1. Chief, Health Systems Division, USAID/India
Use of DHS Data to Influence FP/MNCH Programs & Policies: India National Family Health Survey
Sheena Chhabra
Chief, Health Systems Division, USAID/India
Reconvening Bangkok
March 9, 2010

2. 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

3. NFHS data were instrumental in revitalizing routine immunization
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%
Data Source: For NFHS-2 and NFHS-3 - Table no. 9.6 (NFHS-3 Chapter)
For NFHS-1 India fact sheet (NFHS-3)

4. NFHS reiterated the need to focus on proven & simple child health interventions
Key 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
Percentage of children age with diarrhoea in
the past 2 weeks
Data Source: For NFHS-3 India fact sheet
For NFHS-2 Table no India report,(NFHS-2)
RCH-2

5. 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.
Percent

6. NFHS-3 informed programs for improving nutritional status
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
Percent of age-eligible children in areas with an AWC

7. NFHS data influenced design of JSY Janani 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 ( )

8. NFHS data helped improve focus on birth spacing
Key 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.
Percent of currently married women age 15-49

9. Deaths in the first year of life per 1000 live births
NFHS data helped to evolve strategies for healthy timing and spacing of births
Deaths in the first year of life per 1000 live births

10. NFHS-3 helped devise appropriate strategies for vulnerable population groups
Key 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 have unmet need for family planning.
Child mortality rate is 61% higher for girls than for boys.
Two in five currently married women age 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.

11. NFHS-3 Key Data Source for RCH-2 Performance Review of States
Segmentation of States based on RCH-2 Performance
Top Guns
High Achievers
Movers and Shakers
Promising
Goa
Kerala
Sikkim
Uttaranchal
Himachal Pradesh
Karnataka
Maharashtra
Tamil Nadu
Manipur
Chhattisgarh
Madhya Pradesh
Orissa
Andhra Pradesh
Gujarat
Haryana
Jammu & Kashmir
Punjab
West Bengal
Meghalaya
Mizoram, Tripura
Bihar
Jharkhand
Rajasthan
Uttar Pradesh
Arunachal Pradesh
Assam
Nagaland
Source: RCH-2 – Program Management Support Group (PMSG), Donor Coordination Division

12. 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

13. …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)