Step 2: Reviewing Impact of Health Programmes

Worksheet 2: Status of Maternal, Newborn, Child, Adolescent and Reproductive Health

Indicators

Tasks for Step 2

2.1. Reviewing available data on mortality and morbidity related to maternal,

child, adolescent and reproductive health : Filling Worksheet 2

2.2 . Summarizing the impact data to identify areas where the programme is doing
well, where the programme needs to do more and where more data is
required : Filling the summary sheet of worksheet 2

Worksheet 2 1
2.1 Collect, Review and discuss morbidity and mortality data in worksheet 2: indicators for maternal,
child health, adolescent and reproductive health status.

Data review team will collect the baseline and most recent data on the listed indicators in this worksheet.
The data sources mentioned in the last column will be used to collect the data.

These will be reviewed and discussed in the large group.

This worksheet is provided prefilled except for the column titled ‘is the state on track’ which has to be
commented upon by the participants after discussion on each indicator.

Participants review each indicator by asking the following questions:

(i) Is data available?

(ii) What are the trends compared to the baseline?
(iii) Is there a set target and whether the target is likely to be achieved or not
(iv) Are there significant area wise or group wise differences.

How to record the result in the column titled ‘Is the state on track’

(i) Mark a Tick () for indicators with a positive result – This is when
 the trends over time are positive and
 targets have been (or are likely to be) achieved
(ii) Mark a Cross () for indicator with a negative result – This is when
 the trends over time are negative or static and
 targets have not been (or are unlikely to be ) achieved or
 there are significant area-wise or group-wise differences
(iii) Shade with grey( ) for areas where more data is needed

2.2 Summarizing the impact data to identify areas where the programme is doing well, where
the programme needs to do more and where more data is required : Filling the summary
sheet of worksheet 2
After completing discussion on worksheet 2, the summary sheet is completed. All indicators are
grouped in the following three categories based on the remark in the column titled ‘is the state on track’:
(i) Health status indicators - programme is doing enough now : All indicators with tick mark
(ii) Health status indicators - programme needs to do more :all indicators with cross mark
(iii) Health status indicators – more data is required : all indicators shaded grey

 The data review team will fill impact indicators in worksheet 2 using the data
sources listed in the last column.
 The column titled ‘Is the state on track’ is to be left blank at the time of data
review. It will be filled after discussion during the review workshop. Summary
sheet will also be completed in the review workshop.

Worksheet 2 1
Worksheet 2:
Worksheet 2: Status of Maternal, Newborn, Child, Adolescent and Reproductive Health
Indicators aged (15-19)
(To be filled before the discussion except last column)
Data Measures Baseline Most Target Differences by Is the Data
Required data recent (_____) Region/District or state Source
(2005) data group on
(SES/Gender/Plac track
e) (√/X)
Maternal Maternal 136 To  SRS/AHS/
Morbidity mortality ratio 303 reduce NFHS/MY
70 per HEART
one BHUBANE
lakh SWAR
live ORISSA
births
by 2030
Prevalence of 76.2 47.6 Urban-53.9 HMIS
anaemia in Rural-66.6
pregnant women

HIV prevalence 0.24 0.26 Joint Urban-31 HMIS

united
in pregnant (2013) 2017 Rural-69
nation
women program Urban-27.2
me on Rural-72.8
hiv
initiative
called
95-95-95
strives to
end aids
by 2030
Prevalence of Urban- HMIS
positive syphilis 0.31% 0.14 Rural-
serology in (2010) (2019)
pregnant women
Still birth rate 21.5 ,200 22 per Less Urban DLHS
7 1000 than Rural knoema
births 10 per
1000bi
rths

Causes of Deaths
Data Causes Most Recent data Remarks:
Required Use regional data if State specific data
Causes of is not available
Maternal APH/ PPH:% 38% Use of oxytocin for
death active management of
the third stage of labour,

Worksheet 2 2
 because it reduces PPH
by more than 60%.
PIH:% 9.2% Lack of quality care in the
health facilities
Puerperal Sepsis: % 8%
Obstructed labor:% to reduce MMR faster,
simultaneous investment is
important in strengthening
the health system; education
and empowering women;
and making available
qualified human resources
in health, good governance,
and transportation facilities.
Anaemia:% 61.1%
Other causes:% 8% Avoiding unsafe abortions,
Giving priority to institutional
delivery

Worksheet 2 3
 Data Measures Baseli Most Target Differences by Is the Data
Required ne recent (_____) Division/District state on Source
data data or group track
(SES/Gender/Place (√/X)
)
Child Early neonatal SRS
Deaths mortality rate
Neonatal mortality SRS
rate

Causes of Causes Use regional data if State specific Remarks:

Neonatal data is not available
Deaths Neonatal sepsis:%

Birth Asphyxia &

injuries:%
LBW / Prematurity:
%
Other causes:%

Data Measures Baseli Most Target Differences by Is the Data

Required ne recent (_____ Division/Distri state on Source
data data ) ct or group track
(SES/Gender/ (√/X)
Place)
Infant mortality SRS,
rate NFHS,A
HS
Under 5 mortality SRS,
rate NFHS,A
HS

Causes of Causes Use regional data if State specific Remarks:

under- data is not available
five
deaths Neonatal causes:%
Pneumonia:%
Diarrhea:%
Measles:%
Malaria:%
Other causes:%

Worksheet 2 4
 Data Measures Most Remarks:
Require Recent
d Data
Neonatal mortality as a proportion of IMR
Infant mortality as a proportion of under-five mortality

Summary of Worksheet 2
To be printed on a separate sheet. Complete at the end of Step 2.
Retain this sheet for discussion in the end

Health status indicators - programme is doing enough now

Odisha slips to 14th rank in NITI Aayog Health index. MMR, Under 5 mortality rate should be checked.

Health status indicators - programme needs to do more

Health status indicators – more data is required

Yes more significant data is required

Step 3: What are We Doing now?

Worksheet 3 : Knowing the current RMNCH interventions and level of their delivery

Tasks for Step 3

Identifying various RCH interventions being provided in the state and the
packages in which they are delivered.

Worksheet 2 5
Introduction to Step 3
During this step participants assess the interventions that are included in the RCH programme and how
they are delivered. They then review coverage indicators for RCH and decide on interventions that need
more attention. During the review workshop, this step is conducted in small groups. Participants are
divided into following three small groups based on the life cycle approach : (i) Maternal Health (ii) Child
Health (iii) ARSH and Family Planning.

Task : Identifying various RMNCH interventions being provided in the state and the packages in
which they are delivered.

Interventions

RCH interventions are treatments, technologies, and key health behaviors that prevent or treat illness and
reduce deaths among the beneficiaries of RCH programme. Examples of curative treatments include
antimicrobials for treating ARI or pneumonia and ORS for watery diarrhea. Examples of preventive
treatments include micronutrients like iodized salt and vitamin A. Examples of health technologies
include vaccinations. Examples of key health behaviors include appropriate feeding and care seeking for
illness.

Interventions are usually delivered using a combination of : a) services (to provide preventive and
treatment interventions); b) health education (to improve knowledge and behaviors); c) distribution of
essential commodities (such as bednets); and d) infrastructure (such as potable water and latrines).

Packages

It is not practical to implement individual interventions on their own. Instead, health staff are usually
trained to deliver several interventions together in “packages”. Examples of intervention packages that
combine interventions together include:

Routine Immunization (RI) (several vaccines are given at the same time; in some cases vitamin A and de-
worming are added. Newer vaccines, such as Hepatitis B vaccine, can be added to existing
immunization programmes);

Ante Natal Care (ANC), Post Natal Care (PNC) IMNCI, BEmOC, CEmOC are all examples of
Intervention Packages.

 Day 1 : The data review team will fill all the columns of worksheet 3
 Day 2 : The summary sheet has to be filled in the review discussion. The
groups capture the information regarding interventions which are not being
delivered at all desired levels and interventions with limited geographic reach.

Worksheet 2 6
 WORKSHEET 3: RCH interventions and how they are delivered

(To be filled before the discussion except last column)

Maternal Health
Level at which intervention is

through the given package

How well the intervention
or selected areas – specify
delivered (Tick levels)

Included in programme?

specify package in which

Implemented in all areas

is being implemented
included with other

First level facility

Referral facility
Interventions

interventions

Community
Home and
Tick if yes

Ante Natal Care (Registration  Odisha  All

+ Min 3 visits) mamata districts
yojana of odisha

Tetanus Toxoid immunization  DBT scheme

IFA supplementation  Anaemia  All

mukt bharat districts
od
odisha

Detection of complications  Anaemia

during pregnancy (e.g. mukt bharat
hypertensive disorders,
bleeding, anaemia)

Management of problems  Anaemia  All

complicating pregnancy (e.g. mukt bharat districts
hypertensive disorders, of odisha
bleeding, malpresentations,
multiple pregnancy anaemia)

Worksheet 2 7
 WORKSHEET 3: RCH interventions and how they are delivered

Level at which intervention

How well the intervention

or selected areas – specify
Included in programme?

specify package in which

Implemented in all areas

is being implemented
is delivered (Tick levels)

included with other

through the given

interventions
Tick if yes

First level facility

Referral facility

package
Interventions

Community
Home and
Detection and  National  All the
management of aids states of
syphilis [RTI/STI] control India
program
me

Insecticide treated  Bharat

bednets integrate
social
welfare
agency

Information and
counselling on self-
care, nutrition, safer Janani All districts
sex, breastfeeding, suraksha of odisha
preparedness for yojana
delivery and maternal  
complications

- Use of MCPC
Card  

- Distribution of  
safe motherhood
booklet/ other
information
material

Skilled attendance at  Nrhm/  All districts

birth rch 2 of odisha
program
me

Deliveries Kandhamal
and
1. Use of partograph  JSY Kalahandi
2. Management of Scheme
third stage of 

Worksheet 2 8
 labour
3. Management of
Obstetric
complications
4. Delivery Place 
Home
Institution

WORKSHEET 3: RCH interventions and how they are delivered

Interventions Level at which

Included

Impleme
program

all areas

interven
package

well the
intervention is delivered

nted in
specify

tion is
being
How
(Tick levels)

or
in

Community
Home and

First level

Referral
facility

facility
Post natal care

1.PP visits   All districts

2.Iron
supplementation  

Prevention of mother  
to child transmission
of HIV[PPTCT]
Social support  
(companion) during
birth

Worksheet 2 9
 Summary of Worksheet 3
To be printed on a separate sheet. Complete at the end of Step 3.
Retain this sheet for discussion in the end
Interventions required to be delivered at other levels also (*)

Community level participation should be increased to reduce the desired consequences.

Interventions with limited geographic reach

Dengue and Malaria are major concerns for western odisha.

Step 4: Are the Interventions reaching the

Beneficiaries?

Worksheet 4 : Coverage indicators for RCH

Tasks for Step 4

Step 4 has two tasks

4.1 Reviewing available data on coverage of RCH interventions

4.2 Summarizing the findings to assess the programme’s performance with regard
to coverage of various interventions.

Introduction to Step 4
During this step participants review coverage indicators for RCH and decide on interventions that need
more attention. During the review discussion, this step is conducted in small groups. Participants are
divided into following three small groups based on the life cycle approach : (i) Maternal Health (ii) Child

Worksheet 2 10
Health (iii) ARSH and Family Planning. However, before that the data review activity must be completed
by filling worksheet 4.

Task : Reviewing the coverage of various RCH interventions in the state.

Population-based indicators are used to measure intervention coverage. Population-based indicators are
proxy measures of progress toward impact – without improvements in intervention coverage; it is
unlikely that there will be a long term impact on mortality.

Data review team will collect the baseline and most recent data on the listed indicators in this worksheet.
The data sources mentioned in the last column will be used to collect the data.

This will be reviewed and discussed in the small groups. This worksheet is provided prefilled except for
the column titled ‘is the state on track’ which has to be commented upon by the participants after
discussion on each indicator.
Participants review each indicator by asking the following questions:
(i) Is data available?
(ii) What are the trends compared to the baseline?
(iii) Is there a set target and whether the target is likely to be achieved or not
(iv) Are there significant area wise or group wise differences.
How to record the result in the column titled ‘Is the state on track’
(iv) Mark a Tick and shade with green ( ) for indicators with a positive result –
This is when :
 the coverage has definitely improved over time and
 targets have been (or are likely to be) achieved
(v) Mark an upward arrow an shade with yellow ( ) for indicators with positive trend -
This is when :
 the coverage has shown a positive trend over time but
 targets are unlikely to be achieved
(vi) Mark a Cross and shade with red () for indicator with a negative result –
This is when
 the coverage has been static or shows a decline over time and
 targets have not been (or are unlikely to be ) achieved or
 there are significant area-wise or group-wise differences . Additionally an oval is put to
highlight indicators having significant area wise or group diffreneces.
(vii) Shade with grey( ) for areas where more data is needed

Summarizing the findings to assess the programme’s performance with regard to coverage of various
interventions.

After completing small group discussion on worksheet 4, the worksheet is presented in plenary and
finalized. After large group presentation, the summary sheet is completed. All indicators are grouped in
the following three categories based on the remark in the column titled ‘is the state on track’:

Worksheet 2 11
 (iv) Coverage Indicators – Trend is positive and likely to achieve target (All indicators shaded green)
(v) Coverage Indicators – Trend is positive but unlikely to achieve target or no set target (All indicators
shaded yellow)
(vi) Coverage Indicators – Trend is static or negative or significant group / area wise differences (All
indicators shaded red)
(vii) Coverage Indicators – More data is required (All indicators shaded grey)

Worksheet 2 12
 Worksheet 2B: Coverage indicators for RCH
Coverage Target

(Specify Sources and

(Specify Sources and

Most recent data

region or group
measure (_____)

Differences by

Is the state on
Baseline data
Interventions

Data Source
Period

track
year)

year)
Pregnancy Registration Proportion of 80% 90% yes DLHS/
pregnant women HMIS
who registered
for ANC in the
first trimester
Adequate Proportion of 85% Atleast No DLHS/
antenatal care mothers who 80% NFHS
received at least
3 ANC check
ups
Tetanus Toxoid Proportion of DLHS/
to all pregnant mothers who NFHS
women received TT2+
during
pregnancy
Iron Proportion of 90% 95% No DLHS/
supplementatio women who ROP
n received iron
during
pregnancy
>90 days
Full ANC Proportion of 85% 90% Yes DLHS
women who had /NFHS/
Full Ante natal
Check-ups (3
ANC+TT2 + 90
IFA)
Voluntary Proportion of 65% India
counselling and HIV + mothers
testing for HIV who received
and PMTCT ART
prophylaxis*
*Define as per the New NACO Guidelines: Nevirapine Only versus ART for Mother and Nevirapine for
the Child for six months for exclusive breast feeding

Worksheet 2 13
 Coverage Is the state on Data Source

(Specify Sources and

(Specify Sources and

Most recent data
measure track

region or group
Differences by
Interventions

Baseline data

(_____)
Target
Period

year)

year)
Labor All deliveries Proportion of DLHS
and by a skilled institutional births
deliver birth including sub
y attendant centers
Proportion of total 9.8% DLHS
deliveries conducted
by skilled birth
attendants at home
Management Proportion of DLHS
and treatment pregnant women
of maternal with obstetric
emergencies complications who
such as received treatment
eclampsia Proportion of 13.8 to DLHS /
HMIS/NFHS
and women who 21.6%
obstructed underwent
labor C-section
Referral Proportion of 6% Ambulator DLHS/HMIS
Transport pregnant women y services
using free referral should be
the 1st
transport
preference
facility(108,104,M
MU,Ambulance)
JSY Proportion of DLHS/
mothers who AHS/
received HMIS
government
financial assistance
for delivery (JSY)
for Home Delivery
Proportion of
mothers who
received
government
financial assistance
for delivery (JSY)
for Institutional
Delivery

Worksheet 2 14