A study on the implementation of Mother and child tracking system in Chilakaluripeta Cluster, Guntur district, Andhrapradesh.

(Code: ABO30110403)

By

Dr. M. Siva Durga Prasad Nayak (PG),
Dr. A. Krishnaveni Professor, Dr. S. AppalaNaidu Professor & HOD, Dr. P. J. Srinivas Assistant Professor, Department of Community Medicine, Andhra Medical College, Visakhapatnam.

Background
 In India Maternal mortality& Infant mortality rates are very high when compared to developed countries.  Understanding the role of computers in public health, Indian government started an e-governance tool, Mother& child tracking system (MCTS) in 2010.

Background
 Success of any e-governance tool implementation depends on four pillars.

Aim& Objectives
Aim: To formulate suggestions for better implementation of MCTS. Objectives: 1. To Study the status of availability of infrastructure and skilled personnel related to MCTS. 2. To identify technical errors if any in the design of MCTS website. 3. To study knowledge and practices of ANMs regarding MCTS. 4. To study the e-governance characteristics in MCTS.

Methodology
 Study design: It is an observational cross-sectional study conducted at Chilakaluripeta Cluster, Guntur District which has 1CHNC office, 4PHCs& 34sub-centers .  Study period: October to November 2012.  Study tools: Computer, Internet connection, Mobile phone, CHNC records.  Study Procedure: We had taken prior permission from DM&HO Guntur, obtained username, password& got access of MCTS website. We reviewed tracking procedure, MCTS website& collected information through phone calls to ANMs.

Methodology
 Inclusion Criteria: All the ANMs working in Chilakaluripeta Cluster were included in the study.  Exclusion Criteria: ANMs who were not responded are excluded from study.
Chilakaluripeta Cluster 4 PHCs 34 Sub Centres Health providers

64 ANMs

156 ASHAs

64 ANMs Contacted

51 ANMs Responded

Results:- status of availability of infrastructure
Name of Institution Edlapdu PHC Ganapavaram PHC Kavuru (NRT) PHC Nadendla PHC Chilakaluripeta CHNC Working Computer Present Present Present Present Present Working Internet Connection Present Present Present Present Present

Availability of Working Computers and internet connections were 100% in Chilakaluripeta Cluster

Results:- status of availability of Skilled personnel
Name of Institution Data Entry Operator/ LD Computer Present Present Absent Absent Absent Alternative arrangements for Data Entry with in Institution Not Required Not Required Present Present Absent

Chilakaluripeta CHNC Nadendla PHC Ganapavaram PHC Edlapdu PHC Kavuru (NRT) PHC

Data-entry operators were seen in 40% of institutions, alternative arrangements were made in another 40% institutions

Results:- Technical Errors in design of MCTS webportal

No CAPTCHA was seen, login was not blocked even after 5 failed attempts

CAPTCHA: Completely Automated Public Turing test to tell Computers and Humans Apart

Results:- Technical Errors in design of MCTS webportal
Possibility for duplicate data:
There are four types of possibilities for duplicate data entry 1) Duplicate entry of health providers: a) ANMS details b) ASHAS details 2) Duplicate entry of beneficiaries: a) Pregnant Mother b) New born children Duplicate entry of health providers is most common type which will effect the tracking of registered mother and children.

Results:- Technical Errors in design of MCTS webportal
92 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 28 201 45 293 73

One fourth of health providers registrations were duplicated.

64

156

220

Total Number of Duplicate Registrations Total Number of Registerations in portal

ANMs

ASHAs

Total

Results:- Technical Errors in design of MCTS webportal
Other minor Observations  2% health providers enter Land line numbers instead of Mobile Numbers.  No option to link health facilities for immunization of a child which is available in Maternal services data entry (linking health facility for deliveries).  No separation of Temporary residents and Usual residents in the reports of services delivered by Health facilities.  SMS, Content& IVR modules are not working.

Results:- Knowledge of health workers regarding MCTS
Number of ANMs know about procedure of MCTS 27 24 Number of ANMs don’t know about procedure of MCTS

Total : 51

47% ANMs knew about the procedure of MCTS

Results:- Practices of health workers regarding MCTS
Data entry practices of ANMs
4 4 Entering Data Monthly Entering Data Fortnightly 43 Entering Data Weekly 51

Receiving SMS

ANMs Reciving SMS regularly

Majority of ANMs entering data monthly and all are receiving SMS regularly

Results:- Healthworkers opinion regarding MCTS

51

10

10

Felt as Helpful in their duties Felt as Extra burden to routine duties

All the ANMs felt that MCTS is helpful& one fifth of them stated that MCTS is an extra burden to them.

Results:- Availability of funds for implementing MCTS
 There is no separate allocation of funds for implementation of MCTS program.  ANMs are utilizing untied funds for activities like Data entry, printing reports etc.  Medical officers utilizing Hospital Development society funds for building and maintenance of infrastructure like Computers and Broadband connection.

Results:- E-governance application characteristics in MCTS
For Successful implementation of any E-governance project, the application must have some characteristics. They are… I. II. III. IV. Unique Working style Regional language support Target group size must be very high Mission Critical application character

Results:- E-governance application characteristics in MCTS
 Unique Working style Health department is mainly service oriented department. So it needs a system that will facilitate better delivery of services rendered by the department. MCTS completely fulfilled this.

Results:- E-governance application characteristics in MCTS

Greetings from NRHM !! ANM: Amalleswari (28-39340) District: Guntur District Healthblock: Chilakaluripeta PHC: Nadendla Subcentre: Satuluru-1 Services due during NOV-2012 Names of pregnant women due for service: IFA: TT Booster: Delivery: PNC:

Greetings from NRHM !! ANM: Amalleswari (28-39340) District: Guntur District Healthblock: Chilakaluripeta PHC: Nadendla Subcentre: Satuluru-1 Services due during NOV-2012 Names of Children due for vaccination: BCG: DPT, OPV, HepB 1st dose: DPT, OPV, HepB 2nd dose: DPT, OPV, HepB 3rd dose: Measles:

Results:- E-governance application characteristics in MCTS
Regional language support MCTS is now running as Government to Government model of E-governance and not integrated with citizens directly. But if we want to change it as Government to Citizen model of E-governance tool, then MCTS should have regional language support which is not existing presently.

Note: MCTS project (e-mamta) in Gujarat state had regional language support.

Results:- E-governance application characteristics in MCTS
 Target group size must be high Target group of MCTS includes all pregnant women from conception to till 42 days after delivery and all children up to 5 years of age. Target group size of MCTS is very large.

Results:- E-governance application characteristics in MCTS
 Mission-Critical application character  MCTS is online entry of services delivered by health facilities.  But at the same time we are keeping the same records in field registers at local level.  So there is no problem for delivery of Government services if the project faced any disturbances.

Conclusions
Objective 1: Availability of infrastructure -100% . Skilled persons availability - 40%. Objective 2: Login page of MCTS website had some technical errors. Scope for duplicate registrations . No separation of Temporary residents and Usual residents in the reports. SMS, Content& IVR modules are not working.

Conclusions
Objective 3: 47% ANMs knew about the procedure of MCTS. Majority of ANMs entering data monthly & receiving SMS.

Objective 4: MCTS had Unique working style character. Target group of MCTS is very large. Had Mission Critical application character. But Regional language support was not observed in MCTS.

Suggestions for better implementation of MCTS program
There is a need to  Increase skilled personnel availability,  Rectify identified technical errors in the portal,  Increase knowledge of ANMs about tracking procedure,  Provide regional language support&  Integrate more with beneficiaries for better impact of MCTS program.

References
1) 2) 3) 4) 5) 6) 7) 8) http://pib.nic.in/newsite/PrintRelease.aspx?relid=90343 http://www.who.int/mediacentre/factsheets/fs348/en/index.html http://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate http://pib.nic.in/newsite/PrintRelease.aspx?relid=85669 https://goaonline.gov.in/portalweb/login/E-governance.jsp http://www.csi-sigegov.org/egovernance_pdf/5_33-41.pdf http://e-mamta.gujarat.gov.in/ http://nrhm-mcts.nic.in

Special thanks to
To Dr. M. Gopi Naik, District Medical & Health Officer, Guntur and to Dr. Sivakumar, Senior Public Health Officer, Chilakaluripeta Cluster for giving permission to conduct research and for giving suggestions. To all the ANMs who were participated in the study for giving information.

Hoping this research will be benefited to target group of MCTS Program…..

Thank you

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