abedab en G. Sumra/7 567878 189 38
SMS to beneficiaries Customized SMS Vernacular SMS Apni Matru ane bal kalyan sewao mate najikna arogya kendra ni athava to Mamta divas ni mulakat levi. Mulakat lidhel hoy to aabhar Meaning.. Please visit your nearest PHC or Mamta Diwas for ANC service. Kindly ignore if already taken
Integration of National Health Programmes RSBY CDR MDR HMIS JSY Leprosy e Mamta BSY RNTCP CY School Health ICDS 40
E-mamta vis a vis other mother and Child tracking programs Work Plans to provide list of targeted beneficiaries and ensure no left outs Full Integration of Service delivery and Reporting: Starts from DFHS to store back end data and culminates in HMIS reports. No duplication of mothers: Individual is the unit. All pregnancies of a single mother are recorded together. Complete life cycle approach: Data of an individual is recorded form Birth to Death. 3/16/2015 E- Mamta: Mother and Child Tracking 41
E-mamta vis a vis other mother and Child tracking programs Citizen service features. SMS alerts to beneficiaries and service providers. Complete integration of Health Record of an individual Not only data management tool but service delivery management tool. Access to private providers. Convergence with other Health Programs and Nutrition. Data base of all service providers and communication platform(including Pvt). 3/16/2015 E- Mamta: Mother and Child Tracking 42
Health record of individual 43
WORKPLAN For ANC 3/16/2015 E- Mamta: Mother and Child Tracking 44
Progress so far.. No. of families entered No. of members entered 118.52 lakh AS ON TODAY 5.52 crore (91.39% of Gujarat s Pop.) On-line NAME BASED TRACKING # Service Registered In 2012-13 (in lakh) In 2013-14 (in lakh) 1 No. of PW registered during 12.12 ( 82.71%) 13.28 (94%) the year ( % against Est.) 2 Total Children Registered (0-1 year) ( % against Est.) 99.89 (74.97%) 11.32 (88%) Percentage achievement against Child Registration 3 BCG given 91.1% 85.22% 4 DPT-3/Penta -3 85.5% 77.77% 5 Measles Dose 81.0% 79.87% 6 Fully immunized children 79.10% 78.65% 17 th Dec. 2013 Health and Family Welfare Department, Government of Gujarat 4
Value Added Features Dash board Notice board Immunization record Growth chart Hb., weight chart for Pregnant woman Mother tracking report with LMP Child tracking report with Date Of Birth Line list available of children dropout after delivery of registered mother Mother search option by Mobile number 17 th Dec. 2013 Health and Family Welfare Department, Government of Gujarat 4
e-mamta Sustainability and Scalability Sustainable Institutionalized and integrated with the state health system Training Saturated up to grass root level workers Minimal recurring expenditure UID Compatibility( ADD IN IMPACT ONLY IN ONE LINE ) Scalable Already replicated at National level as Mother and Child Tracking System (MCTS) Modular design which enables newer application for the various programs. Unicode font used to ensure customization in various languages Developed by NIC A Government Organization 17 th Dec. 2013 Health and Family Welfare Department, Government of Gujarat 9
e-mamta Future 1. e-mamta Helpdesk having Toll Free Number (18002331044) for all assistance related to e-mamta 2. Introduction of RCH Portal in place of MCTS (Mother & Child Tracking System) which integrates register number 3,4,5 and based on eligible couple UID. January 8, 2013 Health & Family Welfare Department 48 Health & Family Welfare Department
e-mamta Future Innovative Mobile Phone Technology for Community Health Operation (ImTeCHO) for improvement in performance of ASHA which is facilitated by SEWA Rural organization. January 8, 2013 Health & Family Welfare Department 49 Health & Family Welfare Department
e-mamta Future USSD service has to be started for online entry of e-mamta data through ASHA/FHW for which Vodafone Gujarat will provide service.. January 8, 2013 Health & Family Welfare Department 50 Health & Family Welfare Department
e-mamta Future 1. Voice Messages to all the beneficiaries registered in e-mamta for which application is developed by C-DAC Hyderabad. January 8, 2013 Health & Family Welfare Department 51 Health & Family Welfare Department
Replication : Jharkhand Context Already replicated at national level in the form of MCTS Generate work plan on regular basis Mechanism for dissemination & Collection of work plan (as no PHC structure available) Connectivity E gram ( Just like Gujarat) RCH review based only on MCTS as done in Gujarat Vernacular SMS/Voice messages alert to beneficiaries for due services Regular review of data entry Add more points
Questions & Suggestions