Using Data to Effectively Manage the Family Planning Program

Evidence of Effectiveness

TCI India technically assisted government officials of 20 cities of Uttar Pradesh (UP) on the regular review and monitoring of HMIS data for taking timely decisions. The changes in FP annual client volume at the district, city and UPHC level was analyzed and how UPHCs contributed (or not) to the overall FP acceptors in the district was thoroughly reviewed by the government. Hence, evaluation of HMIS trend by city, by district, by UPHC, and by month through near-real-time data became a practice. The government officials along with TCI India reviewed data at each level and accordingly formulated the coaching, mentoring and implementation plan for the cities.

The HMIS data trend helped the UP government to understand the importance of TCI coaching mentoring model behind the improved performance of 27% cities (20 intervention cities) in comparison to the remaining 73% cities (55 non-intervention cities) of the state, and this provided evidence for scaling up TCI India’s high impact approaches (HIAs) in non-intervention cities in UP. (refer to the trend graph below)

The reversing trend in UPHCs of TCI India supported cities annual client volume for Short-Acting Reversible Contraceptive (SARC) and Long-Acting Reversible Contraceptive (LARC) is visible with great significance, while in remaining cities the trend is diminishing especially for IUCD and stagnant for other methods. The contribution of IUCD in method mix is significant in TCI India cities and its contribution is also positive in city-level achievements. On the other hand, data from the remaining cities in UP reveals a total of 19,139 number of annual client volume in April 2017, which reached 32,397 number with 69% increase in March 2020. Additionally, there is a small increase recorded at UPHCs for SRAC (condoms, DMPA and oral contraceptive pills) and largely no change recorded in IUCD client volume in non TCIHC supported cities.

In March 2017 these 20 cities recorded 105,763 annual client volume which reached 229,793 numbers in March 2020. It also recorded an 119% increase in client volume. Particularly, IUCD, injectable, condoms and pills.

TCI India experience showed that the use of data for program management could be a powerful and a low-cost means to improve access, quality of services, provider’s motivation and accountability. FP performance improved when available data was analyzed routinely (presented through simple line graphs and bar charts) in review meetings headed by AD/CMO and was utilized to inform progress of urban FP strategies against ELA over the given period. By reviewing and discussing the monthly program achievements and the trends over time, health officials were able to identify specific problems requiring attention and were able to take corrective actions including re-allocation of human and other resources to address these problems. Furthermore, the routine review of data in these meetings led to increased visibility, attention and priority was given to the urban FP program in in general.

Data on urban FP indicators presented by TCI India supported cities at division level review meetings triggered an interest at the division level to scale up high impact approaches (HIAs). This interest lead to the division head, AD seek TCI India’s coaching on scale-up of HIAs to cities in the division not supported by TCI; the cities include Mainpuri (Aligarh), Kasganj (Agra), Deoria (Gorakhpur), Orai/Jalaun (Jhansi), Unnao (Kanpur), Raebareli (Lucknow), Baghpat (Meerut), Sambhal (Moradabad), Fatehpur (Allahabad), Bareilly (Badaun) and Chandauli (Varanasi). Each of these cities were coached by master coaches (selected government officials from the system) of the TCI India supported sites in the same division, for example Mainpuri was coached by master coaches from Aligarh. Thus, in line with the cascade coaching model master coaches, coached city UHC on formation and regularization of convergence platform to roll out fixed day static service (FDS)/Antral diwas, build capacities of Urban ASHAs and regular data reporting and review initiated. These eleven cities started conducting FDS/Antral diwas and reported FDS data in the HMIS; a never before activity done by any of these cities.

Guidance on Improving the Urban Slum Population Database

The key to effective data management leading to better program decision-making includes following steps:

Roles and Responsibilities towards Data Usage for Program Management

AD/JD/General Manager FP and Urban

• Include urban FP data review as an agenda in all types of review meetings.
• Issue guidance to all the cities to refer this tool as one of the guidance documents to utilize data effectively for strengthening urban FP program.

CMO/ACMO

• Ensure that facilities report data on a regular and timely basis as per the defined data flow process
• Ensure that all the staff responsible for data management has been appropriately trained, and if required, provide refresher training
• Share the standard template for monthly reporting and reviewing key FP indicators at the district level (facility wise, method-wise and month-wise analysis)
• Ensure provision of funds for review meetings and training of staff on data management is available in the PIP Ensure usage of data during regular supportive supervision visits by nodal officers, ACMOs, DPMs, CCPM for supporting providers, UHC and facilities towards improving the performance
• Recognize high performers and give constructive feedback to others for programmatic improvement
• Urge private sector facilities to report data on agreed indicators on FP services which they provide for HMIS upload
• Issue directives for the formation and regular meeting of data validation committee at the UPHC level
• Issue directive to facilities where errors in data reports are consistent
• Issue directives to facilities which are low performing in providing FP services

CMS/DUHC/Nodal Officer- Urban Health and Family Planning

• Review the performance of providers on services provided in the facility (method-wise and month-wise)
• Review the post-partum and post-abortion FP data against institutional deliveries and clinical abortions respectively
• Give constructive feedback to providers to rectify identified problems and support them to improve

Medical Officer in-Charge (MoIC)

• Collect and collate data from ANMs and UPHC and review it to ensure its completeness and accuracy before reporting to HMIS
• Review performance of ASHAs in periodic ASHA and ANM meeting.
• Based on data give constructive feedback to the UPHC staff, ANMs and ASHAs to rectify identified problems and support them to improve.
• Ensure data validation committee meetings are regularly held and decisions taken are adhered to rectify data errors and improve data quality
• Ensure data is timely collected, collated and validated for HMIS upload.

CCPM

• Ensure capacity building of ASHAs and ANM on data reporting
• In coordination with MOIC, conduct periodic review of ASHAs’ performance on family planning indicators

ANM

• Coach ASHAs to plan household visits based on the data and report to the appropriate higher official
• Coach ASHAs to maintain daily field visit report in the urban health index register/specified reporting format
• Report every month on the given indicators such as number of clients who obtained FP services from public and private sector

Monitoring the Usage of FP Data for Program Management

Monitoring of data usage for program management should be based on the following indicators:

Cost Elements

The following cost elements are required for an effective data usage and management system. Their PIP codes are provided below for easy reference. A state may already have these elements, but if not, then they should be budget-ed in the PIP.

This table is indicative and illustrates the manner in which cost elements are provided in a government PIP, thus giving guidance to the audience on where to look for elements related to a particular task, such as using data to effectively manage the FP program.

Source: NHM PIP Guideline 2022-2024

Sustainability

Routine HMIS provides the basic data, while the staff who enters the data and does the basic analysis is already in place. If the available data is analyzed and made part of the routine review process where people can see the benefit of analyzing data and using it to make necessary corrections/ adaptations, then the entire process of data collection, analysis and feedback will sustain.