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Indian Journal of Community Medicine

Over reporting of RCH services coverage and operational problems in health management information system at the sub-center level

Author(s): Verma R, Prinja S

Vol. 32, No. 3 (2007-07 - 2007-09)

ORIGINAL ARTICLE

Year : 2007 | Volume : 32 | Issue : 3 | Page : 185-188

Over reporting of RCH services coverage and operational problems in health management information system at the sub-center level

Verma R1, Prinja S2
1 Department of SPM, PGIMS, Rohtak, India
2 School of Public Health, PGIMER, Chandigarh, India
Date of Submission 02-Mar-2006
Date of Acceptance 08-Jan-2007

Correspondence Address:
Prinja S
School of Public Health, PGIMER, Chandigarh
India

Source of Support: None, Conflict of Interest: None
How to cite this article:
Verma R, Prinja S. Over reporting of RCH services coverage and operational problems in health management information system at the sub-center level. Indian J Community Med 2007;32:185-8
How to cite this URL:
Verma R, Prinja S. Over reporting of RCH services coverage and operational problems in health management information system at the sub-center level. Indian J Community Med [serial online] 2007 [cited 2007 Nov 30];32:185-8. Available from: http://www.ijcm.org.in/text.asp?2007/32/3/185/36823

Abstract

Objective: To evaluate the coverage of MCH services as against reported coverage and assess the extent of usage of health information system. Study Design : Community-based cross-sectional study. Setting: Twenty sub-centers of block Lakhanmajra, district Rohtak. Participants: Four hundred mothers having children between 1-2 years age. Statistical Analysis : Simple proportions percentages. Results: The study revealed marked variation in reported and evaluated coverage of various service indicators for MCH care. TT coverage and tubectomies performed were the only notable exceptions that where reported and evaluated coverage matched largely. Distressingly, only 10% of health workers used the eligible couple and child information register for prioritizing clients and preparing the sub-center action plans. The workers did not sufficiently use the information generated through registers, records, and reports maintained at sub-centers.

Keywords: Child health program, health information system, reproductive.

Every program develops a management information system to continuously review progress and take corrective measures, if necessary, to improve the performance. Such actions need not wait for intervention from higher levels but should often be taken promptly and effectively even by the officer preparing the report.[1]

During the year 1992, an appropriate "Health management information system version 2.0 implementation in states/UTs at district level" was evolved after a test run in four states. Until now, 13 states/UTs are implementing the system. The system has been given a computer compatible format, which can be operated through satellite-based government informative network, NIC (NIC NET). This unified and integrated system of health management information was a bold decision indeed; however, its phased-manner adoption tends to be a slow process.[2]

In 1999, under ninth five-year plan, speedy operation of computer compatible HMIS was implemented throughout India w.e.f 1.4.1999. The health information so collected at a sub-center is sent through PHC and CHC to Districts and State and is complied by Central Bureau of Health Intelligence, Directorate General of Health Services and published as "Health Information of India." In addition, the rural health division of Directorate General of Health Services publishes a six-monthly bulletin "Rural Statistics in India."[3]

Multipurpose health workers (MPHW), male and female, who form the sub-center team have been trained and given a set of 13 registers to record health management information system (MIS). Since MIS forms an important decision-making tool and its usage varies, it was considered necessary to carry out an operational research to evaluate the coverage and usage of health information system at the sub-center level.

Materials and Methods

The study was conducted in the rural block Lakhanmajra, district Rohtak, which is the field practice area of Department of SPM, PGIMS, Rohtak. Twenty "functional" sub-centers were purposely selected in the present study conducted during the period from September 1998 to February 1999. The criteria of a functional sub-center included a sub-center where MPHW (F) was posted during the year (1998-1999), was not on long leave during this period and the center submitted its reports regularly. Four sub-centers in the block, which did not meet the selection criteria were excluded. The total population covered in the study area was 1,23,280, which included 3127 women with children between 1-2 years of age. The birth rate in the block Lakhanmajra from where the sub-centers have been sampled for the year of study was 25.8 per 1000 population.

The study design was cross sectional. A study population of 400 mothers, i.e., 20 mothers from each sub-center having children 1-2 years of age was selected by systematic random sampling technique from birth register of sub-center. A list of all mothers with children between 1-2 years served as the sampling frame.

The actual coverage of maternal and child services was assessed by the investigators by interviewing the women beneficiaries selected by systematic random sampling as mentioned above. The reported coverage of services for these women (which were selected for coverage evaluation) was assessed from the relevant records. The reported coverage, thus computed, was compared with the evaluated coverage of respective services as evident from the survey.

The actual usage of health information was determined by interviewing and observing records and reports of the respective workers. The investigators interviewed the health workers regarding actual usage of the health information generated. They were asked specific questions pertaining to use of individual registers and evidence of use of information for action was sought and evaluated wherever possible.

Results

The present study was conducted in 20 sub-centers of a rural block of district Rohtak covering a population of 1,23,280 and 24 villages with the objective of evaluating the correctness of reported MCH services coverage. The study also assessed the utilization of data collected and reported. Barring a few exceptions, the study revealed inflated coverage for various services reported by the health workers in their monthly reports.

Reported figure of coverage 97.6% for IFA prophylaxis was quite impressive indeed, and many of the sub-centers enthusiastically reported a high coverage of 308.0%, which by all account is over- ambitious, incorrect, and inflated. The actual coverage level of IFA prophylaxis was around 39.5% as revealed through sample survey [Table - 1].

State and National coverage norms for high-risk pregnant women have been set around 15%. Local norms have not been worked out in this geographical area. Against the National/State norms the identification and referral of high-risk women was distressingly low as 3.4%. On an average, around 10.0% of pregnancies are wasted. Reported wastage figure in the present study was 3.8%, which is quite low as per established norms. Majority of deliveries were assisted by trained dais , i.e., 83.8% as annual reports and only 7.3% deliveries attended by ANMs. The confirmed deliveries attended by ANMs were observed to be only 0.25%. Reported coverage level of 82.3% was much different from actual coverage level of 7.0% in respect of IUD insertions.

Forty-five percent workers admitted having no use of sub-center and village information registers. About 5% of workers agreed that the household and survey register was required for enlisting the children <5 years in IPPI program. Two (10%) workers used the eligible couple and child information register (ECCIR) for preparing action plan. Only seven (35%) workers used this register in calculating the demand of immunization. No use of tuberculosis and leprosy register and daily tour diary was reported according to 60% and 10% of workers, respectively. All (100%) workers used birth register for calculating the birth rate [Table - 2].

The study revealed that the health workers found the monthly report preparation a difficult exercise, which was very time consuming. Besides submitting the reports to the supervisors, the health workers did not find any use of the health information in planning their work schedule or prioritizing high-risk beneficiaries. Further, the workers felt that there was no feedback from the supervisors, except for an emphasis on meeting contraception and immunization targets.

Discussion

The State of Haryana has been implementing the Health Management Information System (version) 2.0) since 1992. Under this system, each sub-center is required to maintain thirteen registers and a monthly report is being submitted on prescribed format, which has been adapted to the requirement of Reproductive and Child Health program and Community Needs Assessment Approach.[4]

The reported and recorded evidence of institutional deliveries was quite low at 8.6%, and the actual observation was just half of the reported level, i.e., 4.5%. The target to achieve 80.0% of institutional deliveries by 2010 appears to be distant, at least in rural areas due to the observed trends of deliveries in rural areas.[5]

The culture of home deliveries persists and there is a strong reason behind this. Involvement of the private sector and NGOs and providing full support appears to be a partial answer to the promotion of universal safe deliveries. There was a mismatch between reported safe deliveries (99.7%) and evaluated coverage (61%) of sample survey in the present study.

Postnatal records and records of neonatal care reflect poor coverage. The routine report of 80.0% or more postnatal care coverage was false/over reporting as only 14.2% of mothers testified having received postnatal care. This is in consonance with the results of District Rapid Household Survey (1997) for Rohtak.[6]

The targeted coverage level as determined by health workers in their annual action plan as a part of Community Needs Assessment has not been initiated yet. The action plan appears to be unrealistic with most of the sub-centers. Only six (30%) sub-centers have reasonably initiated correct action plans. The actual performance of the workers was much different from the target set, as was evident through the annual report submitted by respective sub-center workers. The quantity was given preference over quality, over-reporting and inflation was evident in respect of many components of service as explained in the observation of this study. Need assessment tends to be poorly understood and unrealistic and is understood only by policy planners at the highest level, which has not percolated to the ground level, viz., the sub-center and health workers.[7]

Service registers were incomplete, incorrect with inflated entries. The ICMR study (1989-1992) also reported that one-third of the registers in a national sample of sub-center was not filled correctly.[8] The inflated data was pertinent to IUD insertions, oral pills, and condoms as well as IFA tablets. Low coverage has also been reported through District Rapid Surveys (1997) and National Family Health Survey data (1998-1999).[9]

The result of this study indicates that the information is primarily used to prepare monthly reports as required by the system. The format of monthly report is too complex and difficult to comprehend by the workers at the sub-center. It was observed that the workers had to struggle to transcribe the information

During the basic training of the workers, their continuing education, preparation of reports, and annual action plan in live situation needs to be included. They should also develop the skill to handle data, its analysis, and initiate actions and decisions based on the data.

References

1. Government of India. Child survival and safe motherhood. New Delhi; 1994. p. 113.
2. Government of India. Health management information system- subcentre registers and reporting format model. New Delhi; 1992.
3. Central Bureau of Health Intelligence. Health information of India 1995-96. Ministry of Health and Family Welfare. New Delhi; 1998.
4. Ministry of Health and Family Welfare. Manual of CNA Approach in Family Welfare Programme. New Delhi; 1998.
5. Planning Commission. National Population Policy 2000. Ministry of Health and Family Welfare. New Delhi; 2002.
6. Population Research Centre. Rapid Household Survey Rohtak; 1997. Chandigarh; 1999.
7. Ministry of Health and Family Welfare. Manual on Target Free Approach in Family Welfare Program. New Delhi; 1997.
8. Evaluation of quality and coverage of MCH and Family Planning services at PHC level.: Indian Council Of Medical Research, Govt of India: New Delhi; 1998.
9. International Institute of Population Sciences and ORC Macro. National Family Health Survey-2 (1998-99). IIPS: Mumbai; 1998-99.

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