Presented by Karar Zunaid Ahsan, MEASURE Evaluation's Sr. Resident M&E Advisor for Bangladesh, at the Global Conference on Community Health in March 2013.

1. Role and Scope of MIS in
Monitoring and Surveillance
Systems of HPNSDP
Karar Zunaid Ahsan
Sr. Resident M&E Advisor for Bangladesh
MEASURE Evaluation, USA

2. HPNSDP and Sector-wide Approaches
(SWAp) in Bangladesh’s HNP Sector
Fund
GOB
Name Duration (Billion
%
US$)
Health and Population Sector 1998-
3.2 61%
Program (HPSP) 2003
Health, Nutrition and
2005-
Population Sector Program 4.3 73%
2011
(HNPSP)
Health, Population and
2011-
Nutrition Sector Development 7.7 76%
2016
Program (HPNSDP)
2

3. Structure of the Health Services Delivery
System in the MOHFW
Secretary for Ministry of
Health & Family Welfare
Central
DGHS DGFP
Medical Colleges (18 public, 41 Institute
private) Specialty Hospitals (7) Director
7 Divisions Divisional Divisional
Specialist Hospitals (31) Director Director
64 Districts
Civil Deputy
District Hospitals (61), Surgeon Director FP
MCWC (95)
481 Upazilas Upazila Health Upazila FP
Upazila Health Complex (460) & FP Officer Officer
4,498 Unions Assistant Family Family
Medical
UHFW (2,500), Rural Sub-center Health
Assistant
Welfare Planning
(1,449) Inspector Visitor Inspector
40,482 Wards Family
Health
Welfare
Community Health Clinic (9,722) Assistant
Assistant
Source: MIS-DGHS 2010.
3

4. Monitoring System in HPNSDP
• HPNSDP has a robust Results Framework that enables
effective tracking of results
o 8 impact-level indicators; 33 outcome-level indicators.
• HPNSDP incorporated OP level indicators to monitor
implementation progress
o 342 process/output-level indicators for 32 OPs.
• Following sources are used for monitoring progress:
o MISs from the two directorates and specific programs
o Household and health facility surveys
o Administrative records from OPs
o Expenditure data from ADP review.
• Program Management & Monitoring Unit (PMMU) in the
Planning Wing of MOHFW manages results from different
sources. 4

5. Survey Matrix for HNP SWAps
2017
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
Survey name Implementer
Bangladesh Demographic and Health Survey (BDHS) X X X X NIPORT
Multiple Indicator Cluster Survey (MICS) X X X X BBS
Utilization of Essential Service Delivery (UESD)
X X X NIPORT
Survey
Bangladesh Maternal Mortality Survey (BMMS) X X NIPORT
Bangladesh NCD Risk-factors Survey X X X X DGHS
Bangladesh Urban Health Survey (UHS) X X NIPORT
Bangladesh Medical Equipment Survey X X WBOD
Bangladesh Health Facility Survey (BHFS) X X X X X NIPORT
National HIV Serological Surveillance X X X DGHS
Integrated bio-behavioral Survey (IBBS) X X X DGHS
Coverage Evaluation Survey (CES) X X X X X X X X X X X X DGHS
Source: Updated from HSDP PAD
5

6. Role of MIS in Monitoring HPNSDP Progress
• The existing MISs in MOHFW collect facility-based health
service statistics.
• Routine MISs are primarily used for
o Updating 5 out of 33 RFW indicators
o Monitoring output indicators at OP-level
o Validating DAAR achievements.
• OP-level indicators are currently being revised to foster the
role of MISs in monitoring implementation progress.
• Data Warehouse DMIS currently stores data from HIS, MIS-FP,
IMCI, EPI, TB-LC, and UPHCP with the aim of consolidating
data from different sources.
• A number of initiatives currently ongoing to streamline
routine Health Information System.
6

7. SCOPE OF MIS IN
HNP SWAp
7

8. Building Blocks of a Health System
Source: WHO 2007
8

9. Why Strengthening the Scope of MIS?
• SWAps, and the principles outlined in the Paris Declaration,
focus on improving the effectiveness of development
assistance in developing countries.
• It is not possible to demonstrate any impact of the donor
investments in the health system, let alone on the health of
the population, without reliable routine health information
systems
• Result-based budgeting and monitoring through process
and output indicators are growingly being used for
managing the implementation of SWAp rather than relying
on structural reforms as indicator of success.
9

10. What Needs to be Done?
• Focus to be expanded from public facility-based services to
community characteristics (morbidity, mortality, risk factors)
• Need comprehensive community surveillance
o HA/FWA to collect data on regular basis
o Sentinel surveillance
o Multi-site Health & Demographic Surveillance Systems
(HDSS)
• Ensure coverage and timely processing of information
o data collection through mobile devices (smartphone,
PDA, tablets)
• Use routine data to address major system issues
o PMIS to monitor vacancy and absenteeism
o LMIS to ensure stock and supply of essential drugs.
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11. What Needs to be Done? (contd.)
• Strengthen stewardship and regulatory role of MOHFW
o Make routine data submission from private and NGO-
run facilities as a part of the accreditation process
• Collaborate with private sectors to strengthen monitoring
and surveillance system
o NNS and Brac University’s FSNSP as an example
• Coordinate with other GOB activities
o Compare results of SVRS and other surveys by BBS
with other national surveys (BDHS, MICS, UHS)
• Lastly, put emphasis on physical progress for regular
monitoring
o Expenditure against ADP allocation is primarily used
for reviewing progress of the operational plans under
HPNSDP. 11

12. Thank you.
Questions? Comments?
Email: zunaid@email.unc.edu