rmnch+a rbsk indicator

lR;eso t;rs

Maternal Health Division

Ministry of Health & Family Welfare

Government of India

With Support from

other RCH Divisions 2014

High Impact RMNCH+A InterventionsKey Performance and Quality Indicators for

Key Performance and Quality Indicators for High Impact RMNCH+A Interventions

Ministry of Health & Family WelfareGovernment of India

Key Performance and Quality Indicators for High Impact RMNCH+A Interventions iii

PrefaceThe RMNCH+A strategy encompasses all interventions aimed at Reproductive, Maternal, New Born, Child and Adolescent Health under one broad umbrella with a focus on the life cycle approach. To prioritize its implementation, a 5x5 matrix has been developed for the five thematic areas of reproductive, maternal, newborn, child and adolescent health. The matrix has been prepared on evidence based high impact interventions and also the cross-cutting systemic support required for implementation.

The Government of India in partnership with the states and Development Partners is constantly monitoring the performance and ways to improve RMNCH+A activities both at the health facilities and in the community. However we did not have key performance and quality indicators to quickly assess the level of progress. So a set of key performance and quality indicators have been developed to monitor the progress of activities indicated under the 5x5 matrix. I complement the Program Divisions of this Ministry and all the Development Partners for their contribution in bringing out this document.

I believe, this will be helpful in facilitating the process of reaching the set goals and targets for different thematic areas under the program and assist us to work together to accelerate progress towards MDGs 4 and 5.

(Anuradha Gupta)AS& MD (NHM)

06.05.2014

Key Performance and Quality Indicators for High Impact RMNCH+A Interventionsiv

ForewordThe Ministry of Health and Family Welfare has developed a 5X5 matrix for the Reproductive, Maternal, Child and Adolescent Health (RMNCH+A) strategy, enlisting five high impact interventions under each thematic area.

This matrix is a useful tool for programme managers and other stakeholders to monitor the implementation of the interventions under each thematic area and strengthen the implementation of the RMNCH+A strategy. Essential RCH Commodities have also been enlisted to facilitate programme managers in ensuring their availability at health facilities.

A set of Key Performance Indicators (KPIs) and Quality Indicators (QIs) have also been developed and consolidated into these documents. This would facilitate programme managers at all levels to measure progress of activities under the 5X5 matrix both physical and in terms of quality.

I expect that these indicators would be particularly useful to programme managers for accelerating the progress of interventions in the 184 High Priority Districts identified by the Government of India

(Dr Rakesh Kumar)05.06.2014

Key Performance and Quality Indicators for High Impact RMNCH+A Interventions v

AcknowledgementThe aim of introducing Key Performance Indicators (KPIs) and Quality Indicators (QIs) document is to provide a better understanding of the progress and performance of RMNCH+A implementation at state/district level. If we see the service delivery figures for OPD, IPD, delivery, surgery etc., the quantum of service delivery in terms of number has increased manifold at public health facilities. However, one of our major challenges is to deliver quality services, which meets the aspirations of the clients.

The field visits reveals that there is a need for improving awareness about the standards of performances among service providers. Therefore, in consultation with various program divisions, monitorable indicators which can measure both the performance and the quality of services have been prepared. The 5x5 matrix helps us in giving focused attention on different program activities and KPIs & QIs will ensure its performance and quality aspects. Progress against KPIs and QIs needs to be shared during RMNCH+A quarterly review meetings at district as well as state level for addressing identified gaps and taking corrective actions to close the gaps.

The preparation of this document has been possible due to the active support and guidance provided by Ms. Anuradha Gupta, Additional Secretary and Mission Director, National Health Mission, GOI Mr. Manoj Jhalani, Joint Secretary(Policy) and Dr. Rakesh Kumar, Joint Secretary (RCH), National Health Mission, GOI.

The contribution of all technical divisions under RCH is highly appreciated. The technical inputs from all Development Partners particularly USAID, UNICEF, UNFPA, BMGF, DFID & JHPIEGO in preparing the document were very helpful.

The efforts rendered by the team of experts at JSI, particularly, Dr. Rajesh Singh, Senior Technical Advisor, Dr. Sebanti Ghosh and Dr. Sudhir Maknikar, National RMNCH+A Experts helped in finalizing the guidelines after several revisions of the draft.

I also thank my Colleagues Dr. Manisha Malhotra, Dr. Dinesh Baswal and senior consultants Dr. Pushkar Kumar, Dr. Rajeev Agarwal and Dr. Ravinder Kaur for their valuable inputs and support. The support from the National Resource Unit (NRU) team is also appreciated.

I sincerely hope this document will help policy makers, state & district program officers to measure and improve the service delivery through not only optimizing the performance but also enhancing the quality.

(Dr. Himanshu Bhushan)

Key Performance and Quality Indicators for High Impact RMNCH+A Interventionsvi

LIst of ContrIbutors

1. Ms. Anuradha Gupta, AS&MD (NHM), MoHFW

2. Mr. Manoj Jhalani, JS (Policy), MoHFW

3. Dr. Rakesh Kumar, JS (RCH), MoHFW

4. Dr. Himanshu Bhushan, DC (MH I/c), MoHFW

5. Dr. Manisha Malhotra, DC (MH), MoHFW

6. Dr. Dinesh Baswal, DC (MH), MoHFW

7. Dr. Ajay Khera, DC (CH & Imm I/c), MoHFW

8. Dr. S.K. Sikdar, DC (FP I/c), MoHFW

9. Dr.Haldar,DC(Immunization),MoHFW

10. Dr. P.K. Prabhakar, DC (CH), MoHFW

11. Dr. Sila Deb, DC (CH), MoHFW

12. Dr. Sushma Dureja, DC (AH), MoHFW

13. Dr. Devendra Khandait, SPO, BMGF

14. Dr. Rajesh Singh, Senior Technical Adviser, JSI

15. Dr.SudhirMaknikar,NationalRMNCH+AExpert,JSI

16. Dr.SebantiGhosh,NationalRMNCH+AExpert,JSI

17. Dr.GoverdhanK,NationalTechnicalOfficerM&E,MCHIP

18. Dr. Pushkar Kumar, Lead Consultant, MH, MoHFW

19. Dr. Rajeev Agarwal, Sr. Consultant, MH, MoHFW

20. Dr. Ravinder Kaur, Sr. Consultant, MH, MoHFW

21. Dr. Gulfam Ahmed Hashmi, Regional Coordinator, NRU

22. Dr. Akash Malik, Regional Coordinator, NRU

23. Dr. Ashish B Chakraborty, Regional Coordinator, NRU

24. Ms. Manorama Bakshi, Deputy Regional Coordinator, NRU

25. Mr. Mohit Sharma, Deputy Regional Coordinator, NRU

26. Dr. Manju Singh, Deputy Regional Coordinator, NRU

27. Dr.AjayKeshavPatle,M&ESpecialist,NRU

Key Performance and Quality Indicators for High Impact RMNCH+A Interventions vii

AbbrevIAtIons

AnC Ante Natal Care MbHt Mobile Block Health Team

AnM AuxiliaryNurseMidwife MCH Mother and Child Health

AWW Anganwadi Worker MCP MotherandChildProtection

bCG BacillusCalmetteGuerin MCts Mother and Child Tracking System

bemoC BasicEmergencyObstetricCare MDr Maternal Death Review

CDr Child Death Review MoHfW Ministry of Health and Family Welfare

CemoC ComprehensiveEmergencyObstetric Care

MtP MedicalTerminationofPregnancy

CHC Community Health Center MvA ManualVacuumAspiration

DeIC DistrictEarlyInterventionCentres

ne NorthEast

DH District Hospital nrC NutritionRehabilitationCenter

DP Delivery Point nssK Navjaat Shishu Suraksha Karyakram

DPt Diphtheria, Pertussis, Tetanus oCPs OralContraceptivePills

DQAC District Quality Assurance Committees

oPv Oral Polio Vaccine

eAG EmpoweredActionGroup ors OralRehydrationSolution

eCPs EmergencyContraceptivePills PHC Primary Health Center

emoC EmergencyObstetricCare PnC Post-Natal Care

fbnC Facility Based Newborn Care PPH Post-Partum Haemorrhage

esb EnsuringSpacingatBirth PPIuCD Post-partum Intra-uterine ContraceptiveDevice

fru First Referral Unit PtKs Pregnancytestingkits

GoI Government of India rbsK Rashtriya Bal Swasthya Karyakram

HbnC Home-Based Newborn Care rCH ReproductiveandChildHealth

HDC HomedeliveryofContraceptives rKsK Rashtriya Kishor Swasthya Karyakram

Hr Human Resource sAM SevereAcuteMalnutrition

IDr Infant Death Review sbA SkilledBirthAttendant

IfA Iron-Folic Acid sC Sub-Center

IMnCI Integrated Management of Neo-natal and Childhood Illnesses

sDH Sub-District Hospital

IuCD Intra-UterineContraceptiveDevice

snCu Special Newborn Care Unit

LHv Lady Health Visitor srH SexualandReproductiveHealth

Key Performance and Quality Indicators for High Impact RMNCH+A Interventions ix

Contents

Introduction .............................................................................................................................1

Guidance notes .......................................................................................................................2

Key Performance and Quality Indicators for High Impact RMNCH+A Interventions .............3

1. Reproductive Health .......................................................................................3

2. Maternal Health ...........................................................................................12

3. new-born Health ..........................................................................................19

4. Child Health ..................................................................................................24

5. Adolescent Health ........................................................................................29

Key Performance and Quality Indicators for High Impact RMNCH+A Interventions 1

IntroDuCtIon

In February 2013, the Ministry of Health and Family Welfare (MoHFW), Government ofIndia(GoI),releasedacomprehensiveReproductiveMaternalNewbornChildandAdolescentHealth (RMNCH+A) strategy thatwasdevelopedusing a life-cycle andcontinuum-of-careapproachtomeettheMillenniumDevelopmentGoals4and5.Intheyearthatfollowed,aseriesofotherguidelinesandhandbooksonRMNCH+Ahavebeendeveloped forbetterunderstandingof the strategyand for role clarificationamong the Development Partners , state governments and other stakeholders.

Apart from these guidelines, the MoHFW also developed a RMNCH+A 5x5matrix enlisting five high priority interventions under each thematic area. Theseinterventionshavebeenproposedtobecloselymonitoredbyprogrammanagersandotherstakeholdersforbetterperformancemonitoring.Alongside,alistofessentialcommoditieshasbeenenlistedinordertoensuretheiravailabilityinthefacilitiesaswell as in the community.

In continuationof strengthening the implementationofRMNCH+A strategy, thereisaneedtomonitortheperformanceofhighimpactinterventionsidentifiedinthe5x5matrix.SettingKeyPerformanceIndicators(KPIs)isawaytoperiodicallyassesstheperformanceoforganizations,departments,employees,orprogrammes.Qualityindicators (QIs) are statistical measures that give an indication of output qualityor process quality. Accordingly, KPIs andQIs need to be defined in away that isunderstandable, meaningful, and measurable.

This booklet provides a list of KPIs and QIs that the MoHFW has developed to monitor progressofhighimpactinterventionsidentifiedintheRMNCH+A5x5matrix.Theseindicators can be uniformly used by program managers at state, district and block level acrossalloverthecountry,withspecialfocuson184highprioritydistrictsidentifiedbytheGoI.Itisproposedthatthefindingsfromthefirstroundbeconsideredasthebaseline and used to monitor the progress in the coming years.

Key Performance and Quality Indicators for High Impact RMNCH+A Interventions2

GuIDAnCe notes

• Datawillbecollected,compiledandanalysedonaquarterlybasisforreportingagainst the indicators mentioned in this booklet. The states will report theprogressmadeagainsttheKPIsandQIsonaquarterlybasisandinaprescribedformat.Appropriatesoftwarewillbedevelopedtofacilitateonlinereporting.

• Thefindingsfromthefirstroundwillbeconsideredasthebaselineinformationand used to monitor the progress in the coming years.

• Inmost cases, the datawill be compiled at the block level and a cumulativesummary will be prepared at the district and the state level. The data would be gathered and compiled using the following: Mother and Child Tracking System (MCTS),routineHealthManagementInformationSystem(HMIS),healthfacilitylevel records and registers, frontline worker records and registers, programme andschemespecificreportingformats,trainingrecords,Anganwadirecords,andbeneficiarysurvey(onasamplebasis),insomespecificcases.

• The states are encouraged to maintain district-wise segregated data and closely monitortheprogressagainsttheseindicatorssothattimelyandqualitydataisgeneratedandusedforinformeddecisionmakingtoimproveRMNCH+Aservicedelivery.

• Similarly, the districts would maintain block-level disaggregated data and undertake its regular review to take facilitative and corrective actions at theperipheryforimprovingtheperformance,withfocusonquality.

• Designated supervisors at the state/district/block level would conduct data validationduringsupportivesupervisionand/orblockmonitoringvisits.

• Progress against KPIs andQIs needs tobe sharedduringRMNCH+Aquarterlyreviewmeetingsatthedistrictandthestatelevelforaddressinggapsthathavebeenidentifiedandrequiredcorrectiveactions.


1. Reproductive Health1.1 Focus on spacing methods, particularly post-partum intra-uterine contraceptive device (PPIUCD), at high

case load facilities

Intervention brief: Insertion of intra-uterine contraceptive device (IUCD)within 48 hours of the delivery orafterexpulsionorremovalofplacenta.Thisserviceiscurrentlybeingprovidedathighcaseloadfacilitiesandsubsequentlyneedstobeprovidedinallthefacilitiesthatconductdelivery.

Indicator Details of the indicator (Definition, where required, numerator and denominator)

Means of verification

Key Performance Indicators

Women who had institutionaldeliveriesand accepted PPIUCD services (%)

Numerator: Number of post-partum women acceptingPPIUCDservicesinthedistrict

Denominator: Total number of women who deliveredatfacilitiesthatprovidePPIUCDservicesinthe district

• HMIS

• PPIUCD register

• Labour room register

L2andL3facilitiesproviding PPIUCD services (%)

Numerator: NumberofL2andL3facilitiesprovidingPPIUCD services in the district

Denominator: TotalnumberofL2andL3facilitiesinthe district

• District-level summary report

• Facility-wise monitoring at the district level

Number of PPIUCDs inserted per trained provider per month

Definition: Number of PPIUCD inserted by each trained provider in the district during a month. TrainedserviceprovidersareMedicalOfficers(MOs),StaffNurse(SN),LadyHealthVisitor(LHV),andAuxiliaryNurseMidwives(ANMs)

• Training records, PPIUCD register

• Monitoring at the district level by designated supervisors.

• Facility-wise records at the block level as well as records at the district level to be maintained

Trained service providers providing PPIUCD services at L2 andL3facilities(%)

Numerator: Number of trained service providers providingPPIUCDservicesatL2andL3facilitiesinthe district

Denominator: Total number of service providers (in position)whoaretrainedonPPIUCDinL2andL3facilitiesinthedistrict

• Training records and provider-wise PPIUCD insertionregister


L3 delivery points having an RMNCH counsellor (%)

Numerator: Number of L3 delivery points in the districthavingRMNCHcounsellors(inposition)

Denominator: Number of L3 delivery points in the district

• Staffpositionrecordsatthe district level

• Facility-wise monitoring at district level

Key PerforMAnCe AnD QuALIty InDICAtors for HIGH IMPACt rMnCH+A InterventIons




Quality IndicatorsPPIUCD clients who returnedforthefirstfollow-up (%)

Numerator: Total number of PPIUCD clients in the districtwhoreturnedforthefirstfollow-upafterfourweeksofIUCDinsertion

Denominator: Total number of women who received PPIUCD services in the district

• PPIUCD follow-up register


PPIUCD clients who returned with complications,infectionsandexpulsions(%)

Numerator: Number of PPIUCD clients in the district whoreturnedwithcomplications(infectionandexpulsion)anytimeafterinsertion

Denominator: Total number of women who received PPIUCD services

• PPIUCD follow-up register


L2andL3facilitiesreported stock out of IUCDs in the last quarter(%)

Numerator: Number of L2 and L3 delivery points in the district that reported IUCDs stock out during the reportingquarter

Denominator: Total number of L2 and L3 delivery points in the district

• Stock register at the facility level

• Facility-wise monitoring at district level (block and district level records to be maintained)

Service providers who receivedincentiveforPPIUCDinsertioninthelastquarter(%)

Definition: Service providers are ANMs/SNs/MOs for this indicator

Numerator: Number of service providers in L2 and L3 deliverypointsinthedistrictwhoreceivedincentivesforPPIUCDinsertioninthelastquarter

Denominator: Total number of service providers in L2 and L3 designated delivery points who have inserted PPIUCDs

• Block/district/state level records

• Monitoring at the district level by designated supervisors

ASHAs who received incentiveforPPIUCDinsertioninthelastquarter(%)

Numerator: Number of ASHAs in the district who receivedincentiveforPPIUCDsinthelastquarter

Denominator: Total number of ASHAs in the district whomotivatedclientsandgottheinsertionsdone.




1.2 Focus on interval IUCD at all facilities, including Sub-Centres, on fixed days

Intervention brief:ProvisionofintervalIUCDservicesonfixeddaysthroughouttheyearinahealthfacilitybytrained providers posted in the same facility.




Sub-Centres and PHCs providing interval IUCD servicesonfixeddays(%)

Numerator: Number of Sub-Centres and PHCs designated as delivery points in the district providing interval IUCD services on fixeddays

Denominator: Total number of Sub-Centres and PHCs designated as delivery points in the district

• HMIS monthly report

• Facility-wise monitoring done at the district level

CHC/SDH/DH providing interval IUCD services on demand (%)

Numerator: Number of CHC/SDH/DH providing interval IUCD services on demand in the district

Denominator: Total number of CHC/SDH/DH designated delivery points in the district

• IUCD service register/district level facility reports


Sub-Centres with ANMs trained in IUCD insertion(%)

Numerator: Total number of Sub-Centres in the district with ANMs trained on IUCD insertion

Denominator: Total number of Sub-Centres in the district

• Stafftrainingrecords


Trained ANMs providing fixeddayIUCDservicesout of total available (%)

Numerator: Number of trained ANMs in the districtprovidingfixeddayIUCDservicesatSub-Centres

Denominator: Total number of ANMs trainedonIUCDinsertioninthedistrict

• IUCD service register


Number of interval IUCDs inserted per trained provider per month

Definition: Number of interval IUCDs inserted by each trained provider in the district during a month. (Trained service providers are MOs, SN, LHV and ANMs)

• Training records, IUCD register, performance monitoring register


• Facility-wise records at the block level and records at the district level




Quality IndicatorsInterval IUCD clients who returned for the firstfollow-upafterthenextmenstrualperiod(%)

Numerator: Total number of women in the districtwhoreturnedforthefirstfollow-upafterthenextmenstrualperiod

Denominator: Total number of women who received interval IUCD services in the district

• IUCD follow-up register


Interval IUCD clients who returned with complications,infectionsandexpulsions(%)

Numerator: Total number of women in the districtwhoreturnedwithcomplications(infectionandexpulsion)

Denominator: Total number of women who received IUCD services in the district

• IUCD follow-up register



1.3 Home Delivery of Contraceptives (HDC) and Ensuring Spacing at Birth (ESB) through ASHAs

Intervention brief:

HDC: Door-to-door distribution of contraceptives (condoms, oral contraceptive pills (OCPs), and emergencycontraceptivepills (ECP))byASHAs to thebeneficiaries.ASHAscancharge` 1 for a pack of three condoms, ` 1 for a cycle of OCP, and ` 2forapackofonetabletofECP.

ESB:Underthescheme,servicesofASHAswillbeutilisedforcounsellingnewlymarriedcouplestoensuredelayoftwoyearsinbirthaftermarriageandtoensurecoupleswithonechildhavespacingofthreeyearsafterthebirthofthefirstchild.Theschemeisbeingimplementedin18statesofthecountry(eightEmpoweredActionGroup(EAG)states,eightNorthEast(NE)states,Gujarat,andHaryana).ASHAwouldbepaidfollowingincentivesunder the scheme:

• ` 500forensuringspacingoftwoyearsaftermarriage

• ` 500forensuringspacingofthreeyearsafterthebirthofthefirstchild

• ` 1000incasethecoupleoptsforapermanentlimitingmethod(uptotwochildrenonly)




ASHAs who maintain a line list of eligible couples (%)

Numerator: Total number of ASHAs in the district maintaining a line list of eligible couples

Denominator: Total number of ASHAs available(inposition)inthedistrict

• Eligiblecouples’register/village register of ASHA

• To be monitored at the block and the district level by designated supervisors

ASHAs who faced stock outofanycontraceptiveinthequarter(%)

Numerator: Total number of ASHAs in the districtwhoreportedcontraceptivestockoutinthereportingquarter


• ASHA stock register

• Monitoring at the district level by designated supervisor

ASHAs who received incentivesunderESBscheme (%)

Numerator: Number of ASHAs who received incentivesunderESBschemeinthedistrict

Denominator: Total number of ASHAs in thedistrictwhomotivatedclientsandcouldmaintain desired spacing between children



Utilisationofcondoms/OCPs/ECPsthroughASHAs of the district (%)

Numerator: Numberofcondoms/OCPs/ECPsutilizedthroughASHAsofthedistrictinthequarter

Denominator: Number of condoms/OCPs/ECPsdistributedtoASHAsofthedistrictinthequarter

• ASHA stock register

• Block/district level records



1.4 Ensuring access to Pregnancy Testing Kits (Nishchay kits) and strengthening comprehensive abortion care services

Intervention brief: PregnancyTestingKits(PTKs)areusedindetectionofpregnancybytestingurine.EachSub-CentreinthecountryisentitledtoreceivePTKsbasedonitsprojectedrequirementbutnotexceeding150kitsperyear.TheSub-Centresshouldensurethat50%ofthereceivedstocksofPTKsaredistributedequallyamongtheASHAsattachedtotheSub-Centreandreplenishtheirstockstrictlyonthebasisofperformanceandnotonnormativebasis.TheASHAshallreplenishherstockeverymonthfromtheSub-Centre.




ASHAs who faced stock out of PTKs in thereportingquarter(%)

Numerator: Total number of ASHAs in the district who reported PTK stock out in the reportingquarter


• ASHA register

• Monitoring at the block/district level by designated supervisors

Sub-Centres that reported stock-out of PTKsinthereportingquarter(%)

Numerator: Total number of Sub-Centres in the district that reported PTK stock out in thereportingquarter

Denominator: Total number of total Sub- Centres in the district

• Stock register at Sub-Centre


L2 and L3 delivery points (DP) that providedsafeabortionservices (%)

Numerator: Number of L2 and L3 delivery pointsinthedistrictprovidingsafeabortionservices

Denominator: Total number of L2 and L3 designated delivery points in the district

• District records


L2 and L3 DPs that faced stock-outs of Mifepristone in the lastquarter(%)

Numerator: Total number of L2 and L3 delivery points in the district that reported Mifepristone stock out in the last month of thereportingquarter

Denominator: Total number of L2 and L3 designated delivery points in the district

• Stock register at L2 and L3 level


Quality Indicators

MTPs through MVA out of total MTPs by surgical methods (%)

Numerator: Total number of women in the district who underwent MTP through MVA duringthefirsttrimester

Denominator: Total number of women who underwent MTP by surgical method during thefirsttrimesterinthedistrict

MTP register

UtilisationofPTKsthrough ASHAs of the district (%)

Numerator: NumberofPTKsutilisedthroughASHAsofthedistrictinthequarter

Denominator: Number of PTKs distributed toASHAsofthedistrictinthequarter

Block/district level record




UtilisationofPTKsat Sub-Centres of a district (%)

Numerator: NumberofPTKsutilisedthroughSub-Centresofthedistrictinthequarter

Denominator: Number of PTKs distributed atSub-Centresofthedistrictinthequarter

Block/district level record

Service providers trained on safe abortion(%)

Definition: Trained Service providers, MOs

Numerator: Total number of service providers in the district who are trained on safeabortion

Denominator: Total number of service providers posted in L2 and L3 delivery points

• Training records at the district level


Trained service providers performing abortions(%)

Numerator: Number of trained service providers in the district who are performing safeabortion

Denominator: Total number of service providers in the district who are trained on safeabortion

• MTP register


Increase in MTP at L2 and L3 DPs (%)

Numerator: Number of MTPs conducted in thedistrictduringthecorrespondingquarterof the preceding year

Denominator: Number of MTPs conducted inthedistrictduringthereportingquarterofcurrent year

HMIS monthly report


1.5 Maintaining quality sterilization services

Intervention brief: Provisionofmale(vasectomy)andfemalesterilization(minilapandlaparoscopic)servicesasper the prescribed norms.




L2andL3facilitiesprovidingfemalesterilizationservicesin the district (%)

Numerator: NumberofL2andL3facilitiesprovidingfemalesterilizationservicesinthedistrict

Denominator: Number of total L2 and L3 facilitiesinthedistrict

• Block/district records


Facilitieswithatleastonedoctor trained on female sterilizationservicesinthedistrict (%)

Numerator: NumberofL2andL3facilitieswith at least one doctor trained on female sterilizationservicesinthedistrict.

Denominator: Total number of L2 and L3 facilitiesinthedistrict

• Training records/facility record

• Facility-wise monitoring at the district level (block and district level records to be maintained)

L2andL3facilitiesprovidingmalesterilizationservices in the district (%)

Numerator: NumberofL2andL3facilitiesprovidingmalesterilizationservicesinthedistrict.


• Training records/facility records


Facilitieswithatleastonedoctor trained on male sterilizationservicesinthedistrict (%)

Numerator: NumberofL2andL3facilitieswith at least one doctor trained on male sterilizationinthedistrict.


• Training records/facility records





Quality Indicators

Trained doctors providing femalesterilizationservices out of the total doctors trained on female sterilization(%)

Numerator: Number of trained doctors providingfemalesterilizationservicesinL2andL3facilitiesinthedistrict

Denominator: Total number of trained doctors in the district

• Training records/OT register


Trained doctors providing malesterilizationservicesper month out of the total trainedonmalesterilization(%)

Numerator: Number of trained doctors providingmalesterilizationservicesinL2andL3facilitiesinthedistrict

Denominator: Total number of trained doctorspostedinL2andL3facilitiesinthedistrict

• Training records/OT register


Number of clients (disaggregatedbysex)reportedcomplication/failure/deathattributabletosterilization

Not applicable • Facility case sheets/records


DistrictswithfunctioningDistrict Quality Assurance Committee(DQAC)aspernorms (%)

Numerator: Number of districts in the state withDQACfunctioningaspernorms

Denominator: Total number of districts in the state where DQAC has been formed

District records


2. Maternal Health2.1 Use MCTS to ensure early registration of pregnancy and full ANC

Intervention brief: Pregnantwomenandchildrenhavebeengivenidentificationcodestobeuniquelyidentifiedasanentitysothatpregnantwomenandchildren,whoareregisteredatonelocation,maygetservicesfromotherlocations.Forthis,datarelatedtothesepregnantwomenandchildrenneedstobeavailableatrespectivelocations.




Women registered in thefirsttrimesteroutofthe total registered (%)

Numerator: Total number of pregnant women registeredinthefirsttrimesterforANCinthedistrict

Denominator: Total number of women registered for ANC in the district

HMIS, MCTS

Registrationsoutoftotalexpectedpregnancies (%)

Numerator: Total number of pregnant women registered for ANC in the district

Denominator: Totalnumberofexpectedpregnantwomen in the district

HMIS, MCTS

Quality Indicators

Total number of pregnant women and children data entered in MCTS portal out of expectedbeneficiariesin the block/district

Numerator: Total number of women/children data entered in MCTS in the district

Denominator: Totalnumberofexpectedwomen/children data to be entered in the block/district

MCTS

Registered pregnant women who received full ANC (%)

Definition of full ANC:FullANCisdefinedasfour antenatal check-ups that include abdominal examination;checkingforheightandweight;haemoglobinestimationandurinetestforproteinandsugarduringeachcheck-up;twodosesoftetanustoxoid;distributionof100IFAtablets;andcounselling on diet, rest, birth preparedness, and family planning.

Numerator: Total number of women who received full ANC in the district

Denominator: Total number of pregnant women who are registered with MCTS in the district

MCTS

Registered infants who received full immunization(%)

Numerator: Total number of infants who received fullimmunizationinthedistrict

Denominator: Total number of infants registered in MCTS in the district

HMIS

MCTS


2.2 Detect and line list high risk pregnancies, including severely anaemic mothers, and ensure appropriate management




Pregnant women line listed for severe anaemia out of total registered for ANC (%)

Numerator: Total number of pregnant women detected with severe anaemia in the district

Denominator: Total number of women registered for ANC in the block/district


• MCTS

• Anaemia tracking register

Pregnant women diagnosed with hypertension out of total registered for ANC (%)

Numerator: Total number of pregnant women diagnosed with hypertension

Denominator: Total number of women registered for ANC in the block/district

• MCTS


Pregnant women who delivered before 37 weeks (%)

Numerator: Total number of women who delivered before 37 weeks of pregnancy

Denominator: Total number of women delivered atalllevelsoffacilitiesinthedistrict

• MCTS


Quality Indicators

Pregnant women who improved from severe to moderate anaemia out of total severe anaemia cases line listed (%)

Numerator: Total number of pregnant women who improved from severe to moderate anaemia in the district

Denominator: Total number of pregnant women ever detected as severely anaemic and line listed in the district

• Anaemia tracking register

• Facility records where treatment received

• Monitoring at the district level

Hypertensive pregnant women managed at PHC in the district out of total pregnant women diagnosed with hypertension in the district (%)

Numerator: Total number of pregnant women whoarediagnosedwithhypertension(definedas >140/90 mm Hg) and managed at PHCs in the district

Denominator: Total number of pregnant women ever diagnosed with hypertension in the district

• Facility records where treatment received

• MCTS


Pregnant women who received uterotonic drug post-delivery as part of ActiveManagementofthe Third Stage of Labour (AMTSL) (%)

Numerator: Total number of women who received uterotonic drug post-delivery as part of AMTSL in the district

Denominator: Total number of deliveries in the district

• Delivery register


Pregnant women who delivered before 37 weeks and received antenatal corticosteroids(%)

Numerator: Total number of women delivered before 37 weeks and received antenatal corticosteroidsinthedistrict

Denominator: Total number of women delivered before 37 weeks of pregnancy at all delivery points in the district

• Delivery register


DPs using Safe Birth Checklist (%)

Numerator: Total number of delivery points in the district using Safe Birth Checklist

Denominator: Total number of delivery points in the district

Block monitoring visit


2.3 Equip delivery points with highly trained HR and ensure equitable access to emergency obstetric care (EmOC) services through FRUs; add MCH wings as per need

Intervention brief:ProvisionofEmOCatFRUsisbeingdonebyoperationalisingallFRUsinthecountry.Whileoperationalising,thethrustisonthecriticalcomponentssuchasmanpower,bloodstorageunits,referrallinkages,etc.Availabilityof trainedmanpower (skillbased training forMBBSdoctors) is linkedwithoperationalisation of FRUs.




ANMs/SNs/LHVs trained in SBA (%)

Definition: The indicator to be reported separatelyforeachcategoryofstaff

Numerator: Total number of ANMs/SNs/LHVs trained in SBA in the district

Denominator: Total number of ANMs/SNs/LHVs available in the district

• Training records


Villages without access to24x7PHCs(BEmOCfacilities)within30minutes of transport (%)

Numerator: Total number of villages without accessto24x7PHCswithin30minutesoftransport in the district

Denominator: Total number of villages served bythe24x7PHCs(BEmOCfacilities)inthedistrict

• Block/district level data


Villages without access toFRUs(CEmOCfacilities)withinonehour of transport (%)

Numerator: Total number of villages without accesstoFRUs(CEmOC)withinonehouroftransport in the district

Denominator: Total number of villages served(basedonpopulation)byFRU(CEmOCfacilities)inthedistrict

• Block/district level data


IdentifiedL3facilitieswithout full triad of paediatrician, anaesthetist/LSAStrained doctor, and OBGYN/EmOCtraineddoctor (%)

Numerator: TotalnumberofL3facilitiesthatdo not have fully trained specialists/doctors (paediatrician,anaesthetist/LSAStraineddoctor,andOBGY/EmOCtrained)inthedistrict

Denominator: TotalnumberofL3facilitiesinthe district

• Facility records


L3facilitiesnotprovidingCEmoCservices(%)

Numerator: TotalnumberofL3facilitiesnotprovidingCEmOCservicesinthedistrict







Quality Indicators

C-sectionoutoftotaldeliveries at L3 levels (%)

Numerator: TotalnumberofC-sectionsperformedatL3facilitiesinthedistrict


HMIS monthly report

Women with antenatal and post natal complicationsmanagedatL3facilitiesoutofthetotal reported (%)

Definition: Majorantenatalcomplicationsinclude any bleeding during antenatal period, severe anaemia, hypertension, bad obstetric history(BOH),malpresentation;majorpost-natalcomplicationsincludepostpartumhaemorrhage (PPH) and puerperal sepsis.

Numerator: Total number of women with antenatalandpostnatalcomplicationsmanagedatL3facilitiesinthedistrict

Denominator: Total number of women reported antenatal and post-natal complicationsatL3facilitiesinthedistrict

Facility records

Ambulances in a district, covering more than 100 kms per day (average of thelasttwoquarters)(%)

Definition: Indicator reports average kilometres that an ambulance runs for transportingwomen/infantstohealthfacilities.Perdayaverageinthelasttwoquarters.

Numerator: Number of ambulances covering more than 100 kms per day in the district

Denominator: Number of total ambulances (including any ambulance supported by state/NHM or other source but dedicated as ambulance) in the district

• District ambulance call centre (102/108)records



2.4 Review maternal, infant and child deaths for corrective actions

Intervention brief:MaternalDeathReview(MDR)isanimportantstrategytoimprovethequalityofobstetriccare and reduce maternal mortality and morbidity. The importance of MDR lies in the fact that it provides detailedinformationonvariousfactorsatfacility,community,district,regional,andnationallevelthatneedtobe addressed to reduce maternal deaths.




Maternal deaths reported against estimatedmaternaldeaths in the district (%)

Definition: MaternalDeathisdefinedasdeathof a woman from any cause related to or aggravated by pregnancy or its management (excludingaccidentalorincidentalcauses)during pregnancy and childbirth or within 42 daysofterminationofpregnancy,irrespectiveofthedurationandsiteofthepregnancy

Numerator: Total number of maternal deaths reported in the district

Denominator: Totalnumberofestimatedmaternal deaths in the district.

• HMIS

• MDR reports

• MCTS

Child deaths reported againstestimatedchilddeaths in the district (%)

Numerator: Totalnumberofunder-fivechilddeaths reported in the district

Denominator: Totalnumberofestimatedchilddeaths in the district.

• HMIS

• MCTS

Infant deaths reported againstestimatedinfantdeaths in the district (%)

Numerator: Total number of infant deaths reported in the district

Denominator: Totalnumberofestimatedinfant deaths in the district.

• HMIS

• MCTS

Stillbirthsreportedagainst total deliveries at L3 delivery points (%)

Numerator: Totalnumberofstillbirthsreported in L3 delivery points in the last quarterinthedistrict

Denominator: Total number of deliveries conductedinL3facilitiesinthelastquarter.

• HMIS


Medical colleges conductingnearmissAudit (%)

Definition: Maternalnearmissisdefinedas a woman who survives life threatening conditionsduringpregnancy,abortion,childbirth or within 42 days of pregnancy termination,irrespectiveofreceivingemergencymedical/surgicalinterventionsorotherwise.

Numerator: Total number of medical colleges inthestateconductingnearmissaudit

Denominator: Total number of medical colleges in the state

Near miss audit report




Medical colleges and district hospitals conductingprescriptionaudit (%)

Definition: Prescriptionauditincludesrandom review of at least 5% of indoor admissionprescriptionsbythefacilityteamforunderstanding the key issues/problems to take correctiveactionforfuture

Numerator: Number of medical colleges anddistricthospitalsinthestateconductingprescriptionaudit

Denominator: Total number of medical colleges and district hospitals in the state

Prescriptionauditreport

Quality Indicators

Reported maternal deaths reviewed within two months as per standard protocols (%)

Numerator: Total number of maternal deaths reviewedwithintwomonthsofreportinginthedistrict

Denominator: Total number of maternal deaths reported in the district

• MDR report/records

• Village RCH register

• MCTS

Reported child deaths reviewed within two months as per standard protocols (%)

Numerator: Total number of child deaths reviewedwithintwomonthsofreportinginthedistrict

Denominator: Total number of child deaths reported in the district

• CDR reports

• MCTS

Reported infant deaths reviewed within two months as per standard protocols (%)

Numerator: Total number of infant deaths reviewedwithintwomonthsofreportinginthedistrict

Denominator: Total number of infant deaths reported in the district

• IDR report


• MCTS

Maternal deaths categorised as “others” (%)

Numerator: Total number of maternal cause of death categorised as “others” in the district

Denominator: Total number of maternal deaths reviewed in the district

MDR reports/records


2.5 Identify villages with low institutional delivery and distribute Misoprostol to selected women in the eight month of pregnancy for consumption during the third stage of labour; incentivize ANMs for home deliveries

Intervention brief: TheMoHFW, GoI has taken a policy decision for prevention of PPH to permit ASHAs toundertake advancedistributionofmisoprostol to pregnantwomenwho are likely to deliver at home. Threetabletsof200µgeachmustbegivenattheeightmonthofpregnancyforconsumptionduringthethirdstageoflabour.




Number of villages identifiedwithmorethan 20% home deliveries

Numerator: Total number of villages with more than 20% of home deliveries reported in the lastoneyearidentified

Denominator: Total number of villages in the district


• Sub-Centre/block records

Deliveries conducted by ANMs out of the total home deliveries (%)

Numerator: Total number of home deliveries attendedbySBAtrainedANMsinthedistrict

Denominator: Total number of home deliveries in the district

• ANM records

• MCTS

Womenintheidentifiedvillages who received Misoprostol at the eight month of pregnancy for consumptionduringthethird stage of labour (%)

Numerator: Total number of women in the district who received Misoprostol and consumed three tablets of misoprostol during the third stage of labour

Denominator: Total number of women who deliveredathomeinnotifiedvillagesaspertheGoI criteria in the district.

• Register of advanced distributionofmisoprostolmaintained by ASHAs


Quality Indicators

Villages with less than80%institutionaldeliveries showing an increasing trend of institutionaldeliveries(%).

Numerator: Total number of villages with lessthan80%institutionaldeliveriesshowingincreaseininstitutionaldeliveriesinthedistrict

Denominator: Total number of villages identifiedasreportinglowinstitutionaldeliveries (less than 80% deliveries) in the district


• Sub-Centre/block records


PPH cases managed at L2 facility out of total complicationsreportedin postpartum period (%)

Numerator: Total number of PPH cases managedatL2facilitiesinthedistrict

Denominator: Total PPH cases reported at L2 facilitiesinthedistrict

• Labour room register/case sheets



3. newborn Health3.1 Early initiation and exclusive breastfeeding

Intervention brief:Earlyinitiation(withinonehourofbirth)andexclusivebreastfeedinguptosixmonths.




L3 delivery points that have at least two ANMs/SN trained in infant and young child feeding practices/IMNCIdeputedin PNC ward (%)

Numerator: Total number of L3 delivery points that have at least two ANMs/SN trained in infant and youngchildfeedingpractices/IMNCIinthedistrict

Denominator: Total number of L3 delivery points in the district

• Trainingrecords/staffpostingrecords


Quality IndicatorsWomen who delivered at public health facilitiesandinitiatedbreastfeedingwithinonehour of birth (%)

Numerator: Total number of women who delivered atpublichealthfacilitiesandinitiatedbreastfeedingwithin one hour of child birth in the district

Denominator: Total number of deliveries in the district

Labour room/facility register/records

Infantsexclusivelybreastfedforsixmonths(%)

Numerator: Total number of infants who were exclusivelybreastfedforsixmonthsinthedistrict

Denominator: Total number of infants in the district

Sample survey – 10% ofclients/beneficiariesinterviewed in the district onquarterlybasis


3.2 Home-based newborn care through AsHA

Intervention brief:ASHAwillvisitallnewborns,accordingtoaspecifiedschedule,upto42daysafterbirth.Theproposedincentiveis`50perhomevisitofaroundonehourduration,amountingtoatotalof`250forfivevisits.Thiswouldbepaidatonetimeafter45daysofdelivery,subjectedtothefollowing:

• Recording of weight of the newborn in MCP card

• EnsuringBCG,firstdoseofOPV(zerodose)andDPT-1andHepB1vaccination

Boththemotherandthenewbornaresafetill42daysafterdeliveryandregistrationofthebirthhasbeendone




ASHAs fully trained in Module 6 and 7 (%)

Numerator: Total number of ASHAs received training on Module 6 and 7 in the district

Denominator: Total number of ASHAs available in the district

• ASHA training records


SicknewbornsidentifiedbyASHAs (%)

Numerator: Total number of sick newborns identifiedbyASHAsinthedistrict

Denominator: Total Number of total sick newbornsidentifiedinthedistrict

• ASHA records (HBNC register)


• Monitoring at district level

Sick newborns referred by ASHAstohigherfacilities(%)

Numerator: Total number of sick newborns referredtohigherfacilitiesbyASHAsinthedistrict

Denominator: Number of total sick newborns identifiedbyallASHAsinthedistrict

• ASHA records



Low birth weight babies identifiedbyASHAsduringHBNC visits (%)

Numerator: Total number of low birth weight babiesidentifiedbyASHAsduringHBNCvisitsin the district

Denominator: Total number of newborn visited by ASHAs

ASHA records (HBNC register)


3.3 Essential newborn care and resuscitation services at all delivery points

Intervention brief: Navjaat Shishu Suraksha Karyakram (NSSK) is a programme aimed at training health personnel inbasicnewborncareandresuscitation.Itwaslaunchedtoaddresscare-at-birthissuessuchaspreventionofhypothermia,preventionofinfection,earlyinitiationofbreastfeeding,andbasicnewbornresuscitation.




DPswithfunctionalNewborn Care Corner (%)

FunctionalNewbornCareCorner(NBCC)hasthe following:• Functionalradiantwarmer

• Functionalbagandmask

• Functionalmucousextractordevice

• Functionalweighingmachinefornewborn

• Emergencydrugstrayfornewborn

• RecordkeepingofasphyxiatedandLBWnewborn

• ANM/SN trained in NSSK

Numerator: Total number of delivery points withfunctionalNewbornCareCornerinthedistrict


• Block/district records

• Facility wise monitoring by district.

DPswithNSSKtrainedstaff(%)

Numerator: Total number of delivery points withNSSKtrainedstaffinthedistrict


• Block /district records

• Facility wise monitoring by district

Quality IndicatorsAsphyxiatednewbornssuccessfully resuscitated (%)

Numerator: Total number of newborns with asphyxiawhoaresuccessfullyresuscitatedinthe district

Denominator: Total number of newborns diagnosedwithasphyxiainthedeliverypointsin the district



TrainedNSSKstaffwhoprovided newborn resuscitationservices(%)

Numerator: TotalnumberoftrainedNSSKstaffwhoprovidednewbornresuscitationservicesin the district

Denominator: NumberofNSSKtrainedstaffwho are posted at the delivery points in the district



Newborn admission due to asphyxiaoutoftotalinbornadmissions at SNCU (%)

Numerator: Total number of inborn admission inSNCUduetoasphyxiainthedistrict

Denominator: Total number of inborn admissions in SNCU in the district

SNCU admission register


3.4 Special Newborn Care Units (SNCU) with highly trained human resource and other infrastructure

Intervention brief: States have been asked to set up at least one SNCU in each district. SNCU is a 12-20 bedded unitandrequiresfourtraineddoctorsand10-12nursesforroundtheclockservices.




Total SNCUs with FBNC trained and designated MedicalOfficer(%)

Numerator: Total number of SNCUs in the state withFBNCtrainedMedicalOfficers

Denominator: Number of total SNCUs in the state

Training records

Total SNCUs with trained anddesignatedStaffNurses (%)

Numerator: Number of SNCUs in the state with trainedStaffNurse

Denominator: Total number of SNCUs in the state

Training records

Quality IndicatorsSNCU admissions due to asphyxia(%)

Numerator: Total number of admissions in SNCUsduetoasphyxiainthedistrict

Denominator: Total number of admissions in SNCU in the district


Ratioofinborntooutborn referrals to SNCUs

Iftherearexin-bornreferralsandyout-bornreferralstoSNCU,thentheratioisas

xin-bornreferrals:yout-bornreferrals


Ratioofmaletofemaleinfants in outborn admissions

Not applicable SNCU admission register

Mortalityrate(asphyxiaand sepsis)at SNCU in newborns weighing 2.5 kg or more

Numerator: Total number of deaths due to asphyxiaandsepsisatSNCUamongnewbornsweighing 2.5 kg or more

Denominator: Total number of SNCU deaths in the district



3.5 Community level use of Gentamicin by AnM




ANMs oriented in Gentamicin use (%)

Numerator: Total number of ANMs trained in Gentamicin use in the district

Denominator: Total number of ANMs available in the district

District training records

Quality IndicatorsYoung infants (0-2 months) diagnosed with sepsis by the ANM and given pre-referraldoseofinjectionGentamicin and syrup Amoxicillin(%)

Numerator: Total number of infants (0-2 months) given pre-referral dose of Inj. GentamicinandsyrupAmoxicillininthedistrict

Denominator: Total number of infants (0-2 months)identifiedwithsepsisbyANMinthedistrict

• Treatment card

• ANM register

Mortality rate in young infants (0-2 months) treatedwithantibiotics

Numerator: Total number of deaths in children withsepsistreatedwithantibioticsinthedistrict

Denominator: Total number of children with sepsistreatedwithantibioticsinthedistrict

Multiply by 1000


• ANM records (treatment card)


4. Child Health4.1 Complementary feeding, IFA supplementation and focus on nutrition

Intervention brief: • Timelycomplementaryfeedingaftersixmonthswithcontinuedbreastfeedinguptotheageoftwoyears.

• RolloutofNationalIron+Initiative(childrencomponent)andfocusonnutrition:

i. Infants aged 6 to 59 months: Iron-Folicacid (IFA)supplements in liquid formulation indosesof1mlcontaining 20 mg elemental iron and 100 mcg folic acid given twice a week for the whole year

ii. Children 6 -10 years of age: IFA in the dosage of 1 tablet containing 45 mg elemental iron and 400 mcg folic acid given once a week for the whole year.




Sub-CentresreportingadequatestockofIFA syrup (with auto dispenserinformulationrecommended by the GoI) (%)

Numerator: Total number of Sub-Centres in the district which reported minimum one month stock of IFA syrup

Denominator: Total number of Sub-Centres in the district

Sub-Centre stock register

Children 6–59 months old received at least eight doses of IFA syrup in the reportingmonth(%)

Numerator: Total number of children 6-59 months in the district who received at least eight doses of IFAsyrupinthereportingmonth

Denominator: Total number of 6-59 months children in the district

ANM records

Quality IndicatorsSixmonthsoldinfantsinitiatedoncomplementary feeding (%)

Numerator: Total number of 6 months old infants initiatedoncomplementaryfeedinginthedistrict

Denominator: Total number of 6 months old infants in the district

Sample survey – 10% ofclients/beneficiariesinterviewed in the district onquarterlybasis

Children found underweight at Anganwadi Centres (AWCs) (%)

Numerator: Total number of children (less than three years) in the district detected as underweight at AWCs

Denominator: Totalnumberofchildrenexaminedatthe Anganwadi Centres in the district

Anganwadi register

Severely Acute Malnourished (SAM) children who received community based management at Anganwadi Centre (%)

Numerator: Total number of SAM children withoutmedicalcomplicationsinthedistrictwhoreceived community based management service at Anganwadi centre

Denominator: Total number of children diagnosed asSAM(withoutmedicalcomplications)inalltheAWCs in the district

Anganwadi register




SAMchildrenadmittedinNRC discharged with more than 15% weight gain (%)

Numerator: Total number of SAM children in the district who were discharged from NRCs with weight gain of more than 15%

Denominator: Total number of SAM children in the districtadmittedintheNRCsandweredischarged

NRC register

Children (6 to 59 months old) consumed 100 doses of IFA syrup in a year (%)

Numerator: Total number of children (6-59 months old) in the district who consumed 100 doses of IFA syrup in a year

Denominator: Total number of children (6-59 months old) in the district

ASHA records/ANM records

4.2 Diarrhoea management at community level using ORS and zinc




Number of episodes of diarrhoea reported

number of episodes of diarrhoea reported in childrenunder-fiveinthedistrict

HMIS

Children with diarrhoea treated with ORS and zinc (%)

Numerator: Totalnumberofchildrenunder-fivetreated for diarrhoea with ORS and zinc

Denominator: Totalnumberofchildrenunder-fivediagnosed with diarrhoea in the district

ASHA/AWW/ANM records

Quality IndicatorUnder-fivechilddeathsdue to diarrhoea (%)

Numerator: Totalnumberofunder-fivechilddeathsdue to diarrhoea reported in the district

Denominator: Totalnumberofunder-fivechilddeaths reported in the district

HMIS


4.3 Management of pneumonia




Children with pneumonia givenantibiotics(%)

Numerator: Totalnumberofunder-fivechildrentreatedforpneumoniawithantibiotics

Denominator: Totalnumberofunder-fivechildrendiagnosed with pneumonia in the district

ANM records/facility records

Frontline workers trained in IMNCI (%)

Numerator: Total number of frontline workers(ANMs, AWWs, ASHAs) trained in IMNCI in the district

Denominator: Total number of frontline workers (ANMs, AWWs, ASHAs) available in the district



ANMs who know about management of pneumonia (%)

Numerator: Total number of ANMs who know about management of pneumonia in the district

Denominator: Total number of ANMs available in the district

Sample survey – 10% of ANMs interviewed in the districtonquarterlybasis

Quality IndicatorsUnder-fivechilddeathsdue to pneumonia (%)

Numerator: Totalnumberofunder-fivechilddeathsdue to pneumonia in the district

Denominator: Totalnumberofunder-fivechilddeaths reported in the district

HMIS monthly report

4.4 Full immunization coverage

Intervention brief: Achildreceivingallvaccinesundertheprogrammewithinthefirstyearoflife.Thesevaccinesare one dose of BCG, three doses of OPV, three doses of DPT, and one dose of measles




Newborn given BCG and zero dose of polio at birth (%)

Numerator: Total number of newborn given BCG and zero dose of polio at birth in the district

Denominator: Total number of live births in the district

• HMIS

• MCTS

Infants who received the firstdoseofmeasles(%)

Numerator: Total number of infants who received thefirstdoseofmeaslesinthedistrict

Denominator: Total number of infants in the district

• HMIS

• MCTS




Quality IndicatorsAEFIreported(%) Numerator: Total number of children who reported

AdverseEventsFollowingImmunization(AEFI)inthedistrict

Denominator: Total number of children immunized in the district

• Immunizationrecords


Dropout rate at the third dose of DPT out of the firstdoseofDPT

Dropoutrateisequaltothedifferencebetweennumber of infants receiving DPT1 and number of infantsreceivingDPT3,multipliedby100,andtheoverall score is divided by number of infants who received DPT1


• MCTS

4.5 Rashtriya Bal Swasthya Karyakram (RBSK): screening of children for 4Ds (birth defects, development delays, deficiencies, and disease) and their management

Intervention brief:Comprehensivechildhealthcareimpliesassuranceofextensivehealthservicesforallchildrenfrombirthto18yearsofage forasetofhealthconditions.Theseconditionsarebirthdefects,developmentdelays,deficienciesanddiseses(4Ds).Universalscreeningwouldleadtoearlydetectionofmedicalconditionsandtimelyintervention,ultimatelyleadingtoareductioninmortality,morbidityandlifelongdisability.




Blocks saturated with requisiteMBHT(%)

Numerator: Total number of blocks saturated with requisiteMobileBlockHealthTeam(MBHT)

Denominator: Number of blocks in the district

Mobile health team register/Actionplan

Service providers under MBHT trained on RBSK (%)

Numerator: Total number of service providers under MBHT trained on RBSK in the district

Denominator: Total number of service providers in MBHT in the district

Training records

Children screened for 4Ds out of total children in the age group of 0-18 years (%)

Numerator: Total number of children screened for 4Ds in the age group of 0-18 years in the district

Denominator: Total number of children in the age group of 0-18 years in the district

Screening and referral card/Monthlyreportingformat

Children accessing services at secondary/tertiary/DistrictEarlyInterventionCentres(DEIC)(%)

Numerator: Total Number of children accessing servicesatsecondary/tertiary/DEICinthedistrict

Denominator: Total number of children detected with 4Ds in the district

DEICregister




Quality IndicatorsChildren detected with 4Ds out of the total children screened (%)

numerator : Total number of children 0-18 years old detected with 4Ds in the district

Denominator: Total number of children screened in the district

DEICregister

Districts reported less thanexpectedincidencesof 4Ds (%)

Numerator: Total number of districts reported less thanexpectedincidenceof4Dsinthedistrict

Denominator: Total number of districts in the state that reported incidences of 4Ds in the district

Monthly reports

Screened children supportedthroughDEIC(%)

Numerator: Total number of children who received supportthroughDEICinthedistrict

Denominator: Total number of screened children recommendedforsupportfromDEICinthedistrict

DEICregister

Children referred with 4Ds out of the total screened (%)

Numerator: Total number of children referred with 4Ds in the district

Denominator: Total number of children screened in the district

DEICregister


5. Adolescent Health5.1 Address teenage pregnancy and increase contraceptive prevalence in adolescents

Intervention brief:

Community level:• Communicationwithstakeholderstosupportandinfluenceculturalnormstoreduceearlymarriage

• Counsellingofnewlymarriedcouplesandinfluencersontheriskofearlyconceptionandtheimportanceofspacing

• Availabilityofnon-clinicalcontraceptivesthroughsocialmarketing

Facility based:• Counselling

• Provisionofclinicalandnon-clinicalcontraceptivesandpregnancytestingkits




Marriage prevalence rate among adolescents

Numerator: Number of adolescent girls in the district who got married in the last one year

Denominator: Total number of marriages in the district during the last one year

Annual Survey

Adolescent pregnancies among total pregnancies (%)

Numerator: Total number of adolescent pregnant girls in the district

Denominator: Total number of pregnant women in the district

MCTS

High risk pregnancy detected among adolescents (%)

Numerator: Total number of adolescent girls detected with high risk pregnancy in the district

Denominator: Total number of adolescent pregnant girls in the district

MCTS

Coupleprotectionrate among married adolescents (%)

Numerator: Total number of married adolescent couplesusinganycontraceptivemethod

Denominator: Total married adolescent couples in the block/ district

• State Quarterly ReportingFormatforRKSK


Quality IndicatorPregnant adolescents who received four ANC visits (%)

Numerator: Total number of pregnant adolescent girls in the district who received four ANC visits

Denominator: Total number of pregnant adolescents girls registered in the district

MCTS


5.2 Introduce community based services through peer educators

Intervention brief: This interventionenvisagesbeyond-health-facility-based serviceprovision.Peereducators(bothboysandgirls)areselected,trainedandsupportedbyteachersintheinstitutionalsettingandbyASHAsandANMsinthecommunitysetting.Theywillserveasthefirstpointofcontactforreachingouttoadolescentsin their spaces.




Peer educators selected against planned (%)

Numerator: Total number of peer educators selected in the district

Denominator: Total number of peer educators planned in the district

• Peereducationregistrationform

• State Quarterly Peer EducationProgressReportingForm

• District/PHC Monthly PeerEducationProgressReportingForm

Peer educators trained against planned (%)

Numerator: Total number of peer educators received training in the district

Denominator: Total number of peer educators planned to be trained in the district

• State Quarterly Peer EducationProgressReportingForm

• District/PHC Monthly PeerEducationprogressReportingForm

Quality IndicatorSessions held by peer educators against sessions planned (%)

Numerator: Total number of sessions held by peer educators in the district

Denominator: Total number of sessions by peer educators planned in the district

• QuarterlyReportingFormat for RKSK

• State Quarterly Peer EducationprogressReportingForm


• PeerEducatorMonthlyReportingForm

Adolescents reached through peer educators per month (%)

Numerator: Total number of adolescents reached through peer educators per month in the district

Denominator: Total number of adolescents in the district



• PeerEducatorMonthlyReportingForm

• PeerEducationSessionFormat


5.3 Strengthen Adolescent Friendly Health Clinics (AFHC)

Intervention brief: TheAFHCsarededicatedspacesforadolescentsintheexistinghealthsystem.Theseclinicswillensureavailabilityofcounselling,commodities,medical,para-medical,andspecialisedservicestoadolescents,withemphasisonprivacyandconfidentiality.




FacilitieshavingfullyoperationalAFHCsaspernorms (%)

Numerator: TotalofL2andL3facilitiesinthedistricthavingfullyoperationalAFHCs(asperRKSK guidelines)

Denominator: Total number of L2 and L3 delivery points in the district


• Checklist for AFHC assessment


MO/ANMs/LHVs providing services at AFHCs trained on Adolescent Friendly Health Services (AFHS) against planned (%)

To be calculated separately for each category of service provider

Numerator: Total number of MO/ANMs/LHVs in the district providing services at AFHCs trained on Adolescent Friendly Health Services (AFHS)

Denominator: Total number of MO/ANMs/LHVs in the district providing services at AFHCs planned to be trained


• Training records at block/district level


Counsellors selected against planned (%)

Numerator: Total number of counsellors selected in the district

Denominator: Total number of counsellors planned to be recruited in the district




Counsellors trained against planned (%)

Numerator: Total number of counsellors received training in the district

Denominator: Total number of counsellors in the district planned to be trained




Quality IndicatorsAdolescents accessing AFHCs forSRH,nutrition,mentalhealth, substance misuse, injuries, violence, and non-communicable disease related problems (%)

Numerator: Total number of adolescents accessing AFHCs in the district

Denominator: Total number of adolescents in the district


• Facility level AFHC registers

Adolescents counselled at AFHCs (%)

Numerator: Total number of adolescents counselled at AFHCs in the district

Denominator: Total number of adolescents whoattendedAFHCsinthedistrict


• Facility level counselling register


5.4 Roll out of National Iron + Initiative including weekly IFA supplementation

Intervention brief:Theinterventionincludesthefollowing:administrationofsupervisedWeeklyIron-FolicAcidSupplementation(WIFS);screeningoftargetgroupsformoderate/severeanaemiaandreferringthesecasestoan appropriate health facility; biannual de-worming, sixmonths apart, for control of helminthes infestation;information and counselling for improving dietary intake and for taking actions to prevent intestinal worminfestation.




Caregivers (teachers, AWWs) who have been trained on implementationofWIFS(%)

Numerator: Total number of caregivers (teachers, AWWs) in the district who have been trainedonimplementationoftheWIFS

Denominator: Total number of caregivers available in the district

• QuarterlyReportingFormatfor RKSK


Schools and AWCs provided with IFA and Albendazole tablets (%)

Numerator: Total number of schools/AWCs in the district provided with IFA and Albendazole tablets

Denominator: Number of schools/AWCs available in the district

• School health program records

• Anganwadi register

Schools/AWCs reported adequatestockofIFAandAlbendazole tablets (%)

Numerator: Total number of schools/AWCs reported minimum one month stock of IFA and Albendazole tablets

Denominator: Total number of schools/AWCs in the district provided with IFA and Albendazole tablets

• School health program records

• Anganwadi register

Quality IndicatorsAdolescents (in-school and out- of-school girls) givenfourorfiveIFAtabletsinthereportingmonth (%)

Numerator: Total number of adolescent girls (in-school and out- of-school girls) given four or fiveIFAtabletsinthereportingmonth

Denominator: Total number of adolescent girls in the district


• AWW or ASHA records

• School health program register

Adolescents (in-school and out-of- school girls) given biannual Albendazole tablets (%)

Numerator: Total number of adolescent girls (in-school and out-of-school girls) given biannual Albendazole tablets



• AWW or ASHA records

• School health program register


5.5 Promote menstrual hygiene

Intervention brief: This programme aims at ensuring that girls in the age group of 10-19 years in the rural areas haveadequateknowledgeand informationaboutmenstrualhygieneandhaveaccesstohighqualitysanitarynapkinsalongwithsafedisposalmechanisms.TheschemeenvisagesprovidingapackofsixsanitarynapkinsundertheNRHM’sbrand‘Freedays’.Thesenapkinsaresoldtotheadolescentgirlsat`6forapackofsixnapkinsinthevillagebyASHA.Onsaleofeachpack,theASHAgetsanincentiveof` 1 per pack, besides a free pack of sanitary napkins per month.




ASHAs who have sanitary napkins with them (%)

Numerator: Total number of ASHAs in the district who have sanitary napkins with them

Denominator: Total number of ASHAs available in the district

ASHA records/stock register

ASHAs who faced stock-out of sanitary napkins in the lastquarter(%)

Numerator: Total number of ASHAs in the district who reported sanitary napkin stock-out inthereportingquarter

Denominator: Total number of ASHA available (inposition)inthedistrict

ASHA stock records

Quality IndicatorsAdolescent girls who received counselling on menstrual hygiene (%)

Numerator: Total number of adolescent girls in the district who received counselling on menstrual hygiene


ASHA records

Adolescent girls who were provided with sanitary packs‘Freedays’(%)

Numerator: Total number of adolescent girls who were provided with sanitary packs ‘Freedays’


• Adolescent Health Day(AHD)datacollectionformat at the block level

• StateQuarterlyReportingFormat for RKSK

• ASHA records

lR;eso t;rs

Maternal Health Division

Ministry of Health & Family Welfare

Government of India

With Support from

other RCH Divisions 2014

High Impact RMNCH+A InterventionsKey Performance and Quality Indicators for

rmnch+a rbsk indicator

Documents

performance of rmnch

high impact rmnch

high impact interventions

adolescent health rmnch

progress of interventions

interventionskey performance

terms of quality

health facilities