monitoring and evaluation strategy & plan document 2010-2013 · the overall monitoring &...

Monitoring and Evaluation

Strategy & Plan Document

2010-2013

Norway India Partnership Initiative

Introduction

Launched in 2006, Norway India Partnership Initiative (NIPI) has a mandate to contribute to Millennium Development Goal 4 (MDG4) of reducing Child Mortality by two thirds in 2015. Since child health is intertwined with maternal health, NIPI focuses its efforts on improving newborn and related maternal health. Consequently, NIPI aims to contribute to achievement of MDGs 4 and 5. The strategic emphasis of NIPI is to reduce neonatal mortality working along the continuum of care framework, strengthening newborn and related maternal health both at the level of the facility and community by catalyzing the National Rural Health Mission (NRHM). The continuum of care framework is based on the premise that preventive and curative interventions go hand in hand. Along the continuum of care framework, 3 key elements of NIPI’s strategy include:

Quality health services for mother and child, both facility and home based Enabling mechanisms Learning and sharing of experiences

Central to this are the cross cutting issues of gender and equity.

Agreements have been entered into by the Royal Norwegian Embassy (RNE) with WHO, UNICEF and UNOPS for carrying out child and related maternal health interventions under NIPI. Each of the implementing Partners has a Memorandum of Understanding (MoU) with Ministry of Health & Family Welfare (MoHFW), Government of India at the National level as well as the Departments of Health & Family Welfare, at the State level. MoU has been entered at the State level with State Governments of Bihar, Orissa, Madhya Pradesh, Rajasthan and Uttar Pradesh. These 5 Focus States have been selected based on the fact that they are the lowest performing States of India on indicators related to child and maternal health.

Programmatic interventions under the NIPI Partnership have been ongoing since 2008. Though information to track progress of the Partnership has been collected since 2009, no rigorous and systematic Monitoring & Evaluation (M&E) system has been in place. This strategy and plan document encapsulates the framework for Monitoring & Evaluation (M&E) of NIPI interventions in a systematic manner.

NIPI Monitoring and Evaluation framework is designed to be at 3 levels. At the highest level, focus shall be at the National Rural Health Mission (NRHM) level. Level 2 shall focus at the Overall Partnership. At level 3, the interventions specific to each Partner are monitored.

In the subsequent sections, details pertaining to the NIPI Monitoring & Evaluation for each level are presented. At the outset, it is stated that this is a dynamic document and is refined at regular intervals, keeping the core fundamentals in place.

NRHM Level

Overall Partnership Level

Communicate to RNE,

PMG, JSC

Level 1 Specific Partner’s Interventions

2

1

WHO

UNICEF

UNOPS

LFA

3

Section 1

Results Based Monitoring

The overall Monitoring & Evaluation framework for NIPI is based on the results chain model (cf. Figure 1).

Figure 1 Results chain model

Definitions:

Inputs: Donor and partner contributions- Royal Norwegian Embassy (RNE), Government of India, UNICEF, WHO, UNOPS LFA, Research Institutes.

Activities: Tasks undertaken to convert inputs to outputs.

Outputs: Products and services delivered as a result of inputs and activities.

Use of outputs (Intermediate outcomes): How the products and services delivered by the programme are being utilized.

Outcome: Benefits accrued to the target beneficiaries as a result of use of outputs.

Impact: Indirect benefits which cannot be attributed solely to the programme. Other external factors play a role.

Since there are a number of health programs ongoing in India, it may be difficult to establish a direct causal relationship of NIPI at the outcome and impact levels. Furthermore, at the outcome level, the fact that while for some indicators direct causal linkages can be established, for some others it may not be possible, needs to be factored in the M&E framework. Therefore, at the interventions’ level, more focus shall be on the outputs and utilization of outputs (intermediate outcome) levels in the results chain model. Utilization of outputs is considered as intermediate

outcomes. Henceforth, it will be referred to ‘intermediate outcomes’. And outcome level will be delved into as well to the extent attribution of any change can be directly or indirectly made to NIPI.

Figure 2 Modified results chain model for NIPI

NIPI Monitoring and Evaluation Framework

Seven steps to NIPI Monitoring and Evaluation include:

i. Identification of main goal of NIPI ii. Identification of key indicators for measuring the contribution of NIPI interventions

towards attainment of its main goal iii. Development of Data Management Information System (DMIS) iv. Comparison of key indicators over time to measure change based on

a. Routine Statistics through Health Management Information System (HMIS), Ministry of Health & Family Welfare, Government of India

b. Regular, routine monitoring data of Partners’ programmatic interventions c. Independent surveys such as National Family Health Surveys (NFHS) &

District Level Household Surveys (DLHS) d. Independent assessment surveys commissioned by NIPI Secretariat e. Other independent evaluations undertaken during the time period 2010-2013 f. Qualitative studies, case studies to document what works and what does not,

photo narratives, stories from the field v. Measurement of effectiveness of NIPI interventions vis-à-vis costs based on

a. Unit cost analysis undertaken by Advisor, M&E, NIPI Secretariat

Attribution Gap

b. Independent evaluations undertaken to measure cost effectiveness of NIPI interventions by a hired expert in the field of health economics

vi. Analysis, Reporting and Communications vii. Integration of Data Management Information System with Health Management

Information System

1. Identification of main goal of NIPI

Overall goal of NIPI is to improve delivery of child & maternal health services.

2. Identification of key indicators for measuring the contribution of NIPI interventions towards attainment of its main goal

NIPI is an initiative designed to facilitate States to improve delivery of child and related maternal

health services with efficient techno-managerial structures. Sustainability based on the uptake

of the system is fundamental.

The Indian public health system does not cater uniformly to all segments of society. While some segments of society have access to quality health services, the poorer and marginalized segments of the population lack access to quality health services. As a result, infant and neonatal morbidity and mortality is more among the poor, marginalized segments of society. Focus of NIPI is on these poor and marginalized segments of society.

In tune with the overall goal of NIPI, the following indicators have been identified for measuring the contribution of the programme towards the National Rural Health Mission.

At the macro level (outcome and intermediate outcome i.e. utilization of outputs level in the results chain model), indicators that shall be monitored are reflected in the Table given below:

The indicators measured at the NRHM and overall Partnership levels are reflected in the Table below:

Level Type of Indicator Definition of Indicator Data Sources

National Rural Health Mission Outcome

Children (12-23 months)fully immunized

HMIS, Coverage Evaluation

Survey, National Family Health

Survey, District Level Household

Survey, NIPI Baseline/Midline/

Endline Infant Mortality Rate Sample

Registration System, National

Family Health Survey

Neonatal Mortality Rate National Family Health Survey

Overall Partnership

Intermediate outcome (use of output)

Institutional Births (%) HMIS, Coverage Evaluation

Survey, National Family Health

Survey, District Level Household

Survey, NIPI Baseline/Midline/ Endline, UNOPS LFA HBPNC & SNCU Formats

Average retention period (hours) in case of

institutional delivery (hours)

Post natal care provided to mothers and neonates- Children had check up

within 10 days after delivery (based on last live birth) (%)

Institutional deliveries

Home New born babies –

breastfed within 1 hour of birth (%)

Referral done for mothers

with illness and complications during

pregnancy (%)

Output Labour rooms with a newborn corner matching

existing standards (%)

Facility Survey

Input State level Allocation of NRHM funds for Neonatal

Child Maternal Health (NCMH)

State Programme Implementation

Plan (SPIP), Government Expenditure Reports, RBI

Report

Since gender is a cross cutting issue, efforts shall be made to present analysis using this lens. Wherever appropriate and possible, data shall be disaggregated by gender and analysed from a gender perspective.

It would be the role of Advisor M&E, NIPI Secretariat to analyse the progress of programs based on the agreed output and intermediate outcome indicators for each Partner and report at the outcome / intermediate outcome levels.

3. Development of Data Management Information System (DMIS)

4. Development of Data Management Information System (DMIS)

In order to manage all the data collected from all Partners in a systematic and ordered way, a data management information system is being set up. This will enable all data to be collated on a periodic basis and analysed. The analytic reports would be available on a monthly, quarterly, semi-annual and annual basis.

4. Comparison of indicators to measure change over time

NIPI Secretariat will follow 2 processes for comparing indicators to measure change over time.

1. Regular, ongoing monitoring process of the indicators for Partners’ interventions which shall be carried out by Advisor, M&E, NIPI Secretariat, based on program progress reports received from various Partners. Qualitative studies, case studies, photo narratives to capture stories from the fields shall also be part of this ongoing monitoring process.

2. Independent surveys and evaluations: Baseline has been conducted for UNOPS LFA focus Districts in the year 2008. In the year 2010-11, the baseline for Betul District (an additional District added in 2010) is planned to be conducted. It is planned to conduct an endline in 2013 (towards the end of the Programme). It is also proposed to conduct a midline to assess the programmatic interventions at a mid point. Given that NIPI’s aim is to strengthen the existing public health programs in India, a majority of the indicators that shall be monitored and evaluated at the macro level viz., level 3 are common to the public health programs in India. These indicators shall be measured using the information from District level household surveys (DLHS) which are conducted every 5 years and independent assessment surveys commissioned by NIPI. Additionally, information from Health Management Information Systems (HMIS) Government of India as well as other any independent evaluations shall feed into the overall monitoring and evaluation system of NIPI. Furthermore, Ministry of Health & Family Welfare (MoHFW) is in the process of institutionalizing Annual Health Surveys which shall also be used for triangulating information collated from DLHS and assessment surveys.

DLHS 3 was completed in 2008. Results from DLHS 4 should be available before 2013. Data shall be compared to analyse trends over a period of time from 2008 to 2013.

Some qualitative studies, case studies shall be undertaken to delve deeper into key query areas emerging from quantitative surveys.

Working with National/ State Health Management Information System (HMIS)

Uptake of the interventions by the Government system is a measure of sustainability. For the program to be sustainable, it is necessary to strengthen the monitoring and evaluation system of NIPI which is integrated within the National/ State Health Management Information System (HMIS). In the same spirit, NIPI Secretariat shall work closely with Departments of Health and Family Welfare both at the National and State levels to monitor NIPI interventions. Facility and community based monitoring mechanisms shall be strengthened to ensure quality data and analysis leading to informed decision making.

NIPI Secretariat is providing technical support to Ministry of Health & Family Welfare, Government of India’s Monitoring and Evaluation Division to strengthen State/ District/ Block levels health information management system, hospital based management information system, mother and child name based tracking system and data triangulation. This, in turn, will ensure quality data and use of data for decision making at the State, District and Block levels.

5. Measurement of effectiveness of NIPI interventions vis-à-vis costs

Government of Norway has contributed 500 million NOK (approx. USD 80 million) to Government of India to reduce child mortality and improve child health with a view of attaining Millennium Development Goal 4 by 2015. In order to assess cost effectiveness of NIPI interventions, analysis is to be undertaken at two levels.

i. Periodic monitoring to assess unit cost of activity under each intervention vis-a-vis funds spent. Focal areas of this periodic monitoring shall include: a. What are the funds being utilized for? b. Rate of utilization as a function of activity under each intervention c. What are the achievements?

This shall be carried out by Advisor, M&E, NIPI Secretariat along with the Operations Associate, NIPI Secretariat.

ii. Cost benefit analysis: This shall be carried out by a hired expert in the field of health economics at two points of the NIPI programme. The 1st shall be undertaken in 2011 to give a mid-point scenario while the 2nd one shall be scheduled for at the end of NIPI i.e. 2013.

6. Analysis and interpretation at the macro level focusing on key indicators identified for results based monitoring of NIPI

Analysis is proposed to be carried out at different levels. At each level, results shall be summarized and presented in the Monitoring & Evaluation framework1.

Overall Monitoring & Evaluation Framework

Analysis at the levels of intermediate outcome and outcome levels is carried out by NIPI Secretariat using all information from the Partners. The caveat here is that there is an attribution gap with regards to analysis at the outcome level. Since NIPI works within the overall NRHM framework, a direct attribution in regards to changes in the indicators is not possible. 1 Guidelines for Preparing a Design and Monitoring Framework, Asian Development Bank, July 2007.

Indicators Performance Targets/

Indicators

Data Sources/

Reporting

mechanisms

Assumptions/ Risks

Outcome

Attribution Gap

Improved child and maternal

health services in NIPI focus

States- universal immunization

coverage, reduction in infant

mortality

National Family

Health Survey 4;

HMIS; Independent

assessments

Consideration shall need to be given to any

attribution gap.

Utilization of

Outputs

Improved safe delivery

practices, immunization

& Post Natal Care

Programmatic

formats; District Level

Household Surveys;

HMIS; Independent

Assessments;

Programmme reports

Based on outputs from each partner

Outputs Given under each

Partner

Given under each

Partner

Given under each Partner

Activities Given under each component

Inputs

Progress tracking system2 (PTS) is used for monitoring progress of NIPI interventions. To set the status, a baseline indicator is taken into consideration which is measured over time. The progress tracking system (PTS) as depicted in the attached template is used for presentation purposes. In case there is no change witnessed from baseline to the time when the indicator is being measured again, then it shall be depicted by “yellow” colour. In case the indicator shows a regression, then it shall be depicted by “red” colour and in case of progression, it shall be depicted by “green” colour.

2 Adapted from GTZ Results Based Monitoring System, 2008-2009.

Progress Tracking System (PTS) for monitoring progress of Overall NIPI Partnership

No. Indicator Present Status Reasons for discrepancy Rating

Outcome (It needs to be considered that at outcome level, it may be seen as NIPI contribution but cannot attribute the change entirely to NIPI) Overall: Improvement in delivery of child and maternal health services in the NIPI focus Districts under National Rural Health Mission A Quality health services for child &

maternal health

a.1 Institutional births (%) a.2 Average retention period (hours) in

case of institutional delivery (hours)

a.3 Post natal care provided to mothers and neonates- Children had check up within 10 days after delivery (based on last live birth) (%) (Institutional deliveries)

a.4 Post natal care provided to mothers and neonates- Children had check up within 24 hours after delivery (based on last live birth) (%) (Home deliveries)

a.5 New born babies – breastfed within 1 hour of birth (%)

a.6 Referral done for mothers with illness and complications during pregnancy (%)

a.7 Labour rooms with a newborn corner matching existing standards (%)

B Enabling mechanisms b.1 State level Allocation of NRHM funds

for Neonatal Child Maternal Health (NCMH)

C Learning and sharing of experiences c.1 Documentation of innovations under

NIPI program

c.2 Uptake of NIPI interventions by Government system

c.3 Expansion of NIPI interventions in non NIPI States

Overall M&E System

The overall NIPI M& E system as envisaged is depicted below:

Research Institutes WHO UNICEF UNOPS- LFA

Level 3: NIPI Secretariat

Half Yearly Reports pertaining to Monitoring Formats for each Intervention

Financial Status Reports

Semi Annual and Annual Reports

Level 1 Programme Management at State, District and

Block Levels

3

2

1

UNOPS- LFA UNICEF

Level 2: Partners’ Interventions

Sharing with RNE, JSC, PMG

Details for Levels 2 and 1 have been provided under Sections 2 and 3. Levels 1 and 2 shall be monitored by

the Partners themselves. Semi annual and annual reports using the agreed upon standardised program progress

formats shall be used by the Partners and shared with the NIPI Secretariat.

NIPI Secretariat, in turn, shall analyse and share with the Donor (Royal Norwegian Embassy), Joint Steering Committee (JSC) and Program

Management Group (PMG).

Section 2

Monitoring & Evaluation of Partners’ Interventions

Partners: UNOPS LFA, UNICEF, WHO, Research Institutes

Figure 1

NIPI Secretariat is responsible for monitoring interventions of each Partner under the overall NIPI umbrella. In the subsequent sections, this strategy and plan document attempts to detail out the Monitoring and Evaluation framework for each Partner. Reports from each Partner feeds into the overall M&E system of the NIPI Secretariat.

NIPI Secretariat

UNOPS LFA

WHO

Research Institutes

UNICEF

In order to keep the Royal Norwegian Embassy (RNE) abreast of the progress of NIPI, the following reporting mechanisms are followed by the NIPI Secretariat. Reports from Partners to Royal Norwegian Embassy (RNE) via NIPI Secretariat need to be submitted at 2 points of time in a year viz., by end of February and end of July. Therefore, all reports from the Partners need to reach NIPI Secretariat no later than 7th of February and 7th of July each year.

Table 2 Type of reporting Aspects covered

Annual progress reports (to be prepared by NIPI Secretariat using semi-annual reports from Partners)

Description of actual outputs vis-à-vis planned outputs (as defined in annual work plans) Summary of use of funds compared to budget Assessment of efficiency of services and resulting contribution to implementation of NIPI (Efficiency will include resources- financial, personnel as inputs which are converted to outputs) Explanation of any major deviations from annual work plans

Semi annual reports (to be reviewed by Joint Steering Committee (JSC))

Planned activities approved by JSC Description of activities Outputs achieved Utilization of outputs i.e. intermediate outcomes Planned outputs for next half year

Annual work plans and budget Income and expenditure projections Main activities planned for each calendar year

In the subsequent sections, details of Monitoring and Evaluation system of interventions under each Partner have been stated.

UNOPS- Local Fund Agent (LFA)

Government of Norway has made available to UNOPS a Grant for implementation of interventions aimed at improving child and related maternal health services during the stated period of the programme (2006-20133).

UNOPS Local Fund Agent (LFA) includes the State Nodes of the Enabling Mechanism. This consists of one office in each Focus State with 3 personnel in each office. These UNOPS LFA State offices are set up within the State Health Societies (SHS) with the exception of the State of Madhya Pradesh where it is located within the Information, Education, Communication (IEC) Bureau.

Within UNOPS LFA, the Monitoring and Evaluation (M&E) Associate at the National Level with support from Programme Associates at the State Level shall be responsible for managing the UNOPS LFA Monitoring and Evaluation system to track progress of UNOPS LFA interventions. Indicators shall be primarily measured at the levels of process, output and intermediate outcomes. These levels are selected as it can be stated with greater confidence whether UNOPS LFA interventions have brought about a change.

As a process, UNOPS LFA shall share all required quantitative and qualitative information collected for each intervention with NIPI Secretariat which in turn will use this information to feed into macro level reports for the Donor, PMG, JSC and other organizations. Reports from the NIPI Secretariat will feed back to UNOPS LFA marking progress over time (cf. Figure 2).

3 NIPI was initially from 2006-2012. No cost extension has been agreed upon till 2013 at the 9

th JSC meeting.

Figure 2

Step-by-step Monitoring & Evaluation framework for UNOPS LFA has been stated in the following paragraphs.

Monitoring & Evaluation framework of UNOPS LFA interventions:

Identification of key interventions of UNOPS LFA Identification of key indicators for each UNOPS LFA intervention Monitoring progress of each UNOPS LFA intervention Analysis, Interpretation & Communication

Programme Associate collects,

validates and analyses data on a

regular basis using prescribed

uniform formats.

Sends to M& E Associate, LFA Delhi

Office.

M &E Associate, LFA Delhi

analyses and share reports with

M&E Advisor, NIPI Secretariat.

M&E Advisor, NIPI Secretariat

analyses and prepares programme

progress reports.

LFA Delhi and State Offices use

information for decision making.

NIPI Secretariat shares reports

with RNE, PMG, JSC. Also will

share as and when external

evaluation happens.

Modifies programme in tune with

recommendations from programme

progress reports at State, District

and Block levels.

Identification of key interventions of UNOPS LFA

Putting in the strategic framework of NIPI, the key interventions for UNOPS LFA include: Key elements of strategy Key interventions Quality of health services Home Based Post Natal Care

Sick Newborn Care Units Routine Immunization

Enabling Mechanisms Techno- managerial support Yashodas/ Mamtas

Learning and Sharing Documentation of NIPI interventions through National Child Health Resource Centre (NCHRC) Documentation of NIPI interventions through State Child Health Resource Centre (SCHRC) Uptake of NIPI Interventions by Government for scaling up Request for technical support for NIPI Interventions in other non NIPI States Documentation of interventions within the public domain

All the above mentioned interventions are monitored on a regular basis by the Monitoring & Evaluation in charge at National and State levels. Results emerging from are owned by the Programme Staff in charge of each UNOPS LFA intervention as well as the State staff. Suggested formats for monitoring UNOPS LFA interventions are provided as annexure.

Identification of key indicators for and monitoring progress of each UNOPS LFA intervention

Home Based Post Natal Care (HBPNC)

It has been noted that neonatal and infant care at home is a weak link in the service chain. Neonatal deaths are primarily attributable to infections, asphyxia, hypothermia, and prematurity. About a third of all neonates have low birth weight (less than 2.5 kgs) which is of grave significance given that high proportion of mortality occurs in low birth weight babies.

In order to address this gap, NRHM has a strategy developed for comprehensive care of neonate and child health interventions. Following from this, in October 2008, State Coordination Committees in all 4 NIPI LFA focus States decided to implement Home Based Post Natal Care (HBPNC) with support from UNOPS LFA.

There are two modules – 2 days and 5 days respectively- developed to train Accredited Social Health Activists (ASHAs) on Home Based Post Natal Care. The training modules have been developed under the leadership of All India Institute of Medical Sciences (AIIMS) and with technical inputs from National Neonatology Forum (NNF), Indian Academy of Paediatrics (IAP), WHO, and UNOPS LFA.

ASHAs learn about the requisite information required to be imparted during their home visits, get trained on counseling mothers on basic newborn care including breastfeeding, kangaroo care and refer mothers and neonates in case of danger signs. ASHAs are to make 6 home visits in the post natal period i.e. just after the birth of the child. In some States, there is one visit during the 8th month of pregnancy whereby the ASHA counsels the pregnant woman on birth preparedness and the importance of delivering in the presence of a skilled birth attendant.

In order to keep track of all the required visits made by the ASHA to one household, a Post Natal Card (PNC) has been developed by the NIPI focus States with support from UNOPS LFA (attached as annexure). This PNC card on completion is verified by the ASHA’s supervisor viz., Auxiliary Nurse Midwife (ANM) which is further counter signed by the Medical Officer (MO). Thereafter this card is submitted to the Block Office for ASHAs to receive an incentive payment of Rs 200/- per mother-neonate cohort that she follows. Additionally, ASHAs can refer neonates identified with danger signs. For this, they receive a small fund for referral transport.

Continuous supportive supervision and learning is a key for this intervention to be successful and UNOPS LFA is working in this direction.

Key intermediate outcome indicators to be measured include:

o Percent mother neonate cohorts visited 3 times during 1st 10 days after child birth o Number/ Percent of mothers identified with danger signs o Number/ Percent of mothers with danger signs referred to health facility o Number/ Percent of neonates identified with danger signs o Number/ Percent of neonates with danger signs referred to health facility o Percent of neonates breastfed within 1st hour of birth o Percent of institutional deliveries

Monthly reports are prepared using the information collected by ASHAs in the PNC card (attached as annexure) to have a better understanding of the intervention outputs. These monthly reports are collated and analyzed by the UNOPS LFA M&E team on a regular basis.

Analysed reports focusing on the 7 key intermediate outcome indicators are shared with NIPI Secretariat on a semi-annual basis.

The process for data collation and analysis under HBPNC is as follows:

Sick Newborn Care Units (SNCUs)

Sick Newborn Care Units (SNCUs) are part of the continuum of care efforts under UNOPS LFA. NIPI focus States have adopted an integrated approach for establishing and equipping Level II SNCUs which are 12 bedded facilities with staffing structures varying slightly between States. Medical Colleges in these States are involved in training and providing oversight to these SNCUs. Technical support has been provided to these States for setting up Level II SNCUs by UNOPS LFA in collaboration with the Institute for Post Graduate Education and Research (IPGMER), Kolkata, West Bengal.

Sick neonates are referred to these SNCUs both by Yashodas based in health facilities and ASHAs present at the community level.

ASHA fills in PNC card,

completes, signs and submits to

supervisor at facility level

Supervisor validates and submits

to Medical Officer. Medical

Officer counter signs and submits

at Block level

Data entry at Block/ District

Levels using software. Data

checked and validated at State

Level

All data from all States sent to

Central Server located at

NCHRC/NIHFW

Analysis undertaken by UNOPS LFA

and NIPI Secretariat

Community

Health

Facility

Block/

District

State

National

As part of the UNOPS LFA M&E framework, a standardized format is used for monitoring the SNCU intervention. Details of output indicators as covered in the monitoring format, frequency of data collection and person(s) responsible are provided in the annexure. This information is collected on a regular basis by the M&E team of UNOPS LFA.

The process for data collection with regards to SNCUs is as follows:

Key intermediate outcome indicators for measuring change because of SNCUs are:

Number of neonates admitted in SNCUs Number of neonates treated in SNCUs Mortality rate at SNCUs

These intermediate outcome indicators are disaggregated by gender and inborn/ outborn admissions. Analysed data for these intermediate outcome indicators are shared by UNOPS LFA Team with NIPI Secretariat on a semi-annual basis.

Nursing staff at SNCU provides

information

District Child Health Manager

collates in the required format

Programme Associate at State level

collates, validates, analyses and

prepares monthly and cumulative

report

M&E Associate, UNOPS LFA analyses

and shares with Advisor, M&E NIPI

Secretariat

Health

Facility

District

State

National

Routine Immunization

Focus of the routine immunization interventions under NIPI is to strengthen the Universal Immunization Program (UIP) through improvements in service delivery and demand generation. This is aimed to be achieved by way of techno-managerial support at Block and District levels. Monitoring of the UNOPS LFA interventions under routine immunization would require focusing on several components, especially program management, supply chain management of vaccines and logistics, service delivery including health system capacity & performance, social mobilization and program supervision & monitoring. While each of these components would need several indicators to measure the progress, a few selected indicators outlining key processes and outputs, monitored at regular periodicity (monthly) at several management levels could give an understanding of program performance and progress. This shall be undertaken by the M&E UNOPS LFA team on a regular basis.

Key intermediate outcome indicators include:

Percent of planned immunization sessions held in a month

Percent immunization sessions monitored with all vaccines and syringes available

Percent immunization sessions monitored with ASHAs/ mobilizers

Percent sessions monitored with updated due lists DPT1 to DPT3 drop-out rates Percent full immunization coverage at 1 year

Analysed data focusing on intermediate outcome indicators are shared by UNOPS LFA M&E team on a semi-annual basis with the NIPI Secretariat.

Techno managerial support:

One of the pillars of National Rural Health Mission (NRHM) is the establishment of decentralized planning processes. Accordingly, a number of responsibilities have shifted to the District and to some extent to the Block level. Programme management units (PMUs) have been set up at the State, District and Block levels to support managerial facilitation of service delivery.

However, it has been noted that there have been difficulties in absorbing all potentially available funds. In this context, UNOPS LFA is facilitating the State Health Societies to access NIPI funds to strengthen their techno managerial structures and systems so they can more efficiently and effectively deliver quality child health services under the NRHM programme. Following from this, NIPI States have identified critical staff positions to support the existing health management system reach its potential.

For each State (directly employed by NIPI), 3 staff personnel are in place.

The following staff personnel are employed by the District but supported by NIPI funds:

At the Block level, NIPI funds are supporting:

Other positions identified by States for NIPI support include:

State Finance Assistant (All 4 NIPI focus States with the exception of Rajasthan) State Data Assistant (Bihar and Orissa) State Data Analyst (Madhya Pradesh) State Child Health Consultant State HR Assistant (Orissa) State Media and Communication Consultant

District level:

Training Officer District Training Coordinator District Public Health Nurse Manager (Focus Districts of Rajasthan)

Senior Programme Officer

Programme Officer Programme Associate

District

District Child Health Manager, Deputy

Managers, Maternal & Child Health

Managers

Child Health Supervisor

Deputy Child Health

Supervisor

Block

Block Child Health

Manager

Divisional Logistic Manager (Madhya Pradesh)

Techno managerial support includes remuneration, mobility support, budget for attending meetings, office expenses etc. This support can be measured against process indicators (list attached as annexure). The process indicators are collected by the UNOPS LFA team on a regular basis.

UNOPS LFA shares the following process indicator with the NIPI Secretariat on a semi- annual basis.

Number of positions being supported by NIPI funds

Gender lens will be used at the level of analysis.

Yashoda/ Mamta

Yashoda is a Hindi word meaning ‘foster mother’, the idea being that the Yashoda serves as an advocate and guide for the mother and her newborn child. In Bihar, the word Mamta is used instead of Yashoda. To improve quality of care, Yashodas provide counseling and guidance on child care to new mothers and family members during their stay at the birthing facility. Linked is the availability of birthing kit consisting of a delivery and neonatal kit in the NIPI focus States.

Yashodas hand over birthing kits to mothers in the labour room. Rationale is to create a bond between the Yashoda and the mother as well as establish the principles of hygiene and cleanliness right at the outset. Each kit costs no more than Rs 100 (less than NOK 15/USD 2).

Similar to the Accredited Social Health Activists (ASHAs) at the community level, Yashodas are volunteer support workers who are paid an incentive. Yashodas are provided training in accordance to the curriculum which includes an orientation, induction and on the job recurrent training. Training manuals for Yashodas have been developed in close cooperation with the Nursing Council of India, Trained Nurses Association of India, National Neonatology Forum (NNF) and the National Institute of Health & Family Welfare (NIHFW).

A monitoring format for the Yashoda interventions has been developed which is collected on a monthly basis (attached as annexure) by the Programme Associates at the State level and M&E Associate, UNOPS LFA, National level. Raw data base generated in MS excel or MS Access is shared with Advisor, M&E at NIPI Secretariat for analysis and report generation.

Process for monitoring of Yashoda intervention

Key measurable intermediate outcome indicators for this intervention are:

o Percent mothers staying at least 24 hours at the health facility after child birth o Percent mothers initiating breastfeeding within 1st hour of birth o Percent neonates weighed at birth o Percent neonates immunized for 0 dose Polio o Percent neonates immunized for BCG

Analysis is undertaken using the gender lens. Analyzed reports focusing on intermediate outcome indicators are shared with NIPI Secretariat on a semi-annual basis.

Data collation at Facility

level

Child Health Supervisor /

Deputy Child Health

Supervisor

District / Block Child

Health Manager/

DPMU

State level-

Programme Associate

UNOPS LFA

Compiles into monitoring format,

validates & analyses along with UNOPS

LFA M&E Associate

NIPI Secretariat

Analysis reports

RNE, PMG, JSC

District & Block levels

UNOPS LFA Programme Progress Reporting Format

UNOPS LFA team share the progress reports on a semi-annual basis with the NIPI Secretariat.

1. Quality of Health Services

Key Interventions Description of activities/ processes during current period

Indicators Quantitative Data to monitor change (please indicate data source)

Qualitative information to substantiate quantitative data (please use additional sheets, if required)

Reasons for discrepancy in case of no change or negative change in indicators from last period

a. Home Based Post Natal Care

Percent of mother neonate cohorts visited 3 times during first 10 days after birth

Number & Percent of mothers identified with danger signs

Number & Percent of mothers referred to health facility with danger signs

Number & Percent of neonates identified with danger signs (disaggregated by gender)

Number & Percent of neonates referred to health facility with danger signs (disaggregated by

gender)

Percent of neonates breastfed within 1st hour of birth (disaggregated by gender)

Percent of Institutional deliveries

b. Sick Newborn Care Units Number of neonates admitted in SNCUs (disaggregated by gender & Inborn/ Outborn)

Number of neonates treated in SNCUs (disaggregated by gender & Inborn/ Outborn)

Mortality rate at SNCUs (disaggregated by gender & Inborn/ Outborn)

c. Routine immunization Percent of planned sessions held per month

Percent sessions monitored with all vaccines and syringes available

Percent sessions monitored with ASHAs/ mobilizers

Percent sessions monitored with

updated due-list prepared

DPT1 to DPT3 drop-out rates

Percent full immunization coverage at 1 year

2. Enabling mechanisms





a. Yashodas Percent mothers staying at least 24 hours at the health facility after birth

Percent mothers initiating breastfeeding within 1st hour of birth

Percent neonates weighed at birth (disaggregated by gender)

Percent neonates immunized for 0 dose Polio (disaggregated by gender)

Percent neonates immunized for BCG

(disaggregated by gender)

b. Techno managerial support

Number of positions being supported by NIPI funds

3. Learning and Sharing





a. Documentation of NIPI interventions

a. Documentation of NIPI interventions through National Child Health Resource Centre (NCHRC)

b. Documentation of NIPI interventions through State Child Health Resource Centre (SCHRC)

c. Documentation of interventions within the public domain as peer reviewed journal articles, policy briefs etc.

b. Uptake of NIPI a. Uptake of NIPI

Interventions by Government

Interventions by NIPI focus State Governments

b. Request for technical support for NIPI Interventions in other non NIPI States

Financial Monitoring

Routine financial monitoring is undertaken to keep track of whether funds have been utilized as planned, for what activities are these funds utilized and the rate of utilization. This is undertaken by UNOPS LFA on a regular basis.

Semi-annual reports are submitted to NIPI secretariat on the following format. NIPI Secretariat is responsible for analysis and reporting to RNE, PMG and JSC.

Expenses incurred during the period January to December (Year)

Project Name : UNOPS-LFA All amounts in INR

Uncommitted balance brought forward as on 1 January (Year)

A

Funds received during (Year)

B

Budget approved by JSC

C=A+B

Funds committed during ( Year) (as per below table)

D

Uncommitted balance as on 31 December (Year)

0

E=C-D

Sr. Budget Heads

Uncommitted balance brought forward as on 1

January (Year) (A)

Funds received during

(Year) (B)

Budget Amount as approved by JSC for (Year)

(C=A+B)

Funds committed

during (Year) (D)

Uncommitted Balance E=C-D

STATE

1 HBPNC

2 SNCU

3 YASODHA

4 Techno Managerial

5 Routine Immunization

6 Others

Total

Analysis, Interpretation and Communication

NIPI Secretariat is responsible for analysis and interpretation of data/ information generated from UNOPS LFA interventions. NIPI Secretariat communicates with the Partner, RNE and shares requisite reports with RNE, PMG and JSC.

Semi Annual and Annual

Progress Reports

Programmatic Directions NIPI Secretariat shares with UNOPS LFA

Semi Annual and Annual

Reports

Programme Progress Reports Work plans Financial status reports

NIPI Secretariat shares with RNE, PMG and JSC

UNICEF

Under NIPI, Government of Norway has channeled funds through UNICEF for implementation of child health interventions aimed at achieving MDG 4. Norwegian Ministry of Foreign Affairs (MFA) and UNICEF entered into a framework agreement on 12 December 2003. UNICEF has received a Grant not exceeding 130 million NOK to be used for NIPI interventions during the stated period of the programme (2006-20134).

Key interventions

Using the strategic framework of NIPI, the key Interventions identified include:

Key elements of strategy Key interventions Quality of health services Acceleration of immunization coverage

through strengthened cold chain and vaccine management systems Facilitation of community based newborn and child care interventions across NIPI focus States through planning, capacity building, supervision and monitoring Improved facility based newborn and child care across NIPI focus States

Enabling Mechanisms District and Block planning and management support across NIPI focus States

Learning and Sharing Develop and promote innovations for child health service delivery, prototyping new models and research activities

Monitoring

Semi annual reports are shared by UNICEF with the NIPI Secretariat. The following format is used for measuring progress of the programme. Information is analysed by NIPI Secretariat and shared with RNE, PMG and JSC.


th JSC meeting.

Reporting Period:

(mention months)

Name of the Reporting Partner: UNICEF

Partner State / District(s):

Name of Reporter:

SUMMARY FOR THE CURRENT PERIOD

Significant Activities in the current period

Outputs for this Period

1. Quality of Health Services Key Interventions Description of activities/

processes during current period



Reasons for discrepancy in case of no change or negative change in indicators from the last reporting period

a. Acceleration of immunization coverage through strengthened cold chain and vaccine management systems

Percent Primary Health Centres (PHCs) with functional cold chain equipment

b. Facilitation of community based newborn and child care implementation across all NIPI focus States through planning, capacity building, supervision and monitoring

Percent of newborns visited 3 times within 10 days after birth (denominator- Number of Districts in Advanced stage of implementation of IMNCI)

Percent of Community Workers trained vs planned in providing newborn and child care (denominator- of the total number of District Hospitals in 5 NIPI focus States)

c. Improved facility based Percent District

newborn care in NIPI focus States

Hospitals with SCNU (Special Care Newborn Units)

Percent First Referral Units with newborn stabilization units

Percent 24x7 PHCs with functional newborn corners

Annual Assessment

Number of neonates admitted to SCNUs (disaggregated by gender)

Facility surveys and Reviews

Number of neonates discharged alive from SCNUs


Number of neonates left against medical advice from SCNUs


Number of neonate deaths at SCNUs


2. Enabling mechanisms Key Interventions Description of activities/





a. District and Block planning, management and support

Percent Districts with quality PIPs reflecting evidence

Annual by reviewing sample plans from each

based Reproductive Child Health (RCH) interventions

District

Number of techno managerial staff supported by UNICEF under NIPI (disaggregated by National, State and District levels)

3. Learning and Sharing Key Interventions Description of activities/





a. Develop and promote innovations for child health service delivery, prototyping new models and research activities

Number of new interventions piloted and shared with Government system

Number of peer reviewed journal articles, research studies, policy briefs, manuals on NIPI related child health interventions

4. Please provide a write up in the form of bullet points: Good practices:

Challenges to implementation :

Stories from the field with focus on Gender Equity:

Experiences in collection of data:

Any other issues related to M&E:


Semi-annual financial reports are submitted by UNICEF to NIPI secretariat on the following format. NIPI Secretariat is responsible for analysis and reporting to RNE, PMG and JSC.


Project Name : UNICEF All amounts in USD


A Funds received during (Year)

B


C=A+B Funds committed during (Year) (as per below table)

D

Uncommitted balance as on 31 December (Year) 0

E=C-D

Budget Heads

Uncommitted balance brought

forward as on 1 January (Year) (A)


(B)


(C=A+B)

Funds committed

during (Year) (D)


Analysis, Interpretation & Communication

NIPI Secretariat is responsible for sharing progress reports with RNE and the Joint Steering Committee.

Semi Annual and Annual R Progress Reports Work plans Financial status reports

Shared with RNE Shared at PMG, JSC

WHO

A Framework Agreement has been entered into between Government of Norway and WHO on 13 June 2003. Following this, a Grant not exceeding 65 million NOK is made available to WHO for NIPI programme during the stated period (2006-20135).

Key interventions Using the strategic framework of NIPI, the key interventions include:

Key elements of strategy Key interventions Enabling Mechanisms Expansion of Pre-Service Integrated

Management of Neonatal and Childhood Illnesses (IMNCI) Strengthening of Quality Assurance for Anaesthesia, and Emergency Obstetric Care (EmOC) Strengthening of Skilled Birth Attendance (SBA) training for ANMs and Midwives Accreditation process for Maternal, Neonatal, Child Health (MNCH) services

Learning and Sharing Management of child malnutrition


th JSC meeting.

Monitoring

Semi annual reports are shared by WHO with the NIPI Secretariat. The following format is used for measuring progress of the programme. Information is analysed by NIPI Secretariat and shared with RNE, PMG and JSC.

Reporting Period:

(mention months)

Name of the Reporting Partner: WHO

Partner State / District(s):

Name of Reporter:

SUMMARY FOR THE CURRENT PERIOD

Significant Activities in the current period

Outputs for this Period

1. Enabling mechanisms Key Interventions Description of activities/





a. Expansion of pre-service IMNCI

Percent Districts rolled out IMNCI programs

b. Strengthening of Quality Assurance for Anaesthesia and EmOC

Percent 24x7 PHCs and above health facilities providing EmOC services

Percent 24x7 PHCs and above health facilities providing LSA

c. Strengthening SBA training for ANMs and Midwives

Percent PHCs providing SBA services

d. Accreditation process for MNCH services

Number of States implementing accreditation guidelines

Number of private health facilities accredited in NIPI States

2. Learning and Sharing Key Interventions Description of activities/





a. Develop and promote innovations for child health service delivery, prototyping new models and research activities

Number of new interventions piloted and shared with Government System

Studies undertaken on malnutrition for formulating guidelines


Semi-annual financial reports will be submitted by WHO to NIPI secretariat on the following format. NIPI Secretariat shall be responsible for analysis and reporting to RNE, PMG and JSC.


Project Name : WHO-NIPI All amounts in USD


A


B


C=A+B

Funds committed during (Year) (as per below table)

D

Uncommitted balance as on 31 December (Year)

0

E=C-D

Sr. Budget Heads


(A)

Funds received during

(Year) (B)


(C=A+B)

Funds committed

during (Year) (D)


(A) Strengthening Childhood Immunization and Disease Control Activities

(B) Child Health Interventions

(C) Maternal Health Interventions

Total


NIPI Secretariat is responsible for sharing progress reports with RNE, Programme Management Group and the Joint Steering Committee.

Research Institutes

5% of the total NIPI funds have been allocated for operational research. An Operations Research Committee (ORC) and Sub Committee have been formed. From 1st July 2010, NIPI Secretariat has been given the responsibility of coordination and management of all meetings related to Operational Research. NIPI Secretariat keeps RNE and the Joint Steering Committee abreast of all partnerships with research institutes under Operational Research. The time period of sharing updates shall vary in accordance to the length of the research study.

A monitoring format shall be used to keep track of progress of operations research studies. This is represented below.

Research Topic

Partners Time period for research study

Update (time period to be added in accordance of length of the study)

Status as on (Date)

Reasons for any discrepancy from what has been planned

Remarks

Process Preliminary findings

Start Date

Completion Date

Not yet started Delayed On Time

Semi Annual and Annual Progress Reports Work plans Financial status reports


Financial status reports shall also be shared with RNE, PMG and JSC.

Research Topic

Partners Time period for research study

Financial status Reasons for any discrepancy

Budget allocation

Expenditure


NIPI Secretariat is responsible for sharing progress reports with RNE, PMG and JSC.

Semi Annual and Annual Progress Reports Work plans Financial status reports


Section 3

Programe Management

Programme Management

Programme management is critical to the success of any development cooperation programme. In this current section, processes, activities and inputs covered under programme management shall be dealt with.

N= National; S=State; D=District; B=Block

Programme management for UNOPS LFA and UNICEF are covered under this component. Suggested formats for measuring resources used for programme implementation are depicted below6.

Action Plan Focal Area: Results Level

Outcome Use of Outputs

Output No. Activities Person in

charge Implementation period Resources Notes

J F M A M J J A S O N D P F Others S C P=Personnel includes Staff (S) and Consultants ( C); F=Financial This information is collected by respective partners and made available to NIPI Secretariat as and when required. The NIPI Secretariat, in turn, would then share this information with RNE, PMG and JSC as and when required.

6 Adapted from SIMIMex Handbook GTZ, 2009

Personnel

Time

Financial

inouts=========

Implementation of

Activities

INPUTS

N S D B

Processes Outputs

Utilization of

Outputs

Section 4 Annexures

Information reflected herein is collected and analyzed by the M&E team of UNOPS LFA on a regular basis. As and when required, information is shared with NIPI Secretariat.

Annexure 1

UNOPS LFA: Techno Managerial Support

A. Process indicators

Definition Data source &frequency of measurement

Whether at State/ District/ Block level

Persons responsible for data collection, validation & analysis

Programme staff responsibility

Number of positions sanctioned as NIPI supported State staff (for each NIPI focus State)


State Programme Officer

Programme Associate

LFA format; Semi annual

State State Programme in charge, State Programme Associates, M&E Associate UNOPS LFA

Director UNOPS LFA; Programme Lead at UNOPS LFA Delhi; Senior Programme Officers at State level

Number of positions filled vis-à-vis sanctioned NIPI supported State staff (for each NIPI focus State)


State Programme Officer

Programme Associate

LFA format; Quarterly; Semi annual


Number of Child Health Managers supported by NIPI funds (for each NIPI focus State)

Support District Programme Management Units in formulation of District Programme Implementation Plans (PIPs) for child and related maternal health under NRHM

Support District Programme Management Units in implementation of child and related maternal health interventions

LFA format; Quarterly

District & Block

State Programme in charge, State Programme Associates, M&E Associate UNOPS LFA

Number of positions supported by UNOPS LFA in NRHM Program Management Units

Assisting in program management for child and related maternal health interventions



Number of positions supported by UNOPS LFA at SIHFW/ SCHRC/ SHSRC

Responsible for supporting training, capacity building, research, documentation & dissemination



Number of positions supported by UNOPS LFA at Divisional levels

Responsible for logistics support for child health interventions


Division State Programme in charge, State Programme Associates, M&E Associate UNOPS LFA

Number of Child Health Supervisors at facility level (for each NIPI focus State) supported by UNOPS LFA

Responsible for training, monitoring, mentoring of Yashodas/ Mamtas


District level facility


Number of Deputy Child Health Supervisors at facility level (for each NIPI focus State) supported by NIPI

Responsible for training, monitoring, mentoring of Yashodas/ Mamtas


District / Block level facility

State Programme in charge, State Programme Associates M&E Associate UNOPS LFA

Number of active (trained and in place at health facility) Yashodas/ Mamtas

Yashodas/ Mamtas counsel pregnant women who come to facility for delivery

Refer mothers and neonates in case of danger signs


District / Block level facility


Remuneration of staff supported through LFA funds and engaged in State and District Health Societies

Financial expenditure format- UNOPS LFA; Quarterly

State & District


Expenditure on mobility support, organizing meetings, office expenses etc

Financial expenditure format- LFA; Quarterly

State & District


Annexure 2

UNOPS LFA: Yashodas

A. Measurable indicators Frequency of data

collection Responsibility

Number of active Yashodas

Monthly, Quarterly and Annual


Number / %age of births including still births by gender Number / %age of stillborns by gender Number / %age of neonates identified with illnesses by gender Number / %age of neonates dead after birth by gender Number / %age of neonates discharged within 6 hours by gender Number / %age of neonates discharged between 6-12 hours by gender Number of neonates discharged between 12-24 hours by gender Number / %age of neonates discharged between 24-48 hours by gender Number / %age of neonates discharged after 48 hours by gender Average retention time of neonates by gender Number / %age of neonates given 0 dose Polio by gender Number / %age of neonates given BCG by gender Number / %age of neonates breastfed within 1 hour by gender Number / %age of neonates weighed by gender Number / %age of neonates with weight more than 2.5 kgs by gender Number / %age of neonates with weight between 2-2.5

kgs by gender Number / %age of neonates with weight less than 2 kgs by gender Number of kits distributed to mothers

Annexure 3

UNOPS LFA: Sick New Born Care Units

A.

Measurable indicators Frequency of data collection

Responsibility

Admissions (Inborn/ Outborn) by gender (%age)

Monthly, Quarterly and Annual


Birth weight (Inborn/Outborn)- more than or equal to 2.5 kgs/ less than 2.5 kgs by gender (%age) Gestation (Inborn/Outborn)- more than 37 weeks; less than or equal to 37 weeks by gender (%age) Causes for admission by gender (%age) Deaths (Inborn/ Outborn) by gender (%age) Primary cause of Death by gender Information on deliveries in the hospital- normal, assisted, C section by gender Live births by gender (%age) Still births by gender (%age) Neonatal deaths by gender (%age) Maternal deaths (%age)

B.

Form D 1 (District)

CLINICAL MONTHLY REPORTING FORM

SICK NEWBORN CARE UNIT (SNCU)

Name of Health Facility:

District: State:

Month: Year:

CURRENT MONTH

Male Female Total

A. ADMISSIONS

In-born

Out-born

Total Admissions

1. Birth Weight In-born

> 2500 gm

1800 – 2499 gm

1200 – 1799 gm

< 1200 gm

Total

2. Birth Weight Out-born

>2500 gm

1800 – 2499 gm

1200 – 1799 gm

< 1200 gm

3. Gestation In-born

>37 weeks

34 – 37 weeks

30 – 34 weeks

< 30 weeks

4. Gestation Out-born

>37 weeks

34 – 37 weeks

30 – 34 weeks

< 30 weeks

5. Causes for Admission (Multiple)

Sepsis or Pneumonia

Asphyxia

Hypothermia

Convulsions/seizures/fits

Prematurity

Low Birth Weight

<1499 gms

1500 – 2499 gms

Tetanus Neonatorum

Congenital Anomalies

Hyperbilirubinemia

Any other cause

B. Deaths

Total Deaths in In-born

Early (0 - 6 days) deaths in In-born

Total Deaths in Out-born

Early (0 - 6 days) in Out-born

Deaths in birth weight < 1500 gm

6. Primary Cause of Death

Sepsis or Pneumonia

Asphyxia

Hypothermia

Prematurity

Low Birth Weight

Tetanus Neonatorum

Congenital Anomalies

Any other cause

C. General Information (Hospital)

No. of vaginal deliveries

No. of Cesarean Sections

Total Deliveries

No. of live births

No. of still births

No. of neonatal deaths (Labor Room, Maternity Ward)

No. of maternal deaths

Annexure 4

UNOPS LFA: Home Based Post Natal Care

A. Home Based Post Natal Care Ver 2.0

Postnatal Care Card (This part is to filled and retained by the ASHA as reference copy)

Village Sub-Center Block Mother's name

Father's name

ASHA's Name

Date of delivery

Place of delivery

Health Facility / Home

Sex of baby

Male / Female

Mode of delivery

Normal/ Assisted/ CS

Breastfeeding started

< 1 hr, 1 - 24 hr, > 24hr

Birth weight gms

Still Birth Yes / No

Birth Registration No. Unique ID

Birth Preparedness Visit Date: Discussed:

Birth Plan

Institutional Delivery Referrals

Breast Feeding

Breast Examination

Postnatal Care Card

(To be filled by the ASHA during home visits and handed over to ANM after completion of home visits) Village Sub-Center Block Mother's name

Father's name

ASHA's Name

Date of delivery

Place of delivery

Health Facility / Home

Sex of baby

Male / Female

Mode of delivery

Normal/ Assisted/ CS

Breastfeeding started

< 1 hr, 1- 24 hr, > 24hr

Birth weight gms

Still Birth Yes / No

Birth Registration No. Unique ID

Birth Preparedness Visit Date: Discussed:

Birth Plan

Institutional Delivery Referrals

Breast feeding

Breast Examination

No. of Home Visit 1st Visit 2nd visit 3rd visit 4th visit 5th visit 6th Visit

Day of Birth (Day 1) (Day 2-3) (Day 5-7)

(Day 14-17)

(Day 23-28) (Day 42-45)

Date of Home Visit Baby (fill details if baby alive)

Is baby alive? (Yes/No), If not, Date of Death

Is the baby exclusively breastfed? Y/N Was anything else given in last 24 hrs? Y/N Is there any breast/ nipple problem? Y/N Is the baby sucking effectively? Y/N Has the baby passed urine? (Y/N) Has the baby passed stool? (Y/N) Is the baby covered well and warm? Y/N Look for Danger signs? Mention Y/N Convulsions/Fits Fast Breathing (>60 per minute) Chest Indrawing Not able to feed or stopped feeding well Temperature more than 37.5 Or less than 35.4 Poor Activity/Lethargy Birth Weight less than 2000 gm 10 or more Skin Pustules Or One large boil Yellow soles or palms Is the baby having any local illnesses? Y/N Less than 10 skin pustules Pus from or Redness around Umblicus Pus discharge from Eyes Was the baby bathed? (Y/N) Has the baby received BCG? Y/N Has the baby received OPV? Y/N Weight of baby (gms) Temperature of baby Respiratory Rate Is there any other problem?

Mother (fill details if mother alive)

Is the mother alive? If not, Date of Death Look for any danger signs? Mention Y/N Heavy Bleeding Fever Convulsions/Fits Severe Pain Abdomen Is there any foul smelling discharge? Y/N

Is there any other problem? (Passage of urine, stool etc.)

Referral Does the baby need referral? (Y/N) Does the mother need referral? (Y/N) Counseling & Assistance

Baby care Mother care including adequate food & rest Exclusive breastfeeding Family planning Hygiene Death registration (if applicable) Any Remarks

Signature of ASHA Signature of Mother/Family member

Supervisor's signature

Referral Information (where applicable)

Who was referred? Referred where?

Did they go? If Yes, where did they go?

Transport arranged

Result of Referral

Did ASHA accompany

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