SOURCES OF HEALTH INFORMATION

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SOURCES OF :

SOURCES OF HEALTH INFORMATION - Dr.R.Govindarajan ICM, MMC

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The purpose of any information system For timely decision to achieve objective To ensure the availability of: appropriate information, to the appropriate person, at the appropriate time and place

Data:

Data Are facts obtained from observations, recording, or research.

WHAT IS INFORMATION?:

WHAT IS INFORMATION? The manipulated and processed form of data is called information. More meaningful than data. Used for making decisions. Data is used as input for processing and information is output of this processing. 5

WHAT IS INTELLIGENCE?:

WHAT IS INTELLIGENCE? It is the transformation of information through integration and processing with experience and perceptions based on social and political values that produces intelligence. DATA INFORMATIONINTELLIGENCE

Health Information System ( HIS ): :

Health Information System ( HIS ): It is a mechanism for the collection, processing, analysis and transmission of information required for organizing and operating health services, and also for research and training

Requirements to be Satisfied by health information systems:

Requirements to be Satisfied by health information systems Be population-based. Avoid the unnecessary agglomeration of data . Be problem-oriented. Employ functional and operational terms. Express information briefly and imaginatively (e.g. tables, charts, percentages). Make provision for the feed-back of data.

Components of a health information system :

Components of a health information system Demography and vital events Environmental health statistics Health status : mortality, morbidity, disability, and quality of life Health resources : facilities, beds, manpower Utilization and non-utilization of health services attendance, admissions, waiting lists Indices of outcome of medical care Financial statistics ( cost, expenditure) related to the particular objectives

USES of Health Information:

USES of Health Information To measure the state of health of a community, and to identify its health problems , and medical and health care needs . For comparison For planning , administration and evaluation of health care services and programmes . For research into community health problems

SOURCES FOR COLLECTION OF DATA:

SOURCES FOR COLLECTION OF DATA CENSUS REGISTRATION OF VITAL EVENTS SAMPLE REGISTRATION SYSTEM NOTIFICATION OF DISEASES HOSPITAL RECORDS RECORD LINKAGE EPIDEMIOLOGICAL SURVEILLANCE 11

SOURCES FOR COLLECTION OF DATA:

SOURCES FOR COLLECTION OF DATA ENVIRONMENTAL HEALTH DATA HEALTH MANPOWER STATISTICS POPULATION SURVEY ROUTINE STATISTICS RELATED TO HEALTH

CENSUS:

CENSUS

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“Population census is the total process of collecting , compiling, analyzing or otherwise disseminating demo-graphic , economic and social data pertaining, at a specific time, of all persons in a country or a well defined part of a country.

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It’s the biggest source of comprehensive data on : • Demography • Economic Activity • Literacy & Education • Housing & Household Amenities • Urbanization • Fertility and Mortality • Scheduled castes and Scheduled Tribes • Language, Religion & Migration

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methods of collection of data in a census : de - facto method Extended de-facto method used in india since 1941. de - jure method

LEGAL PROVISIONS :

LEGAL PROVISIONS CENSUS OPERATIONS Census Act , 1948 & Census Rules, 1990

PRE-PLANNING:

PRE-PLANNING

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2001 2011 States/UTs 35 35 Districts 593 640 Tehsils 5463 5767 Towns 5161 7742 Villages 593732 608786 Households 194 Million 240 Million EBs 19.82 lakhs 23.56 lakhs Population 1.03 Bn 1.20 Bn Administrative units 20

Census 2011 was held in two phases:

Census 2011 was held in two phases PHASE 1 House listing & Housing Census and Collection of data on National Population Register April to September 2010

House listing Phase:

House listing Phase Two forms – Each household First form (House listing form) Second form (NPR form) New initiative in 2011

PowerPoint Presentation:

Predominant material of roof, wall & floor of the Census House • Use & Condition of Census House • Name of Head of HH • Ownership status • Number of living rooms • Number of married couples • Amenities available: • Main source and availability of drinking water • Main source of lighting • Latrine within the premises • Type of latrine • Waste water outlet connected to • Amenities available ( contd ): • Bathing facility within the premises • Availability of kitchen • Fuel used for cooking • Assets possessed by the household • Radio/Transistor • Television • Computer/Laptop • Telephone/Mobile phone • Bicycle • Scooter/ MotorCycle /Moped • Car/Jeep/Van • Availing banking services QUESTIONS (35)

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It is a register of usual residents of the country. Comprehensive data base. Comes under citizenship act 1955 and citizenship rules 2003. 11/11/2013 census NPR (National Population Register )

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BIOMETRICS COLLECTED FROM PERSONS 5 YEARS AND ABOVE ( Photograph, 10 fingerprints , 2 Iris prints ) DETAILS FOR ALL PERSONS

PHASE 2:

PHASE 2 Population Enumeration In snow bound areas • Population Enumeration: 11 th to 30 th Sep 2010 • Revision Round : 1 st to 5 th Oct 2010 (Reference Date: 0:00 Hours of 1 st October 2010) In all other areas • Population Enumeration: 9 th to 28 th Feb 2011 • Revision Round : 1 st to 5 th Mar 2011 (Reference Date: 0:00 Hours of 1 st March 2011)

Population Enumeration:

Population Enumeration

Revisional Round:

Revisional Round Enumerator goes back - household 2 Questions Any new visitor (not enumerated already) since last visit but before 0.00hrs of 1 st March 2011 If Yes fill in fresh form Any birth / death since last visit but before 0.00hrs of 1 st March 2011 If yes Update form - birth Cancel entry - death

Census in School:

Census in School sensitize the school students about the ensuing Population Enumeration in Census 2011 covers about 60 to 80 schools in each of the 640 Districts in the country and is specifically designed for participation by the students of the entire school and the students of class VI, VII and VIII in particular.

Activities:

Activities Reading the message on the Census and its importance during the School Assembly. Census Awareness Quiz  . Display of Maps and Data Sheets. Poster Making Competition on the topic ‘Population  Census Week 7th to 12th February 2011

Census 2011:

Census 2011

Limitations:

Limitations two types of error -coverage and content error . Age misreporting. There is no direct question on deaths in Indian census. unable to give the demographic estimates for the period between two censuses.

CIVIL REGISTRATION SYSTEM:

CIVIL REGISTRATION SYSTEM

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Civil registration is defined as the continuous permanent and compulsory recording of the occurrence of vital events

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Vital events are Live births Deaths Foetal deaths Marriages Divorces Adoptions

REGISTRATION OF VITAL EVENTS:

REGISTRATION OF VITAL EVENTS The Central births and Deaths registration Act,1969 came into force on 1 April 1970 . According to Act compulsory registration of births & deaths throughout the country & compilation of vital statistics in the states so as to ensure uniformity & comparability of data. Birth & Death in 21 days 40

Registration of vital events….:

Registration of vital events…. Uses : It keeps a continuous check on demographic changes. When complete & accurate it serves as a reliable source of health information. It is precursor of health statistics Drawback : Registration system in India is very unreliable in regards to accuracy, timeliness, completeness and coverage. Under – registration in some states is due to illiteracy , ignorance, lack of uniformity in the collection compilation and transmission of data. 41

Sample Registration System:

Sample Registration System (SRS)

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One of the largest continuous demographic household sample survey in the world. Dual reporting system Initiated – (1964-65) Operational – ( 1969-70 )

Objectives::

Objectives: To provide annual reliable estimates of birth and death rates at the state and national levels for rural and urban areas separately. To provide other measures like fertility and mortality(TFR, IMR, CMR, etc). To study risk factors and household determinants through causes of deaths .

Structure of the Sample Registration System:

Structure of the Sample Registration System The main components of SRS are : Base-line survey of the sample unit Continuous (longitudinal) enumeration of vital events pertaining to usual resident population by the enumerator Independent retrospective half‑ yearly surveys Matching of events Field verification of unmatched and partially matched events.

STUDY DESIGN:

STUDY DESIGN U ni -stage stratified simple random sample without replacement A simple random sample of enumeration Block is selected without replacement from each of the size classes of towns/cities in each State/UT

Sampling Design :

Sampling Design The sample unit in Rural areas - village or a segmented village Population ≤ 2000- Forming stratum-I Population ≥ 2000- Forming stratum-II Urban area - census enumeration block Divided in 4 strata based on size Population ≤ 100000- stratum-I Population ≥ 100000 ≤ 500000 - stratum-II Population ≤ 500000- stratum-III Four metro cities of Delhi, Mumbai, Chennai and Kolkata -separate strata

Number of sample units at different replacement period:

Number of sample units at different replacement period Residence 1969-70 1977-78 1983-85 1993-95 2004 Rural 2432 3684 4176 4436 4433 Urban 1290 1738 1846 2235 3164 Total 3722 5422 6022 6671 7597 The revision of SRS sampling frame is undertaken in every ten years based on the results of latest census.

SRS Reports :

SRS Reports Publication-Annually by Office of the Registrar General,GOI . The present report ‘SRS Statistical Report, 2010’ is the seventh report of the new sample based on Census 2001 frame Report contents- Age-sex Structure Age specific fertility rate Other fertility indicators Age specific death rates by sex Other selected mortality indicators Medical attention at birth Medical attention received before death

PowerPoint Presentation:

SRS bulletin Regular - half yearly intervals Provide estimates of – Birth and death rates State & national level separately for Rural & Urban

Features of the New SRS:

53 Features of the New SRS Provide vital rates at NSS Natural Division level (which is a group of contiguous districts) for rural areas. It will also provide reliable estimates of IMR at NSS Natural Division level for rural areas. Use of female literacy as a stratifying factor in urban areas Separate estimates for four metros viz. Delhi, Kolkata, Chennai & Mumbai .

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55 Enhancing the scope of data Morbidity data Family planning practices data Data on abortion Personal habits – use of pan, tobacco, alcohol, food habits: veg /non- veg Birth history of all currently married women in reproductive span Data on reasons of migration Data on school attendance (up to 16 years) Data on disability

RHIME:

RHIME Routine, Representative , Re-sampled , Household Interview of Mortality with Medical Evaluation

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Introduction of Verbal Autopsy instrument for determining the cause specific mortality by sex and age. Integral part of SRS from 2004 Verbal Autopsy (VA) is an investigation of train of events, circumstances, symptoms and signs of illness leading to death through an interview of the relatives or associates of the deceased.

STEPS:

STEPS Lay, non-medical staff conducting household investigation of the events leading up to death Use of structured questions plus narrative questions in the investigation Central medical evaluation and adjudication About 5 % random audit by independent team reporting to the academic partners Trained physicians assign underlying cause of death (ICD-10) plus keywords 100% second coding by these trained physicians, and reconciliation

Type of Forms : incl. Structured & Narrative :

Type of Forms : incl. Structured & Narrative

PowerPoint Presentation:

SRS Bulletin-India (oct.2012) INDIA TAMILNADU Birth Rate 21.8 15.9 Death Rate 7.1 7.4 Natural Growth Rate 14.7 8.5 IMR 44 22

NOTIFICATION OF DISEASES:

NOTIFICATION OF DISEASES The primary purpose of notification is to effect prevention or control of disease. Cholera ,plague and yellow fever are internationally notifiable diseases. International Surveillance is required for Louse borne Typhus, relapsing Fever, Polio, Influenza, Malaria, Rabies, Salmonellosis. 61

Notification of diseases….:

Notification of diseases…. Uses : Valuable information regarding fluctuations in disease frequency. It provides early warning about new outbreaks of diseases. Drawback : Notification covers only a small part of the total sickness in the community. Under reporting is common. Many atypical & subclinical cases escape notification 62

HOSPITAL RECORDS:

HOSPITAL RECORDS It forms basic and primary source of information about diseases prevalent in the community . USES : Geographic sources of patients. Age & sex distribution of diseases & duration of hospital stay. Distribution & association between diseases. Period between disease & hospital admission. Cost of hospital care. 63

PowerPoint Presentation:

A register is a permanent record & here the cases can be followed-up. If the reporting system is effective, & the coverage is on national basis, than register can provide useful data on disease specific morbidity & mortality. Disease Registers

EPIDEMIOLOGICAL SURVEILLANCE:

EPIDEMIOLOGICAL SURVEILLANCE Special surveillance activities are conducted for endemic diseases like malaria , filariasis, leprosy ,etc. in our country. This provides considerable morbidity and mortality data for the specific diseases . 65

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Integrated Disease Surveillance Project Overview

Integrated Disease Surveillance Project (IDSP) :

Integrated Disease Surveillance Project (IDSP) Launched in November 2004. Tamilnadu Launched in August 2005. Aims:- To detect early warning signals of impending outbreak and help initiate an effective response in time To provide essential data to monitor progress of on-going disease control program and help allocate resources more efficiently

Methods of Data Collection:

Methods of Data Collection Routine reporting; Passive surveillance Sentinel surveillance Active surveillance Vector surveillance Laboratory surveillance# Sample Surveys Outbreak investigation Special studies

PowerPoint Presentation:

Frequency of Reporting Many epidemic prone dis. has short IP therefore monthly review might delay the timely identification of an outbreak Weekly reporting – if clustering of cases (T & P wise), immediate field visit to avert outbreak Daily report – once outbreak is identified (neighboring areas need to set up surveillance activities to rule out spread) After outbreak subsided wkly report should be continued for at least double the IP

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Reporting Forms Form ‘S’ (Suspect Cases) by Health Workers (Sub Centre) Form ‘P’ (Probable Cases) by Doctors (PHC, CHC, Pvt. Hospitals) Form ‘L’ (Lab Confirmed Cases) from Laboratories

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Types of case definitions in use Case definition Criteria Users Syndromic (suspect) “S” forms Symptoms/ Clinical pattern Paramedical personnel and members of community Presumptive (Probable) “P” forms Typical history and clinical examination Medical officers of PHC and CHC Confirmed “L” forms Clinical diagnosis by a medical officer and positive laboratory identification Medical officer and Laboratory staff More specificity

STRUCTURAL FRAMEWORK OF INTEGRATED DISEASE SURVEILLANCE PROJECT:

STRUCTURAL FRAMEWORK OF INTEGRATED DISEASE SURVEILLANCE PROJECT CSU DSU SSU RURAL SURVEILLANCE URBAN SURVEILLANCE SSPS - Selected Sentinel Private Sites Rural SSPS - 15 PHC , Sub-centres Informers Rural Medical Colleges District/HIV/AIDS District TB Lab ESI Railway Hosp Water Dept. CGHS Corporation Hosp Pollution Control ICMR Labs District Hospital ID Hospitals Dispensaries Informers Urban SSPS – 15 per 10 lac pop Police Med. College Dist. Malaria unit

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Diseases Covered under IDSP Regular Surveillance Vector Borne Disease : 1. Malaria Water Borne Disease : 2. Acute Diarrheal Disease (Cholera) 3. Typhoid 4. Jaundice Respiratory Diseases : 5 . Tuberculosis 6 . Acute Respiratory Infection Vaccine Preventable Diseases : 7 . Measles Diseases under eradication : 8 . Polio Other Conditions : 9 . Road Traffic Accidents (link up with police computers) Other International commitments: 10 . Plague, Yellow fever Unusual clinical syndromes : 11 . Menigoencephalitis / Respiratory Distress, Hemorrhagic fevers, other undiagnosed conditions 2. Sentinel Surveillance: Sexually transmitted diseases /Blood borne : 12. HIV, HBV, HCV Other Conditions : 13 . Water Quality 14 . Outdoor Air-Quality 3. Regular periodic surveys: NCD Risk Factors : 15 . Anthropometry, Physical Activity, Blood Pressure, Nutrition , Tobacco 4. State specific diseases: e.g. Dengue , JE, Leptospirosis

ENVIRONMENTAL HEALTH DATA:

ENVIRONMENTAL HEALTH DATA Health statistics provide data on Various aspects of air , water and noise pollution Harmful food additives Industrial toxicants, etc. USES: Environmental data can be helpful in the identification and quantification of factors causative of disease. DRAWBACK : Collection of environmental data remains a major problem for future. 76

HEALTH MANPOWER STATISTICS:

HEALTH MANPOWER STATISTICS It gives Information relating to the number of physicians , dentists, pharmacists, hospital nurses , medical technicians, etc. By age ,sex , specialty and place of work . There records are maintained by the state medicals/dental /nursing councils and the DME. 77

SURVEYS:

SURVEYS The term health survey is used for surveys relating to any aspect of health-morbidity, mortality, nutritional status. may be Eneumeration surveys or Sample surveys. 78

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National family health survey District level household survey Annual health survey National sample survey Vital events survey Pilot/Ad hoc survey

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National Family Health Survey (NFHS)

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large-scale, multi-round survey conducted in a representative sample of households throughout India . Provides state level and national data. Conducted by Ministry of Health and Family welfare.   Nodal agency- IIPS, Mumbai NFHS-1 :1992-93 NFHS-2 :1998-99 NFHS-3 :2005-06

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Technical assistance by ORC Macro (USA ). Funding by USAID, DFID, the Bill and Melinda Gates Foundation,UNICEF , UNFPA, and MOHFW, GOI . NACO and NARI provided assistance for the HIV component NFHS-3 fieldwork was carried out by18 Research Organizations including some Population Research Centres between December 2005 and August 2006.

GOALS:

GOALS To provide essential data on health and family welfare needed by the Ministry of Health and Family Welfare and other agencies for policy and programme purposes To provide information on important emerging health and family welfare issues

Scope of NFHS-3:

Scope of NFHS-3 All 29 states are covered Slum and non-slum areas of eight cities, i.e. Chennai, Delhi, Hyderabad, Indore, Kolkata, Meerut, Mumbai, Nagpur Interviews were conducted with Women age 15-49 Men age 15-54

Biomarkers Measured in NFHS-3:

Biomarkers Measured in NFHS-3 Height and weight Haemoglobin content in the blood to measure anaemia Collection of blood samples for HIV testing

Provides data regarding :

Provides data regarding Household and Individual Characteristics Fertility, Marriage and Family Planning Maternal Health Immunization and Child Health Nutritional Status of Children and Adults HIV Knowledge, Behaviour and Prevalence new and emerging issues Perinatal mortality, male involvement in family welfare, adolescent reproductive health, high-risk sexual behaviour, family life education, safe injections, Tuberculosis, and malaria;

Survey method :

Survey method Three questionnaires used : ( translated into 18 Indian Languages) The Household Questionnaire, The Eligible men & Woman Questionnaire The Village Questionnaire (rural areas )

Procedure:

Procedure Household survey As a part of it, cooking salt is tested for iodine Content. Individual respondent interview Measurement of height, weight, Hb % in women, men, children born in Jan 2000 or later Collection of blood samples on filter paper in men and women for HIV testing.

SAMPLING DESIGN:

SAMPLING DESIGN In each state, the Rural sample was selected in two stages The selection of Primary Sampling Units (PSUs), which are villages, with probability proportional to population size (PPS) Random selection of an equal number of households within each PSU in the second stage.

SAMPLING DESIGN:

In urban areas , a three‐stage procedure was followed. Wards were selected with PPS sampling. One Census Enumeration Block ( CEB) was randomly selected from each sample ward . An equal number of households were randomly selected within each sample CEB. SAMPLING DESIGN

NFHS-3 Sample from 29 states:

NFHS-3, India, 2005-06 NFHS-3 Sample from 29 states Number Interviewed Response Rate Households 109,041 97.7 Women (age 15-49) 124,385 94.5 Men (age 15-54) 74,369 87.1

Summary and Highlights:

Summary and Highlights NFHS‐3 is the first nation‐wide community based survey to provide an estimate of HIV prevalence in the general population. Substantial improvements have been seen in child survival Fertility continues to decline Urban women have already reached the replacement level of fertility, but rural women even now have an average of three children For the first time more than half of the currently married women are using some contraceptive method INDIA TAMIL NADU

Summary and Highlights (contd.):

NFHS-3, India, 2005-06 Summary and Highlights (contd.) There have been improvements in antenatal care, institutional deliveries, and assistance at delivery by a health professional, but the changes over time have been slow Immunization coverage for children has improved for all vaccines except DPT Under nutrition and anaemia among children remain major challenges Adults suffer a dual burden of under nutrition and overnutrition .

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DISTRICT LEVEL HEALTH SURVEY (DLHS)

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The district is the basic nucleus of planning and implementation of the RCH programme . To provide district level estimates on health indicators to assist policy makers and program administrators in decentralized planning, monitoring and evaluation.

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The Ministry of Health and Family Welfare ( MoHFW ), Government of India has designated International Institute for Population Sciences (IIPS ), Mumbai as the nodal agency for conducting the District Level Household and facility Survey (DLHS ) DLHS -1in 1998-99 DLHS-2 in 2002-04. DLHS-3 in 2007-08

OBJECTIVES:

OBJECTIVES to provide RCH indicators at the district level: Coverage of antenatal care and immunization services Proportion of institutional/safe deliveries JSY beneficiaries Contraceptive prevalence rates ASHA’s involvement Unmet need for family planning Awareness about RTI/STI and HIV/AIDS Family life education among unmarried adolescent girls Linkage between health facility and RCH indicators

PowerPoint Presentation:

DLHS-3 is one of the largest ever demographic and health surveys carried out in India, with a sample size of about seven lakh households covering all districts of the country . A systematic multi-stage stratified sampling method was used Ever-married women (aged 15-49 ), unmarried women (aged 15-24 ) are also added as Respondants . DLHS 3 11/11/2013 98

Ever married women ?:

Ever married women ? Ever married women or men are persons who have been married at least once in their lives although their current marital status may not be “married”.

FACILITY BASED SURVEY:

FACILITY BASED SURVEY An important component of DLHS-3 is the integration of Facility Survey of health institution (Sub centre, Primary Health Centre, Community Health Centre and District Hospital) accessible to the sampled villages . Purpose : To assess the existing situation of the health Care facilities available in the government health Care establishments at different levels in terms of infrastructure, staff, equipments and drugs.  

PowerPoint Presentation:

The main objectives of the facility survey are to assess Percentage of Infrastructure facilities as per the IPHS norms. To identify the gaps of manpower as per IPHS norms. Percentage availability of equipments as per IPHS norms. Percentage availability of Drugs as per IPHS norms.

Vital Events Survey (VES):

Vital Events Survey (VES) In Tamil Nadu, the Vital Events Survey is conducted since 1995 to monitor the fertility and mortality trends through a sample survey . VES were conducted by the Department of Public Health & Preventive Medicine and the Department of Family Welfares for the years 1995,1996,1997,1998, 1999,2003 and 2008 with financial assistance of DANIDA, UNICEF, RCH Project. VES provides district wise vital rates which is useful for planning Cluster sampling method for 2008.

Birth rate and Death rate- TN:

Birth rate and Death rate- TN Tamilnadu Area Male Female Total Birth rate Rural 16.8 16.1 16.5 Urban 16.1 15.4 15.7 Combined 16.6 15.9 16.3 Death rate Rural 7.6 5.7 6.7 Urban 6.2 4.2 5.2 Combined 7.2 5.3 6.3

Dependency ratio- Tamil Nadu:

Dependency ratio- Tamil Nadu TN VES 2003 VES 2008 Total dependency ratio 546 318 Child dependency ratio - 231 Old age dependency ratio - 87

ANNUAL HEALTH SURVEY:

ANNUAL HEALTH SURVEY

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Proposed in 2005 To provide good external monitoring of NRHM activities. Provides core vital indicators at the district level on an annual basis.

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Coverage : Annual Health Survey AHS provides key indicators on Reproductive and Child Health at District level in 8 EAG States and Assam

NATIONAL SAMPLE SURVEY (NSS):

NATIONAL SAMPLE SURVEY (NSS)

NSS Surveys:

NSS Surveys Multi subject survey Started in 1950 Yearly but on varying subjects A subject usually repeated every 5 years or so Aim of NSS - To fill data gaps in national income aggregates

NSSO:

NSSO Till date, the NSS Organisation (NSSO) is the largest survey organisation in the world employing permanent survey staff who are trained in conduct of surveys in diverse areas Because of its size, NSS is able to survey a sample of over 100,000 households in India for the main subject of enquiry in a particular year

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NSS surveys Household surveys Enterprise surveys Other surveys

AD HOC SURVEYS:

AD HOC SURVEYS Besides the regular socio-economic surveys of NSSO, taken up through 10-year survey cycle, NSSO from time to time, also undertakes pilot enquiries and ad-hoc or special surveys . Such surveys are conducted either for methodological studies or on the basis of specific requests received for such surveys, from other agencies. Survey Period Drug Abuse Survey Feb 2010- May 2010 NREGA Survey July 2009-June 2011 Gramin Dak Sevaks Survey March - April, 2008 Baseline Survey on Well-being of Children and Women in collaboration with UNICEF March – May, 2005

H M I S:

H M I S Health Management Information System

HMIS:

HMIS HMIS is a system that provides up-to-date, reliable , complete timely information to health managers, at various levels ( Subcentre , SHC,PHC, CHC, SDH & District Hospitals.)

DEVELOPMENT OF HMIS IN INDIA:

DEVELOPMENT OF HMIS IN INDIA The National health policy adopted by the parliament in 1983 stated that “appropriate decision- making and programme planning in the health and health related fields is not possible without establishing an effective “ health information system ”. Exercises in development of more effective HMIS continued and version 1.0 and 2.0 of HMIS were evolved in 1990.

PowerPoint Presentation:

After a test run, it was decided in 1991 to implement computer compatible HMIS version 2.0 all over the country. Under NRHM the HMIS formats have been revised The HMIS web portal launched by the MoHFW on 21st October, 2008. MoHFW initially rolled out the HMIS up to the district Level and, from 2011 onwards, this has been expanded to allow the Sub District/Block level facility wise data entry.

Key feautures:

Key feautures provides information on service delivery relating to maternal and child health care Utilization laboratory testing for disease like HIV, STI/RTI, TB and cataract operation under Blindness Control Program. Facility based information

PowerPoint Presentation:

The sub centre ANMs & Anganwadi workers are the responsibility centers for HMIS and they prepare monthly reports.

KEY REGISTERS AT SUB CENTRE LEVEL:

KEY REGISTERS AT SUB CENTRE LEVEL Survey registers Sub centre village information Household information Eligible couple and children information Continuous care registers Family welfare services Maternal care services Child care and immunization services Tuberculosis and leprosy control Malaria and blood smear and treatment Other registers Home visit diary Clinic registers Stock and issue registers Birth and death registers Accounts of untied funds and JSY( Janani Surakasha Yojna )

Registers at AWC:

Registers at AWC Anganwadi workers (AWWs) have set of registers like household survey register, birth and death register, beneficiary register for mother and children, immunization, growth charts and weight book and stock registers.

PowerPoint Presentation:

Health intelligence wing of the Directorate General Of Health Services. At the national level it is the main organization which deals with the collection, compilation, analysis and dissemination of the information on the health conditions in the country.

Reasons of setbacks:

Reasons of setbacks failure to prepare grass-root level functionaries problem of providing registers, stationary, training ,lack of motivation.

Success story of TAMIL NADU…:

Success story of TAMIL NADU… HMIS

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Envisaged by the Health & Family welfare department of Govt of Tamil Nadu through Tamil Nadu Health Systems Project as part of the on going initiatives for IT enablement of health sector .

Project Strategy :

Project Strategy 1. ICT Initiatives 2.Policy Initiatives 3. Process Initiatives 4. Paradigm Shift

PowerPoint Presentation:

Two components I . Hospital Management System- HMS II . Management Information System- MIS

Smart Architecture:

Smart Architecture Centralized web based software solution to minimize technology support and maintenance dependencies Connectivity through Tamil Nadu State Wide Area Network (TNSWAN), a 2Mbps dedicated leased line – hassle free, reliable and supported by Ms Electronics corporation of Tamil Nadu Ltd. (ELCOT) 2Mbps redundant broadband fallback connectivity Centralized server hosting the application and storing the entire data base at State Data Centre

PowerPoint Presentation:

In coordination with TN Electricity Board (TNEB) we have ensured no power cuts during out-patient hours. The hospitals have been moved out of load shedding grid by TNEB. UPS with two-hours backup supplied to all hospitals in case of power failure.

Innovations brought about by the project:

Innovations brought about by the project Unique Patient identification Number (PIN) Unique Institution codes across all government hospitals and office Unique employee numbers/ user names and passwords – for access to system Re-use of drug codes (from other Central procurement agency) Re- use of the treasury codes for Finance related information Uniform and standardized reporting formats across all institutions. TNHSP has proposed to link the PIN to the UID that is to be developed by the Government of India. The Lab tests results are being given to the patient with reference values The final disease diagnosis is linked to International Disease Code- 10

SUMMARY :

SUMMARY The Indian census has been a goldmine for the population data including vital events. To avoid the limitation of larger interval between two censuses in getting information on vital statistics, CRS has been the most important source providing a constant data base even at lower administrative levels like cities/towns. But, even after a constant effort to strengthen the CRS it suffers heavily with the coverage errors. SRS is fulfilling the gap created by CRS, but it has limitation that it is not able to provide below state level indicators .

PowerPoint Presentation:

NFHS provide reliable estimates at national & state level. DLHS , VES (IN TN ) provides district level data required for micro-level planning and programme implementation. Surveillance in India has taken a new turn after the introduction of IDSP , but the major challenge ahead is Lack of integration of Private Sector in surveillance activity & Poor Laboratory capacity.

Conclusion:

Conclusion We are entering into a new era in global health. The country is witnessing the process of rapid health transition, which not only includes demographic and epidemiological transition but nutritional and socio-cultural transitions as well. The present health information systems in the country are not sufficiently equipped and often fail to respond adequately to this complex health transition.

PowerPoint Presentation:

Healthcare organizations are increasingly operating in data-rich and information-poor environments . In today’s high-tech era, we are constantly gathering and storing data, only to never use it because it is inaccessible, improperly formatted or presented in an irrelevant way.

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So the need of the hour is Integration of hospital based statistics with health information generated from peripheral health facilities. Developing a coherent health information system which can quickly produce and make data available on a real-time basis through reduced data turnaround time for immediate response and decision making.

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The establishment of a dedicated Health Management Information System (HMIS) portal for all Public Health related information incorporating data triangulation for validation of data, by GOI is a welcome step. Its also equally important for the states to adopt similar measures in strengthening and improving HMIS at various levels within the states and subsequently build capacities at all levels.

PowerPoint Presentation:

Integrating health information is not just about getting databases to communicate with each other. It’s about moving toward a nationwide trend in healthcare reform—integrated care.  

References:

References

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