Ministry of Health & Family Welfare Government of India Mother and Child Tracking System (MCTS) An innovation towards strengthening of health care services Welcome note <<Good evening every body >> September 2012

Contents Status of key health indicators and services Introduction to MCTS MCTS Operational Flow How MCTS can benefits Beneficiaries ANM / ASHA CMO’s / BMO’s / DIO’s State(s) Current Status Expectations of MoHFW Key Concerns for States Way Forward The agenda for the presentation is we’ll have a look at the health indicator (IMR / MMR etc.) Then we’ll identify the need and objective of the MCTS We’ll have a look at the illustrative process flow of the MCTS Then I’ll present some of the befits of the MCTS for different stakeholders. And subsequently we’ll see the Current Status of the services delivered to Pregnant women and Children At the end I’ll Present our expectations and way forward

Health Performance Indicators Health Indicator India Good Performing State Low Performing State MMR (SRS: 2007-09) 212 81 (Kerala) 390 (Assam) IMR (SRS: 2010) 47 13 62 (Madhya Pradesh) TFR 2.5 1.7 (Tamil Nadu) 3.7 (Bihar) Full Immunization (DLHS-3) 53.5 % 89.8 % (Goa) 13.3 % (Arunachal Pradesh) Full ANC (DLHS- 3) 18.8 % 90.9 % 3.3 % (Uttar Pradesh) ANAEMIA (NFHS- 3) 55.3 % 32.8 % 69.5 % (Jharkhand)

Objective(s) of MCTS To ensure that All pregnant women should receive their: Full Ante Natal Care (ANCs) services at due time Full Post Natal Care (PNCs) services at due time Encourage institutional delivery particularly of high risk mothers All children should receive their full immunisation at due time This will help improve IMR, MMR, TFR and morbidity in women and children. The key objective of the MCTS is To ensure that All pregnant women should receive their: Full Ante Natal Care (ANCs) services at due time Full Post Natal Care (PNCs) services at due time Encourage institutional delivery particularly of high risk mothers All children should receive their full immunisation at due time

MCTS- A Path Breaking Initiative Mother & Child Tracking System(MCTS) is a centralized web based application for improving delivery of health care services to pregnant women and children up to five years of age through name based tracking of each beneficiary and monitoring service delivery It has been declared as a Mission Mode Project under the National e-Governance Plan (NeGP) in July 2011 MCTS was started on Dec-2009 and since then has come long way. MCTS is a centralized web based application developed in co-ordination with NIC. MCTS application is introduced for improving delivery of health care services to pregnant women and children up to five years of age through name based tracking of each beneficiary and monitoring service delivery. In July 2011 MCTS has been declared as the Mission Mode Project under NeGP (National e-Governance Plan)

ASHA - Identification of beneficiary (pregnant women and children) ASHA - Maintain the information into a diary and inform about the same to ANM as and when she visits the village and through phone and assist the ANM in service delivery to identified beneficiary Alternate vaccine carrier - Supply of immunization vaccines in villages, Collection of work plan from PHC/CHC/Block and distribution to ANM at the vaccination site and Collection of service delivery data from ANM and submit it for data entry at the health facility ANM - Delivery of maternal and child health services in the village ANM - Maintain the register of beneficiaries ( beneficiary and service delivery information), and also updates workplan ANM - Monthly visit to PHC for review meeting by M/O in charge, for further action and guidance Data Entry Operator – upload the data on MCTS portal, generate the work plan Work plan received by ANM/ASHA through SMS Sending SMS to beneficiaries about the due delivery Review of the MCTS progress and various program related to RCH Services through reports generated at different levels (facility level, block level, district level, state level and National level) Verification of beneficiary records through state level/national level help desk Corrective measures taken by health managers at all levels in their respective areas

MCTS- Protocol State District Block Primary Health Centre Sub Centre Mission Director State Programme Officers State Data Officer State District Magistrate District Health Officer CMHO / CMO DPM DDO District BPM Block BMO Medical Superintendent (CHC) Data Entry Operator Primary Health Centre M/O In-charge Alternate Vaccine Courier Data Entry Operator ANM Sub Centre Through this slide we will explain you about the hierarchy of the administrators, health policy makers, health administrators, health service providers at all the levels of the state and will also explains their roles/responsibilities/protocols for making the MCTS programme a great success, successful roll out of MCTS and effective usage of MCTS data for micro planning of health related programmes/schemes. Our expectation from Health managers/Health Service Providers at different levels and for different process are as follows: Data collection, Data entry and data updation in the system – there should be as minimum as possible time gap between the actual service delivery and updation of data in the MCTS. It should be less than a week. Work Plan – work plan should be regularly generated and timely distributed to field level health service providers so that its proper utilization can be there Maintenance of quality of data - IT managers at various level as well as health administrators should regularly review the data in MCTS and help in improving its quality Regular review meeting – there should be regular review meeting on MCTS implementation at all levels (state level or district level or block level) Use of MCTS data as the only source of information for review of RCH services Senior level health managers/Administrators ( State level) should use the MCTS data to take the policy decision for the different schemes and health related programmes, identify the bottlenecks and Middle level health managers/ Administrators should use the MCTS data for micro level planning like distribution of vaccines/drugs, logistics, Human resource etc. Medical officers at all the levels should use the MCTS data for reviewing the progress of their catchment area ASHA Village

How MCTS can benefit - Beneficiaries Information about desired services, Government Schemes & Benefits Advance information about the due services Facilitate in timely delivery of full complement of services Facilitate better interaction with Health Service Provider Facilitate availing the services from any Health Centre based on need Free consultation from Central Helpdesk (Toll Free No) MCTS can benefit Beneficiaries by providing Information about required services, Advance information about the due services Different Government Schemes & Benefits Facility to interaction with Health Service Provider Facility in timely delivery of full complement of services Flexibility to availing the services from any Health Centre based on need Free consultation from Central Helpdesk (Toll Free No)

How MCTS can benefit – ANM / ASHA Auto generation of work-plan Better guidance from senior supervisors Contact details of the Beneficiaries SMS based workplan Micro planning for Filed Visit Readily available Services due list MCTS benefits ANM/ASHA by providing Auto generated of work-plan Readily available Services due list Micro planning for field Visit Contact details of the Beneficiaries SMS based work-plan Better guidance from senior supervisors

How MCTS can benefit – CMO’s / BMO’s/DIOs Readily available analytical reports Better planning for Vaccination Supply & Management Group /Individual SMS’s to health workers and beneficiaries Direct communication with ANMs / ASHAs and beneficiaries Facility reporting status Actionable reports of registration and service updating status MCTS is a very good tool for the DIO’s/ CMO’s and BMO’s and provides Actionable reports of registration and service updating status Readily available analytical reports Facility reporting status Direct communication with ANMs / ASHAs and beneficiaries Group /Individual SMS’s to health workers and beneficiaries Better planning for Vaccination Supply & Management

How MCTS can benefit – States At a Glance real time State progress report of the entire state Facilitate in identification of poor performing Districts, health facilities, Sub- Health Centres Graphical Dashboard for pictorial representation of the reports Special reports of high risk cases Dedicated helpdesk for feedback and suggestion Focused deployment of health workers & any supplementary immunization activity planning Better data analysis for preparation of District /Block health action plans Improved supply chain management of vaccines and Drugs Effective IEC and communication with field workers and beneficiaries MCTS has various reports that states can utilize to review the implementation progress and take necessary corrective measures MCTS provides At a Glance real time State progress report of the entire state Facilitate in identification of poor performing Districts, health facilities, Sub- Health Centres Graphical Dashboard for pictorial representation of the reports Special reports of high risk cases Dedicated helpdesk for feedback and suggestion Focused deployment of health workers & any supplementary immunization activity planning Better data analysis for preparation of District /Block health action plans Improved supply chain management of vaccines and Drugs Effective IEC and communication with field workers and beneficiaries

MCTS - Current Status (India) An Online Software for MCTS has been developed by NIC which is available at the URL http://nrhm-mcts.nic.in/ Total records entered in the MCT System: 2.80 Crore mother records already entered since inception. In 2012-13 total 65.2 lakh (49.6 % on pro rata basis) mother has already been registered in MCT System. 2.06 Crore Child records already entered since inception. In 2012-13 total 42.3 lakh (35.4 % on pro rata basis) children have already been registered in MCT System. Facilities reporting data related to Mother & Child: Facility Pregnant Women Children District 99.4% Health Blocks 95.6% 94.8% Health Facility 85.5% 82.8% Health Sub-facility 92.2% 87.8% Villages 51.8% 45.1% As I mentioned earlier as well MCTS application is developed by NIC, the MCTS application can be accessed through URL http://nrhm-mcts.nic.in/ Current Status: Registration : Total records entered in the MCT System: Total 2.80 Crore mother records have already entered since inception. In 2012-13 total 65.2 lakh (49.6 % on pro rata basis) mother have already been registered in MCT System. Total 2.06 Crore Child records have already entered since inception. In 2012-13 total 42.3 lakh (35.4 % on pro rata basis) children have already been registered in MCT System. Facilities reporting data Data being reported from Health Facilities and Villages are not satisfactory

Registration Status of Pregnant Women (%) Year 2012-13(Pro-Rata) The graph presents the overall registration status of pregnant women on pro-rata basis for the year 2012-13. It is clear from the graph that average registration rate of the country is less than 50%. However some state like Chandigarh, Punjab, Tamil Nadu, Puducherry, Rajasthan etc. are high performing states and other states such as Bihar, Andaman and most of the States from North East are low performing States.

Registration Status of Children (%) Year 2012-13(Pro-Rata) The graph presents the overall registration status of children on pro-rata basis for the year 2012-13. It is clear from the graph that average registration rate of the country is less than 36%. However some state like Rajasthan, Tripura, Tamil Nadu, Odisha etc. are high performing states and other states such as Uttar Pradesh, Karnataka, Andaman and most of the States from North East are low performing States.

Service Delivered (%) – Pregnant Women ANC Services & Deliveries Reported* The graph represents the tracking of Ante-natal services provided to the pregnant women having LMP in the month of October 2011. Ideally all the ANC services should be delivered to these pregnant women and should have delivered baby by August 2012. But the graph shows a sharp decline in ANC services provided to the pregnant women. Goa, Mizoram etc. are the high performing states in ANC service delivery whereas low performing states are Chhattisgarh, Karnataka etc. * Pregnant women with LMP in October 2011

Service Delivered (%) – Pregnant Women IFA Tablets* The graph represents distribution of Iron and Folic Acid (IFA) tablets to the pregnant women having LMP in the month of October 2011. Average distribution of IFA tablet is approximately 43% for the country. IFA distribution in states such as Rajasthan, Mizoram, Tripura etc. are the good whereas States like Jharkhand, Bihar, Manipur etc. are not satisfactory. * Pregnant women with LMP in October 2011

Service Delivered - Children OPV Services* The graph represents the status of OPV service delivery to the children born in the month of August 2011. The graph shows high variation in service delivery of OPV services among the States. For example Tamil Nadu, Puducherry etc. are having better OPV service performance as compared with Bihar, Chhattisgarh etc. Ideally all the OPV services should be delivered to these children but graph shows a sharp decline in the services delivered to the children (from OPV0 to OPV3). * Children with DoB in August 2011

Service Delivered - Children DPT Services* The graph represents the status of DPT service delivery to the children born in the month of August 2011. Ideally all the DPT services should be delivered to these children but graph shows a sharp decline in the services delivered to the children (from DPT1 to DPT3). Further there is a high variation in delivery of DPT service among the States. For example Tamil Nadu, Tripura etc. are having better DPT service performance as compared with Bihar, Karnataka etc. * Children with DoB in August 2011

Service Delivered - Children HEP Services* The graph represents the status of HEP service delivery to the children born in the month of August 2011. Ideally all the HEP services should be delivered to these children however graph shows a sharp decline in the services delivered to the children (from HEP0 to HEP3). Further there is a high variation in delivery of HEP service among the States for example Tamil Nadu, Lakshadweep etc. are having better HEP service performance as compared with Chhattisgarh, Arunachal Pradesh etc. * Children with DoB in August 2011

Service Delivered - Children BCG & Measles Services* The graph represents the status of BCG and Measles service delivery to the children born in the month of August 2011. Ideally all the BCG and Measles services should be delivered to these children however graph shows a sharp decline in the service delivery. Further there is a high variation in delivery of BCG and Measles services among the States. For example Tamil Nadu, Puducherry etc. are having better BCG and Measles service performance as compared with Bihar, Himachal Pradesh, most of the North East States etc. * Children with DoB in August 2011

Correctness of Data Calls made to the Beneficiaries 70% Records of the beneficiaries were verified through call center. Calls were made to the beneficiary for verification. More than 85% records of the beneficiary were found correct in Delhi, Himachal Pradesh, Goa etc. however only 5% records were found correct in Assam, Chhattisgarh, Bihar etc.

Expectations of MoHFW Use of MCTS data for review and action-for follow up on various schemes and programs related to RCH services. Use of MCTS data for policy formulation, micro planning at different levels and redressal of bottlenecks pertaining to various programs. Advice DMHO and BMHO for continuous monitoring, field visit and taking of corrective action based on MCTS information Improve civil registration 100% Registration of Pregnant Women & Children 100% timely Update of Services Delivered to Pregnant Women & Children on MCTS Portal Use of MCTS application by all levels Health workers. Service Delivery to Pregnant Women and Children ensured Work-plan generation and utilisation Near Real time update of Data on MCTS 100% Registration of Pregnant Women & Children 100% Timely update of Services Delivered to Pregnant Women & Children on MCTS Portal Use of MCTS application by all levels of Health workers. Service Delivery to Pregnant Women and Children ensured Work-plan Generation and utilization Near Real time update of Data on MCTS Use of MCTS data for reviewing and monitoring of various schemes and programmes launched by MoHFW related to RCH services. Use of MCTS data for policy formulation, micro planning at different levels and redressal of bottlenecks pertaining to various programmes. Advice DMHO and BMHO for continuous monitoring and field visit and taking of corrective action based on MCTS information. Improve civil registration

Expectations of MoHFW cntd… Ensure complete and accurate mapping of all the health facilities & health service providers. Ensure records of the proceedings of the meetings of SPeMT and DPeMT should be put on the website. Corrective action from the State level, CMHO and BMO level should be regularly carried out based on the analytical reports generated from MCTS portal. Establish a call centre to verify the records of the beneficiaries and health providers and also for sending the information to the beneficiaries about their due services. A village wise integrated RCH Register has been designed by MoHFW and shared with States/UTs. Ensure its implementation from 2012 Ensure complete and accurate Mapping of all the health facilities & health service provider. Ensure timely and universal registration of the pregnant women and children and services delivered to the beneficiaries on MCTS Portal Ensure records of the proceedings of the meetings of SPeMT and DPeMT should be put on the website. Establish a call centre to verify the records of the beneficiaries and health providers and also for sending the information to the beneficiaries about their due services. A village wise integrated RCH Register has been designed by MoHFW and shared with States/UTs. Ensure its implementation from 2012 Corrective action from the State level, CMHO and BMO level should be regularly carried out based on the analytical reports generated from MCTS portal.

Way Forward Use of mobile (GPRS, SMS)/tablet technology for updating of service delivery data on real time basis. Use of Interactive Voice Response System (IVRS) to: Verify details of beneficiaries, ANMs, ASHAs Update data Send alerts on services due Send Messages MCTS as sole source of reporting and reviewing MCH services Effective operationalization of MCTS protocol Problem Redressing System to review the redressal of MCTS related issues. Trigger Mechanism for delivery of system generated actionable mails/SMS to all the Health Administrators and Managers on MCTS progress/feedback. Operationalization of National/ State Call Centre /helpdesk We are continuously working to further strengthen the MCTS application by introducing new technologies and new channels for the service delivery like: Use of mobile technology for updating of service delivery data on real time basis. Use of Interactive Voice Response System (IVRS) to: Verify details of beneficiaries, ANMs, ASHAs Update data Send alerts on services due Send Messages Ticketing System to review the redressing status of MCTS related issues as well their categorisation based on priority. Trigger Mechanism for delivery of system generated mails to all the Health Administrators and Managers on MCTS progress/feedback. Operationalisation of National Call Centre

Way Forward contd… Capacity building at various levels Effective integration with AADHAR- verification for benefits Integration and convergence of various IT initiatives implemented/ adopted by different department of the Ministry and States under a single window to review the performance of various programmes / schemes launched by MoHFW and improve data quality. MCTS is able to provide good platform and unique opportunity to enable identification of the beneficiary for all schemes of various departments across Ministries in one place and placement of this information on the web for access by the identified functionaries of concerned department. We at MoHFW continuously interacting with states to access their needs and try to address them : Capacity building at various levels Regular Video Conferencing with States/ District Collectors Integration and convergence of various IT initiatives implemented/ adopted by different department of the Ministry and States under a single window to review the performance of various programmes / schemes launched by MoHFW and improve data quality. MCTS is able to provide good platform and unique opportunity to enable identification of the beneficiary for all schemes of various departments across Ministries in one place and placement of this information on the web for access by the identified functionaries of concerned department.

Thank you http://nrhm-mcts.nic.in/

How MCTS can benefit – Centre Provide a mechanism at all levels to directly monitor the delivery of Mother and Child Health (MCH) benefits to the beneficiaries Provide a single source of information related to pregnancy and child immunization health services and possibility of health- related information on mother and childcare Facilitate closer monitoring of ANC and PNC check-ups of pregnant women and reduce avoidable complication Ensure tracking of full immunisation course for all children Better assessment of JSY, JSSK and other benefits Analytical reports for reviewing the progress of MCTS implementation on real time / daily basis Facilitate in identifying of poor performing States, Districts and Facilities

BACK

How MCTS can benefit – Centre Provide a mechanism at all levels to directly monitor the delivery of Mother and Child Health (MCH) benefits to the beneficiaries Provide a single source of information related to pregnancy and child immunization health services and possibility of health-related information on mother and childcare Facilitate closer monitoring of ANC and PNC check-ups of pregnant women and reduce avoidable complication Ensure tracking of full immunisation course for all children Better assessment of JSY, JSSK and other benefits Analytical reports for reviewing the progress of MCTS implementation on real time / daily basis Facilitate in identifying of poor performing States, Districts and Facilities http://nrhm-mcts.nic.in/

Registration Status of Pregnant Women (%) Year 2012-13(Pro-Rata) BACK

Registration Status of Children (%) Year 2012-13(Pro-Rata) BACK

Service Delivered (%) – Pregnant Women ANC1 and ANC2* * Pregnant women with LMP in October 2011

Service Delivered (%) – Pregnant Women ANC3 and ANC4* BACK * Pregnant women with LMP in October 2011

Deliveries Reported (%)* * Pregnant women with LMP in Oct. 2011 BACK

Service Delivered - Children BCG & Measles* * Children with DoB in August 2011 BACK

MCTS- Protocol – DM/MD Monthly review meeting (SPeMT/ DPeMT) Implementation & review of scheme(s) Provide guidance and support Ensure availability of (SPeMT) minutes on MCTS portal. Mission Director State Programme Officers State Data Officer State District Magistrate District Health Officer CMHO / CMO DPM District BPM Block BMO Medical Superintendent (CHC) Data Entry Operator Primary Health Centre M/O In-charge Alternate Vaccine Courier Data Entry Operator ANM Sub Centre ASHA Village

MCTS- Protocol – BPM/DHO/SPO Mission Director State Programme Officers State Data Officer State Regular review meetings Monitoring of Various programs Review of Implementation of MCTS scheme regularly Provide necessary logistics Regular monitoring of Registration status / Facility Reporting and Updation of Service delivery Assessment of Human Resource District Magistrate District Health Officer CMHO / CMO DPM District Block BMO BPM Medical Superintendent (CHC) Data Entry Operator Primary Health Centre M/O In-charge Alternate Vaccine Courier Data Entry Operator ANM Sub Centre ASHA Village

MCTS- Protocol - SDO/DPM Technical Advisor Assessment of MCTS requirements Co-ordination for MCTS implementation Ensure data quality Generation & Circulation of Status reports Mission Director State Programme Officers State Data Officer State District Magistrate District Health Officer CMHO / CMO District DPM DDO Block BMO BPM Medical Superintendent (CHC) Data Entry Operator Primary Health Centre M/O In-charge Alternate Vaccine Courier Data Entry Operator ANM Sub Centre ASHA Village

MCTS- Protocol – M/O In-charge Review Service Delivery Periodic review meetings Supervisory field visits Logistics and supply of vaccines / Drugs Mission Director State Programme Officers State Data Officer State District Magistrate District Health Officer CMHO / CMO DPM District Block BMO BPM Medical Superintendent (CHC) Data Entry Operator Primary Health Centre M/O In-charge Alternate Vaccine Courier Data Entry Operator ANM Sub Centre ASHA Village

MCTS- Protocol - DEO State Data entry Workplan generation District Mission Director State Programme Officers State Data Officer State Data entry Workplan generation District Magistrate District Health Officer CMHO / CMO DPM District Block BMO BPM Medical Superintendent (CHC) Data Entry Operator Primary Health Centre M/O In-charge Alternate Vaccine Courier Data Entry Operator ANM Sub Centre ASHA Village

MCTS- Protocol - AVC State Delivery of Vaccine Mission Director State Programme Officers State Data Officer State Delivery of Vaccine Distribution of Workplan to ANM Collection of Information from ANM and deliver to Data Entry operator District Magistrate District Health Officer CMHO / CMO DPM District Block BMO BPM Medical Superintendent (CHC) Data Entry Operator Primary Health Centre M/O In-charge Alternate Vaccine Courier Data Entry Operator ANM Sub Centre ASHA Village

MCTS- Protocol - ANM State Service Delivery Maintenance of Registers Mission Director State Programme Officers State Data Officer State Service Delivery Maintenance of Registers Attend monthly meeting at PHC & collect Workplan & Data updation District Magistrate District Health Officer CMHO / CMO DPM District Block BMO BPM Medical Superintendent (CHC) Data Entry Operator Primary Health Centre M/O In-charge Alternate Vaccine Courier Data Entry Operator ANM Sub Centre ASHA Village

MCTS- Protocol - ASHA State Identification of beneficiaries Mission Director State Programme Officers State Data Officer State Identification of beneficiaries Capture of information, inform ANM and assist during service delivery Escorting the patients to health facility District Magistrate District Health Officer CMHO / CMO DPM District Block BMO BPM Medical Superintendent (CHC) Data Entry Operator Primary Health Centre M/O In-charge Alternate Vaccine Courier Data Entry Operator ANM Sub Centre ASHA Village

Data Reported (%) by Facilities Pregnant Women August 2012

Data Reported (%) by Facilities Children August 2012