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Use of DHS Data to Influence FP/MNCH Programs & Policies: India National Family Health
SurveySheena Chhabra
Chief, Health Systems Division, USAID/India
Reconvening BangkokMarch 9, 2010
India’s National Family Health Survey (NFHS):A key data-base for promoting data-based decision-making in health • National Five Year Plans• National Population Policy• National Nutrition Policy• State Health & Population Policies• Reproductive and Child Health (RCH)-1 & -2 designs• Integrated Child Development Scheme design• National Urban Health Mission design• Development Partners PHN Strategies & Programs- USAID,
UNICEF, DFID, World Bank, UNFPA, EC, etc.• Designing & tracking program progress• Monitoring MDGs
NFHS data were instrumental in revitalizing routine immunization
Percentage of children age 12-23 months
30
6254
42
52
14
72
63
5155
5
78 78
5955
0
20
40
60
80
100
None BCG Polio3 Measles DPT3
NFHS-1 NFHS-2 NFHS-3
Key Findings• Immunization coverage
stagnant for DPT• Health system is reaching
vast majority of children at least once
• Substantial decrease in full vaccination coverage among children in better-performing states
Response• Strategies for Routine
Immunization• Community mobilization
through Village Health & Nutrition Days
• Improved program monitoring
DPT 1: 76%DPT 2: 67%DPT 3: 55%
NFHS reiterated the need to focus on proven & simple child health interventionsKey findings• Basic package of child
health services is not being delivered– Stagnant ORS use– 69% of the children with ARI
symptoms sought treatment
Response• Newborn & Child Health
Policy• Strategies for home-based
as well as institutional care
33 3325 24
0
20
40
60
80
100
Urban Rural
NFHS-2 NFHS-3
Percentage of children age with diarrhoea in the past 2 weeks
RCH-2
51
4543
40
2023
0
10
20
30
40
50
60
Stunted Underweight Wasted
NFHS-2 NFHS-3
Percent
NFHS highlighted the need for focused attention on malnutrition
Key Findings• No significant
improvements in nutrition status among children under age 3.
• Anemia among children age 6-35 months has increased over the past 7 years.
Response• Prime Minister’s letter to
Chief Minister urging action to address malnutrition especially among children under six.
• Establishment of the Coalition for Sustainable Nutrition Security in India under chairmanship of Prof. M.S Swaminathan.
Key Findings• Only a third of the
eligible children receive any service from an Anganwadi Centre (AWC) under the ICDS
Response• Strategic shift in the
design of Integrated Child Development Services Scheme (ICDS)-3
33
2623
2018
16
0
10
20
30
40
50
60
70
80
Any se
rvice
Supp
lem
entary
food
Pre-sc
hool
Imm
unizations
Gro
wth m
onito
ring
Health
chec
k-up
s
Percent of age-eligible children in areas with an AWC
NFHS-3 informed programs for improving nutritional status
NFHS data influenced design of JSYJanani Suraksha Yojana
• NFHS data helped in improving program focus on coverage and quality of antenatal care & institutional deliveries.
• National Maternity Benefit Scheme modified (JSY) from nutrition-improving scheme to one of addressing all aspects of maternal health.
• Janani Suraksha Yojana designed for promoting institutional deliveries.
Report on the Working Group on Health of Women & Children for the 11th 5 year plan (2007-2012)
NFHS data helped improve focus on birth spacingKey Findings• Contraceptive use increased
steadily with vast majority continuing to rely on female sterilization.
• Some gains in modern spacing method use but use of IUDs remained static.
Response• Shift of the family welfare
program to target-free approach.
• Strategy for repositioning IUDs.
• Enhanced commitment to expand basket of contraceptive methods.
• Standard Days method introduced in National program.
41
37
27
42
12
48
43
34
2 2 3
56
49
37
12
5
23
Any method Any modernmethod
Femalesterilization
Malesterilization
IUD Pill Condom
NFHS-1 NFHS-2 NFHS-3
Percent of currently married women age 15-49
NFHS data helped to evolve strategies for healthy timing and spacing of births
72
56
50
77
80
62
47
64
37
30
50
86
0 10 20 30 40 50 60 70 80 90 100
40-4930-3920-29
< 20MOTHER'S AGE AT BIRTH
7 or more 4-6 2-3
1BIRTH ORDER
4 years or more3 years2 years
< 2 yearsPREVIOUS BIRTH INTERVAL
Deaths in the first year of life per 1000 live births
NFHS-3 helped devise appropriate strategies for vulnerable population groupsKey Findings• Health conditions of urban
poor are similar to or worse than rural population and far worse than urban averages.
• 27% of teenage women and 21% of women age 20-24 have unmet need for family planning.
• Child mortality rate is 61% higher for girls than for boys.
• Two in five currently married women age 15-49 have ever experienced spousal violence in their current marriage.
Response• Design of the draft National
Urban Health Mission highlighting need for programming resources for urban poor.
• Adolescent Reproductive and Sexual Health Strategy (ARSH).
• Improved commitment for gender programming including gender-based budgeting.
• Inputs for the Domestic Violence Act 2005.
Top Guns High Achievers Movers and Shakers
Promising
GoaKeralaSikkim
UttaranchalHimachal PradeshKarnatakaMaharashtraTamil NaduManipur
ChhattisgarhMadhya PradeshOrissaAndhra PradeshGujaratHaryanaJammu & KashmirPunjabWest BengalMeghalayaMizoram, Tripura
BiharJharkhandRajasthanUttar PradeshArunachal PradeshAssamNagaland
NFHS-3 Key Data Source for RCH-2 Performance Review of States
Source: RCH-2 – Program Management Support Group (PMSG), Donor Coordination Division
Segmentation of States based on RCH-2 Performance
Key Learnings
• Government stewardship essential from design stage
• Involve various government departments on Steering & Technical Committees
• Widen ownership by engaging multiple stakeholders early on
• Provide adequate funding• Build various data quality checks
…Key Learnings
• Provide world-class technical assistance• Engage premier local institutions• Anticipate barriers for acceptance of data and plan
appropriately• Disseminate data widely at all levels
– 2 National & 29 State NFHS-3 fact-sheets– National and 29 state reports – 27 dissemination seminars at national and state level– 4 subject reports & 5 subject factsheets– Estimated 2000 media reports including over 500 wholly or
largely based on NFHS-3 results– 124 peer-reviewed journals using NFHS data
• Make data-sets available in public domain (wwwnfhsindia.org)