Using Data to Effectively Manage the Family Planning Program

Purpose: To help district officials to monitor performance of Family Planning (FP) strategies as per Expected Level of Achievement (ELA), to analyze relevant indicators and to take timely corrective measures to meet the FP objectives of the district and the state.

Audience:

  • Chief Medical and Health Officers (CMHO/CDMO/CMO)
  • Nodal Officer – Urban Health and FP
  • District Program Managers (DPMs), District Health Officers(DHOs)
  • Assistant Research Officers(AROs)
  • Data Entry Operators

Background: The Ministry of Health and Family Welfare’s (MoHFW) routine Health Management Information System (HMIS) captures various data related to FP. In addition, the private sector reports FP data to the government via different mechanisms. However, there are issues in data management such as facilities not reporting on FP in the HMIS; reporting formats being filled incompletely; inconsistencies such as IUCD uptake being reported for facilities that have not had IUCD supply in the past months etc. In addition, this available data is not routinely consolidated, fully analyzed or presented in a manner that can help the district level officials, managers, hospital administrators or providers in understanding the current performance or in taking programmatic decisions on the basis of an understanding of the relationship between unmet need and the available resources for FP across both government and private sector facilities. Only when the data is analyzed and discussed in review meetings can it inform decisions for taking corrective measures and encouraging good performance.

Evidence of Effectiveness

The Urban Health Initiative (UHI) experience showed that the use of data for program management could be a powerful, low cost means to increase access and quality of services as well as provider’s motivation and accountability. FP performance improved when available data was analyzed routinely (presented through simple line graphs and bar charts) in CMHO meetings and was utilized to inform progress of 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 reallocation of human and other resources to address those problems. Furthermore, the routine review of data in these meetings led to increased visibility, attention and priority given to the FP program in general.

Specific examples from UHI include the following:

  • Based on an analysis of the HMIS data, CMHOs requested for funding to increase the number of obstetricians in government hospitals having high volume of deliveries
  • No-Scalpel-Vasectomy(NSV) surgeons were more enthusiastic when CMOs monitored their performance and recognized their contributions
  • When CMOs used available data to monitor the performance of community volunteers and rewarded their achievements in increasing coverage of households and the number of new family planning acceptors, their motivation increased and improved their performance over time

Guidance on Using Data to Manage Urban FP Programs

The key to effective data management for better program decision making includes:

  • Determining the indicators that need to be captured, along with their source and frequency. For example, an indicator like the number of clients given different FP methods should be monitored on a monthly basis, while HR and capacity building indicators may require six-monthly monitoring
  • Clearly defining indicators with the numerator and the denominator, wherever required
  • Devising ELAs against which these indicators can be monitored
  • Ensuring that the indicators are understood by all the staff
  • Providing appropriate training to the staff including to the analysts responsible for data management

Important points on use of data

  • Key FP indicators should be reviewed and discussed in monthly review meetings by the CMHO/CMO/CDMO and concerned authorities
  • Line and bar graphs should be produced and displayed each month and at the end of the year in the district health office
  • Feedback including bar charts and graphs showing comparative performance and performance over time should be provided to all facilities
  • Feedback and supportive supervision using data should be provided to individual staff from their supervisors at each level

Using data for feedback: While it is important for the district health teams, facility-in-charges, and ASHA supervisors to review the available data and reports, and take corrective actions on the basis of identified gaps and weaknesses; it is equally important to communicate the gaps to the team in a constructive manner so that it boosts morale and yet provides direction for course correction. A simple way of doing this is to ‘Appreciate and Acknowledge each person right in the beginning, followed by suggested improvement (including offering any support / peer coaching that the person may require) instead of direct blaming, public shaming as it actually demotivates people.

Training staff in data usage: All the staff handling data should be informed and oriented on all the data forms, the definitions of key indicators and basic analysis of the data and indicators. Annual training / refresher training on data management should be considered and funds are available through the PIP. Master trainers can be identified at the city level. Support can be taken from NGOs to support this task.

Roles and Responsibilities towards Data Usage for Program Management

Role
Responsibility
CMHO/CMO
  • 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 for refresher training.
  • Share the standard template for monthly reporting and review key family planning 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 in the Programme Implementation Plan (PIP).
  • Ensure usage of data during regular supportive supervision visits by nodal officers, Additional CMOs (ACMOs), District Program Managers (DPMs), and District Community Program Managers (DCPMs) for supporting providers, Urban Health Coordinators and facilities towards improving performance
  • Recognize high performers and give constructive feedback to others for programmatic improvement
  • Request private sector facilities to report data on agreed indicators on the FP services that they provide
ARO/DPM/Urban Health Coordinator
  • Compile and consolidate monthly data received from the District Women’s Hospital, UPHC and other facilities in the given template providing feedback concerning any data quality issues
  • Prepare a presentation (with line and bar graphs) for the District Health Society and other review meetings based on data, including data from private accredited facilities
  • Discuss the area-specific family planning achievements in ASHA meetings at the UPHC level
Chief Medical Superintendent (CMS)/Nodal Officer Urban Health and FP
  • Review the performance of providers on the services provided in the facility (method-wise and month-wise)
  • Give constructive feedback to providers to rectify identified problems and support them in making improvements
Medical Officer-In-Charge
  • Get data consolidated from the ANMs and the UPHC and review it to ensure data completeness and accuracy before reporting to HMIS
  • Review performance of UPHC staff and ANMs
  • Give constructive feedback to the UPHC staff and the ANMs to rectify identified problems and support them in making improvements
ANM/ U-ASHA
  • Plan household visits based on the data and report to the ASHA facilitator or to the appropriate higher levels
  • Maintain daily field visit record in the given report template
  • Report monthly on the given indicators such as number of clients who obtained FP services from the public and the 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:

Activities
Indicator:

The following indicators should be reported and reviewed on a monthly and annual basis:

  • Percentage of facilities / service delivery points (public and private) reporting in the HMIS
  • Percentage of facilities / service delivery points (public and private) reporting on FP indicators in the HMIS
  • Number and percentage of FP acceptors, by method, by facility (public and private)
  • Method-specific percentages of all FP acceptors by facility
  • Number of Fixed Day Static (FDS) service days, by facility
  • Number of clients served per FDS
  • Number of new FP acceptors mobilized by ASHA
  • Number of clients served per FDS
  • Number and percentage of Post-Partum Family Planning (PPFP) acceptors, by method
  • Number and percentage of Post-Abortion Family Planning (PAFP) acceptors, by method, by facility
Source:
  • HMIS
  • For 3-9 indicator, Monthly Facility / Service Delivery Point Report
Human Resources
Indicator:
  • Percentage of staff positions filled against those planned to be filled (Reported and Reviewed Quarterly):
    • Doctors trained on NSV/ mini-lap, facility wise
    • U-PHC – Medical Officers In-Charge (MOIC), Staff Nurses, ANMs, FP Counsellors, ASHAs

 Source: Monthly Facility Report

Training/Capacity Strengthening
 Indicator:
  • Number of trained staff by facility (Reported and Reviewed Periodically)
    • Number of NSV surgeons trained
    • Number of staff nurses/ ANMs  trained in PP-IUCD
    • Number of doctors trained in Minilap/Laproscopic female sterilization
    • Number of ASHAs trained on FP

Source: Training database updated periodically

Budget
Indicator:
  • Percentage of funds utilized against funds budgeted by facility (Reported and Reviewed Monthly and Annually)

Source: District monthly fiscal report

Accreditation
Indicator:

Number of accredited facilities with various government schemes

Source:
  • In UP: Hausala Sajhedari Dashboard
  • Other states: Monthly Report, Department of Health
Commodities and Equipment
Indicator: 
  • Contraceptive stock outs by method, by month and by facility (reported and reviewed monthly and annually)
  • Equipment available and functional against planned
    • Kelly’s forceps
    • IUCD kit
    • NSV kit
    • Mini lap kit
    • Laproscope

Source: Monthly Facility Indenting Format

Cost Elements

The following 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 budgeted for in the PIP:

Cost Elements FMR Code Source
HR Personnel Cost P.2.1.1, P.3.2.1 and P.4.1 ROP UP 2017-18, NHM-UP

Monitoring – NUHM monitoring/Evaluation – IT

based monitoring

P.4.1.10 ROP UP 2017-18, NHM-UP
Computer, printer and UPS – NUHM at city P.4.4.12.1 ROP UP 2017-18, NHM-UP
NUHM Office expenses at city level P.2.2.3 ROP UP 2017-18, NHM-UP
Internet – NUHM Office expenses at city level P.2.2.3 ROP UP 2017-18, NHM-UP

This table is indicative and illustrates the manner in which cost elements are provisioned 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.

Sustainability

Routine HMIS provides the basic data and the staff who can conduct the data entry and 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 that to make necessary corrections / adaptations, then the entire process of data collection, analysis and feedback will continue and be sustained.

Disclaimer: This document is based on the learnings collated from Urban Health Initiative (supported by BMGF), Health of the Urban Poor (supported by USAID) and Expanded Access and Quality (EAQ) to broaden method choice in Uttar Pradesh (supported by BMGF). This document is not prescriptive in nature but provides overall guidance of how this particular aspect was dealt with in these projects for possible adoption and adaptation.