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Report HMIS Report Observations and conclusion on the Presenting reporting structure (DHIS II/NRHM/MCH) of surveyed blocks of RAJNANDGAON District ● The RD team visited randomly selected 4 blocks of the districts, from each block one PHC was selected randomly. One sub center selected from selected PHC based on operation feasibility. (Annexure I) ● In the surveyed blocks, three parallel reports (MCH, NRHM and DHIS II) are generated from blocks and submitted to district within prescribed guidelines. DHIS II/HMIS reports are filled by ANM at sub centers; Sector Health supervisor compiles Sub centers reports and submit to CHC. At block, health supervisor, BE, BADA, along with DEO compile the reports. The facility wise reports were entered into online software provided at block. ● The team observed that there is lot of confusion about the reporting UNITS at peripheral health institute i.e. facility wise or area wise. The double reporting was observed in Ghumka and Khairagarh blocks and in some pockets of the other surveyed blocks. District HMIS officer should take IMMEDIATE step to correct the confusion. The DDO should focus on accuracy and relevance of the data and should ensure that all the columns are duly completed. If there is any problem in entering data in the prescribed format, he may discuss the same with the concerned and immediately sort out the matter then and there. The he should act like facilitator as well as instructor. ● The one day training on the reporting proforma of DHIS II completed at block level. The guidelines give broad instructions to various users on the forms which are to be filled up, and were available at blocks but none of the interviewed staff gone through that. The 21 interviewed health workers (related to reporting), are unable to understand some of data elements present in the proforma. They requested for orientation training at peripheral health institute especially to ANMs and PHC staff workers. ● The DEO, BADA and Supervisor are preparing 3 reports i.e. DHIS II, HMIS and MCH separately. Lot of discribancyhas been observed in the 3 reports. There should be coordination between the staff so that reports can be prepared based on the actual data. It has also been observed that coordination is 1 lacking at peripheral health institute and district level regarding parallel reporting. ● There should be interaction and feedback between DDO and DEO/BADA before and after submission of reports. ● The poor quality of Xerox proforma was still utilized for reporting while the DDO informed that the printed proforma booklets were distributed to block, but the DEO and BADA have no idea regarding the printed book, which clearly indicated communication gap between district and peripheral institute. ● Reporting variations is to be rectified and corrective actions are to be initiated at district level by mutual understanding of DDO and Assistant Statistical officer. ● More focus should be given at validation error at each levels of reporting units, for example BCG dosages are far more than actual live births in some surveyed blocks and PHC/HSC level. The BMO and Reporting staffs should vigil on such data items and establish inbuilt system of monitoring at block level. ● At Primary health centers, the Medical officer should involvement of in the data verification report in lieu of only signing. Interviewed medical officers urged refresh training on the present reporting system. ●The services of DEO are used for all sundry jobs, activities beyond their compass. There is a need to focus workforce in fruitful manner for improvement of the data quality. 2 Technical Supervision report of 4 blocks of Rajnandgaon GHUMKA BLOCK KAIRAGARH DONGARGARH DONGARGAON Reporting STAFF BADA Vacant Vacant Vacant Vacant DEO YES YES YES YES BADA YES YES - YES Status of training 1 DAY REFRESHER TRAINING Level of understanding of POOR POOR POOR POOR data items (HMIS/DHISII) in staff Reports generated at block DHIS YES YES YES YES NRHM YES YES YES YES MCH YES YES YES YES DISCRIBANCY in figures YES YES YES YES among generated REPORT Duplication in reporting YES YES YES YES Monitoring of reports No No No No HMIS/DHIS II reports NO NO NO NO verification Coordination among NO NO NO NO reporting staff and in charge Reporting linkage WEAK WEAK WEAK WEAK DDO feedback to DEO vice WEAK WEAK WEAK WEAK versa (April - June 2010 reporting) Confusing in facility wise YES YES YES YES reports Involvement of BMO in the verification of reports NO NO NO NO Validation reports LIMITED TO BLOCK ONLY, IT SHOULD BE DISTRIBUTED TO PRIMARY HEALTH CENTERS AS WELL AS EVERY SUBCENTERS Consensus related to reports NO NO NO NO at Block level meeting Mortality data report at block DHIS/NRHM/MCH VARIATION VARIATION VARIATION VARIATION Mortality data report at district DHIS/NRHM/MCH VARIATION 3 SOME OF THE INTERPRETATION REGARDING DATA OF THE DISTRICT AND SURVEYED BLOCKS; a) In month of May 2010, the district showing (3060/3066=99%) of the New mother registered for ANC. How reliable this data is? Table shows district ANC registration and new registered JSY mother and its discrepancy District level data HMIS was forwarded to state Surveyed Block 3 Surveyed block 4 and showing on the (Dongergarh) Dongergaon HMIS web site of Govt of India Total number of pregnant women 3066 444 251 Registered for ANC New women registered 3060 under JSY 147 129 Difference 6 297 122 The data needs to validate at each level before aggregation Interpretation: It looks nice to see the data of the district regarding achievement of JSY registration but it does not match if you verify the data of peripheral health institute. Some health reporting area had JSY less than ANC registration while it was found exceeded in some health institute. The overall data of the reporting units are equally important, if it has to be taken into account, that’s why it is essential that differences noticed in the data items needs to be verified at each level and data to be entered at each level very carefully and in correct manner. The health supervisor should look sub center wise reports of the newly registered pregnant women and status of the JSY registration, so that errors are rectified and corrected at peripheral level. The DDO should also look into the mater and keep a watch at block data compilation. 4 b) BCG is more than Live Births: Facts from Field area The data verified from the surveyed blocks of the district, there was discrepancy among the BCG and Live birth in the different reporting formats at blocks. The table showing the BCG and Live birth variation HMIS web site Block 1 Dongergaon Dongergarh Ghumka District Rajnathgaon (NRHM) April May June April May June April May Jun Apr Ma June e il y Live birth 2155 2001 2698 359 380 389 119 133 133 251 270 BCG 2105 2263 2538 371 377 388 168 168 134 268 251 Difference 50 -262 60 -12 -49 -35 -1 -7 Intra reporting variations Dongergarh block NRHM report HMIS/DHIS II Sub Sub April May June April May June Total Total Difference Live Birth 251 305 330 886 133 251 270 654 232 BCG 268 290 309 867 134 268 251 653 214 Difference -17 -1 -17 Intra reporting variations Dongergaon block NRHM report DHIS II Sub Sub May June May June Total Total Difference Live Birth 119 133 252 70 83 153 99 BCG 168 168 336 168 173 341 -5 Difference -49 -35 -98 -90 -188 Interpretations: In surveyed blocks, BCG vaccination was reported twice/repetition of reports noticed at reporting units. 5 The CHC and PHCs reports are not added in the DHIS II reports in the Dongergarh blocks. The area wise reports are added in the compilation of PHC in Ghumka block. At visited CHC and PHC health facilities, it has been noted that no. of live birth are more than the BCG vaccination indicates that some of the new born babies are discharged after delivery without giving zero dose. Private health institution deliveries are not added in the facility wise reporting while it was noted in MCH and other reporting. c) Sterilization complications: At Dongargarh Block the sterilization complications was mentioned during April and June 2010 DHIS II reports, whereas it was not reflected in the NRHM report. 31 Quality in sterilization services* DHIS II April May June 2010 31.1 Number of complications following sterilization (a) Male 6 0 0 (b) Female 13 5 1 Total {(a) to (b)} 19 5 1 31.2 Number of failures following sterilization (a) Male 3 1 0 (b) Female 4 2 0 31.3 Number of deaths following sterilization (a) Male 1 0 0 (b) Female 0 0 0 Total {(a) to (b)} 0 0 0 ? Might be inadvertently mentioned but it should be verified by the concerned officer before forwarding such type of data d) Adverse events following immunization (DHIS II) Adverse Event Following NRHM DHIS II Immunization (AEFI) April May June April May June Abscess 0 0 1 Death 1 0 0 Others 0 2 0 *Dongargarh Block There was discrepancy among the parallel reporting of the block, data should be verified before uploading, the block needs reorientation training regarding filling the proforma with level of understanding of prescribed data items. 6 e) Mortality reports variation Surveyed Blocks (Reported Reported deaths (all) GHUMKA KAIRAGARH DONGERGARH DONGERGAON Total A REPORTED Deaths IN 143 222 225 213 803 MCH REPORTS (April to June 2010) in surveyed blocks B REPORTED DEATHS IN 262 262 HMIS REPORTS AT DISTRICT RAJNANDGAON Discrepancy in reports Interpretation: There was also discrepancy in the morality data at each level, which needs to be corrected; it should tally at each level and at different reporting system also.
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