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Dr Vishnu Kant Srivastava CD (Stat) Health & Family Welfare
DATA DRIVEN DECISION MAKING
IN
HEALTH & FAMILY WELFARE
Ministry of Health and Family Welfare
DATASET CONTRIBUTED BY THE MINISTRY OF HEALTH AND FAMILY WELFARE
OPEN GOVERNMENT DATA (OGD) PLATFORM INDIA (data.gov.in)
Resource
(Data set)
Resource
(App)
Total
Resources
Total
catalogs
Ministry of H&FW 3155 0 3155 201
Deptt. of H&FW 3141 0 3141 187
NIHFW 4 0 4 2
Deptt. of AIDS
Control
10 0 10 10
AYUSH 4 0 4 4
Note: Data from NIHFW, NACO and Ayush are uploaded by the contributors/controllers of these Departments
Ministry of Health and Family Welfare
DEPTT. PUBLICATIONS:
- HEALTH AND FAMILY WELFARE STATISTICS IN INDIA
- RURAL HEALTH STATISTICS IN INDIA
SURVEY DATA
- NATIONAL FAMILY HEALTH SURVEY
- DISTRICT LEVEL HOUSEHOLD SURVEY
- ANNUAL HEALTH SURVEY
HEALTH MANAGEMENT INFORMATION SYSTEM (HMIS)
- SERVICE STATISTICS AT FACILITY LEVEL UPLOADED BY THE STATES/UTs
KEY INDICATORS FROM CENSUS AND SAMPLE REGISTRATION SYSTEM
- POPULATION BY SEX, REGION, CRUDE BIRTH RATE, INFANT MORTALITY RATE, NEO-
NATAL MORTALITY RATE, UNDER 5 MORTALITY RATE, MATERNAL MORTALITY
RATIO(MMR) etc.
DETAILS OF DATA UPLOADED IN THE PORTAL by the Deptt. of H&FW
Ministry of Health and Family Welfare
.Data disseminated by the ORGI, surveys, HMIS are used by the MoHFW to know the :
• Estimated number of pregnant women, live births, number of infant for immunisation
activities in different States and UTs;
• To assess district-wise need to know the pregnant women, live births and infant for
immunisation activities, service delivery;
• To estimate number of infant deaths, under 5 deaths and maternal deaths to assess the
goals to be achieved under Millennium Development Goals (MDG) and Sustainable
Development Goals (SDG) which would be monitored from 2017 to 2030;
• Data provides valuable input to know the status of different indicators of Maternal
Health e.g. Institutional Delivery, Safe Delivery, ANC, nutritional status, anaemia, Child
Health Indicators viz status of full immunization, nutritional status, anemia and current
use of family planning methods, unmet needs for family planning
Uses of data
Ministry of Health and Family Welfare
Annual Health Survey
o Conceived at the behest of the National Commission on
Population, PMO and Planning Commission
Objective
o Providing benchmarks of core vital and health indicators at the
district level and map its change on a continual basis to assess
the efficacy of various health interventions under National
Health Mission.
o Implemented through the ORGI in 284 districts of 8 EAG
States and Assam
Ministry of Health and Family Welfare
Geographical Coverage : Annual Health
Survey
Odisha
Chhattisgarh
JharkhandMadhya Pradesh
Bihar
AssamRajasthan
Uttar Pradesh
Uttarakhand
Ministry of Health and Family Welfare
NEED FOR AHS
o 9 AHS States namely, Rajasthan, Uttar Pradesh,
Uttarakhand, Bihar, Jharkhand, Odisha, Madhya
Pradesh, Chhattisgarh and Assam constitute:
• 50 percent of country’s Population
• 60 percent of Births
• 71 percent of Infant Deaths
• 72 percent of Under 5 Deaths
• 62 percent of Maternal Deaths
 There is large inter-district variations in these States.
 In the absence of District level vital data, State level
estimates from Sample Registration System (SRS) are
used for formulating district level plans.
Ministry of Health and Family Welfare
Annual Health Survey Contd…
o Baseline during 2010-11 and first updation round in
2011-12 and second updation round in 2012-13.
o A component on Clinical Anthropometric and
Biochemical (CAB) tests to cover height / length &
weight, test for anaemia and fasting blood glucose,
blood pressure and salt testing to assess the level of
iodine in salt consumed by households.
o The survey is funded by MoHFW
Ministry of Health and Family Welfare
Subject Coverage
Following broad areas are covered under AHS:
 Childhood Disease
 Birth Registration
 Breastfeeding & Supplementation
 Awareness in Mothers
 Abortion
 Family Planning Practices
 Disability
 Morbidity
 Personal Habits: adults
 Housing & HH Characteristics
Ministry of Health and Family Welfare
AHS Contd…
KEY FEATURES
Coverage- All the 284 districts of 8 EAG States and Assam.
Sample Units- 20,694 statistically selected sample unit (Census Enumeration
Blocks in urban areas and Villages or a part thereof in rural areas)
Sample Identification Work- to uniquely identify the sample units on ground,
firm up its boundaries, demarcate the localities and prepare a notional map
of the sample unit was done by the staff of ORGI.
Ministry of Health and Family Welfare
KEY FEATURES
 Conduct of Field Work - hybrid approach wherein fieldwork
has been outsourced and supervision is being done by the
ORGI.
 Primary Level of Aggregation – District
 Periodicity- Annual for 3 years
AHS Contd…
Ministry of Health and Family Welfare
Results
 State level Bulletins of all the three rounds containing the
district level vital indicators viz. Crude Birth Rate, Crude
Death Rate ,Infant Mortality Rate ,Neo-Natal Mortality
Rate ,Under Five Mortality Rate ,Maternal Mortality
Ratio ,Sex Ratio at Birth ,Sex Ratio(0-4 Years) ,Sex
Ratio(All Ages) were released in 2011, 2013 and 2014.
 District level fact sheets of all the three rounds
containing different indicators on fertility, Mother and
child care, Family planning practices , Mortality,
disability ,marriage etc. also released
 The survey work of CAB component has been completed
and the results are available in the form of factsheets
AHS Contd…
Ministry of Health and Family Welfare
National Family and Health Survey (NFHS)
NFHS is a large scale nationally represented survey conducted
during 1992-93, 1998-99 and 2005-06 and provides state
and national level estimates
Information on fertility, family planning, morbidity, infant and child
mortality, maternal and child health, utilization of health
services, and nutrition with an emphasis on women and
young children are available
Mortality:-
• Neonatal, Post natal ,IMR, CMR, Under-5 mortality
Fertility:-
• CBR, ASFR,TFR, Birth order
NFHS (2005-06) also provides population based HIV
estimates for six states and provides estimates on a host of
social and economic indicators as well
Ministry of Health and Family Welfare
NFHS-4 as an Integrated Survey
• NFHS and DLHS were conducted with a time gap of 4 – 7
years.
• In spite of having different sample size, different reference
period and definition for some of the indicators included in
these surveys, people /media tend to compare the results of
NFHS and DLHS, leading to different conclusions.
• To avoid / mitigate the problem and to facilitate regular
availability of data to assess and monitor performance at more
closer interval, the Ministry has decided to conduct one
integrated survey in place of different surveys to provide data
at the district level and to be named as National Family
Health Survey (NFHS).
Ministry of Health and Family Welfare
NFHS-4 Highlights
Coverage of all States/ UTs in two phases.
The first phase covers (17 States / Regions)- Andhra Pradesh
& Telangana, Assam, Bihar, Goa, Haryana, Karnataka,
Madhya Pradesh (East), Madhya Pradesh (West),
Maharashtra, Manipur, Meghalaya, Sikkim, Tamil Nadu,
Tripura, Uttar Pradesh (East), Uttarakhand, West Bengal,
Andaman & Nicobar Islands and Puducherry.
The second phase will cover (15 States / Regions) - Arunachal
Pradesh, Chhattisgarh, Gujarat, Himachal Pradesh,
Jharkhand, Jammu & Kashmir, Kerala, Mizoram, Nagaland,
Odisha, Punjab, Rajasthan, Uttar Pradesh (Bundelkhand +
Central), Uttar Pradesh (West), Chandigarh, Dadra & Nagar
Haveli, Daman& Diu, Lakshadweep and NCT of Delhi.
Sample Size under NFHS
NFHS Ever-married
women
Households
NFHS(1992-93) 89777 (age 13-49) 88562
NFHS(1998-99) 90000 (age 15-49) 91196
NFHS(2005-06) 1,24,385
(UM- age 15-24)
(M- age 15-49)
109,041
NFHS-4 625,014 women
(estimated)
568,200 (estimated)
Levels of Information
1. National
2. State
3. Socio-economic and demographic background
Ministry of Health and Family Welfare
• IIPS (INDIAN INSTITUTE OF POPULATION SCIENCES IS THE NODAL AGENCY
• The periodicity of the survey was 5 – 6 years. Four rounds conducted in 2012-13,
2007-08 (7,20,320 Households), 2002-04, and 1998-99;
• National, State and district level estimates on health and nutrition, performance of
reproductive and child health programmes etc. information are made available in
these surveys
• The fourth round of District Level Household Survey (2012-13) has since been
completed, factsheets containing important indicators for 21 States / UTs (Andhra
Pradesh, Arunachal Pradesh, Goa, Haryana, Himachal Pradesh, Karnataka, Kerala,
Maharashtra, Manipur, Meghalaya, Mizoram, Nagaland, Punjab, Sikkim, Tamil
Nadu, Telangana, Tripura, West Bengal, Andaman and Nicobar Islands,
Chandigarh and Puducherry) and 18 State Reports are available on the website of
the Ministry “nrhm-mis.nic.in”. Reports of the ‘‘Facility Survey’ component of
DLHS-4, for 9 States, is also available and to be uploaded on Ministry’s web site
shortly
DISTRICT LEVEL HOUSEHOLD AND FACILITY SURVEY (DLHS)
Health Management Information System (HMIS)
(https://nrhm-mis.nic.in)
Ministry of Health and Family Welfare
Introduction-HMIS
“HMIS is an information system specially designed to assist in
the management and planning of health programmes, as
opposed to delivery of care”- World Health Organization
A health management information system is an essential
management tool to monitor how far we have travelled, and
where the gaps are…
Ministry of Health and Family Welfare
HMIS: Key Features
o Web based MIS where facilities / districts / states are reporting
data on a defined periodicity in pre-defined formats
o Captures data related to service delivery (performance related)
and facility infrastructure
o 1.94 lakh facilities across 672 districts of India uploading
monthly data on performance indicators
o Reports available in public domain
Ministry of Health and Family Welfare
HMIS data is available on Data portal of India under Open
Government Data (OGD) Platform India (https://data.gov.in)
Data includes indicators related to:
Maternal Health related
• ANC related
• Delivery care related
• Post Natal Care
• MTP & Abortion
Child Health related
• New born details
• Immunization related
• Child hood diseases
Family Planning
• Male sterilization
• Female sterilization
• IUCD & other temporary
methods
Health Facility services
• OPD/ IPD
• Surgeries
• RKS
• Ambulance services
Laboratory Testing
• Hb
• HIV
• Malaria
Mortality related
• Maternal Deaths
• Infant deaths
• Adolescent & Adult Deaths
Availability on Data portal of India
List of reports available on HMIS Public Domain
Standard reports
• Data Reporting Status
• Data Itemwise
• Data Itemwise Comparison
• Performance of Key HMIS
Indicators
• RCH Reports - Indicator Wise
• RCH Reports - State Wise
• Min-Max Report
• Range wise Report
Analytical reports
• Scorecard & Dashboard
• Factsheet: State & District
• CHC Star Rating
Shared with Data.gov.in
Ministry of Health and Family Welfare
Use of HMIS Data
o Planning
HMIS data is widely used by States in preparing Program
Implementation Plans (PIPs) under NHM.
Indicators from HMIS (like Institutional Deliveries, C -Section
deliveries, Immunization, IPD, OPD, Surgeries, etc.) are used to
evaluate the state performance during National Programme
Coordination Committee (NPCC) meetings
Facility wise data of CHCs is used for rating the facilities. This rating
is also a conditionality for approval of funds under NHM
Ministry of Health and Family Welfare
CHC Star Rating
 Based on the available infrastructure at the health facility and the
services being provided, the performance of a facility is rated vis-à-vis
other facilities.
 Data reported by the facilities in Infrastructure and MIS monthly
format is used for generating Star rating report.
 For Star Rating report the following aspects / categories are
considered:
• Human Resources available
• Infrastructure available
• Drugs & Supplies
• Service Availability
• Client Orientation
• Service Utilization
Use of HMIS Data: Planning (contd.)
CHC Star Rating: Karnataka (2014-15)
Ministry of Health and Family Welfare
CHC Star Rating (contd.)
The rating of the facility is done based on the criteria given below:
• If the facility satisfies criteria for HR available & Infrastructure available,
facility is eligible for Star Reporting & gets 1 Star.
• Facility gets one star each for satisfying criteria for Drugs & Supplies,
Service Availability, Client Orientation and Service Utilization
• If the facility fails to satisfy criteria for HR available or Infrastructure
available, facility is not eligible for Star Reporting with status “NE” (Not
Eligible)
• If the facility fails to satisfy both of the criteria (i.e. HR available &
Infrastructure available) & do not have Drugs and supplies, Service
availability and Client Orientation then Star Reporting is not applicable
for facility & status of facility will be “NA” (Not Applicable) .
Use of HMIS Data: Planning (contd.)
Ministry of Health and Family Welfare
Use of HMIS Data (contd.)
o Monitoring & Evaluation
HMIS data is used in various monitoring visits like CRM (Common Review
Mission), Supportive supervision, Mission Indradhanush & various field visits
Calculation of DLIs (Disbursement Linked Indicators) for NUHM- DLI1-
institutional Deliveries, DLI2- Fully immunised children
HMIS data is also used in DMU report (Delivery Monitoring Report of
PMO)- DLI1, DLI2, male & female sterilisations.
HMIS data is used in RFD (Result Framework Document) –Home Deliveries
HMIS scorecards are used for evaluating State/ District/ Sub district
performance for indicators related to RMNCH+A
Ministry of Health and Family Welfare
Use of HMIS Data: Monitoring & Evaluation (contd.)
Dashboard & Scorecard
• Visual presentation in the form of ‘Maps’ for depicting
status of different components of services delivered
under RMNCH+A strategy for states/districts/ blocks
• Compares states/districts/blocks using the Overall
Composite Index
• Highlight inequities across states, districts and
blocks for focusing on areas lagging behind
• Two types:
Districts across country
Districts within a State
Ministry of Health and Family Welfare
Dashboard & Scorecard: Indicators
Total of 16 indicators covering 4 stages of lifecycle:
Use of HMIS Data: Monitoring & Evaluation (contd.)
Ministry of Health and Family Welfare
List of Indicators
Sl.
No
Stages of life cycle
Indicators
Association
Proportion of:
1
Pre Pregnancy /
Reproductive age
Post-partum sterilization against total female sterilization
Positive
2 Male sterilization to total sterilization conducted
Positive
3 IUCD insertions to all family planning methods (IUCD plus permanent)
Positive
4
Pregnancy care
1st Trimester registration to total ANC registration
Positive
5 Pregnant women received 3 ANC check-ups to total ANC registration
Positive
6 Pregnant women given 100 IFA to total ANC registration
Positive
7 Cases of pregnant women with Obstetric Complications and attended to reported deliveries
Positive
8 Pregnant women receiving TT2 or Booster to total number of ANC registered
Positive
9
Child Birth
SBA attended home deliveries to total reported home deliveries
Positive
10 Institutional deliveries to total ANC registration
Positive
11 C-Section to reported deliveries
Positive
12
Postnatal maternal&
new born care
Newborns breast fed within 1 hour to live births
Positive
13
Women discharged under 48 hours of delivery in public institutions to total no. of deliveries in
public institutions
Negative
14 Newborns weighing less than 2.5 kg to newborns weighed at birth
Negative
15 Newborns visited within 24hrs of home delivery to total reported home deliveries
Positive
16 Infants 0 to 11 months old who received Measles to reported live births
Positive
Ministry of Health and Family Welfare
Dashboard & Scorecard: Methodology
1. Generation of 16 indicators
2. Identification of Max value and Min value
3. Calculation of Index value for each district for each indicator
• Positive indicator:
• Negative indicator:
4. Calculation of Composite index
Xid- Min(Xid)
Index Value, Xid = -----------------------------------
Max(Xid) – Min(Xid)
Max(Xid)- Xid
Index Value, Xid = -----------------------------------
Max(Xid) – Min(Xid)
Composite Index for dth
(d=1,2,......,n) district =
𝑋𝑖𝑑
𝑦
𝑖=1
𝑦
Use of HMIS Data: Monitoring & Evaluation (contd.)
Ministry of Health and Family Welfare
Dashboard & Scorecard: All India across States (2014-15)
Use of HMIS Data: Monitoring & Evaluation (contd.)
Color coding based on quartiles:
 Green (A) : Quartile 4 – Good performing
 Yellow (B) : Quartile 3 - Promising
 Pink (C) : Quartile 2 – Low performing
 Red (D) : Quartile 1 – Very low performing
Overall Index
Ministry of Health and Family Welfare
Scorecard: All India across States (2014-15)
Sikkim 0.6656 0.4678 0.6472 0.7226 0.9188
Kerala 0.627 0.5334 0.695 0.8183 0.3963
Tamil Nadu 0.6225 0.6153 0.6765 0.6747 0.4938
Lakshadweep 0.5812 0.5588 0.4238 0.6857 0.6016
Punjab 0.5705 0.4888 0.6666 0.6782 0.4308
Karnataka 0.5466 0.4943 0.6085 0.7999 0.1495
Assam 0.5291 0.4735 0.4305 0.6772 0.4734
A &N Islands 0.5281 0.6321 0.5937 0.5994 0.1705
Chandigarh 0.5189 0.5183 0.506 0.5325 0.5102
Maharashtra 0.4998 0.3889 0.6503 0.6921 0.2136
Telangana 0.4939 0.4088 0.5562 0.7128 0.2086
Uttarakhand 0.4936 0.3824 0.4086 0.6982 0.423
AndhraPradesh 0.4891 0.4061 0.4978 0.697 0.2722
Mizoram 0.487 0.3789 0.5279 0.6311 0.3862
Gujarat 0.4815 0.407 0.5076 0.6809 0.2472
Manipur 0.4791 0.1737 0.5122 0.6031 0.7485
Chhattisgarh 0.476 0.3924 0.329 0.7327 0.3345
Overall Index Pregnancycare ChildBirth Postnatal maternal
& newborncare
Composite Index( 2014-15)
Pre Pregnancy/
Reproductive age
group
State/UT
Sikkim 0.6656 0.4678 0.6472 0.7226 0.9188
Kerala 0.627 0.5334 0.695 0.8183 0.3963
Tamil Nadu 0.6225 0.6153 0.6765 0.6747 0.4938
Lakshadweep 0.5812 0.5588 0.4238 0.6857 0.6016
Punjab 0.5705 0.4888 0.6666 0.6782 0.4308
Karnataka 0.5466 0.4943 0.6085 0.7999 0.1495
Assam 0.5291 0.4735 0.4305 0.6772 0.4734
A &N Islands 0.5281 0.6321 0.5937 0.5994 0.1705
Chandigarh 0.5189 0.5183 0.506 0.5325 0.5102
Maharashtra 0.4998 0.3889 0.6503 0.6921 0.2136
Telangana 0.4939 0.4088 0.5562 0.7128 0.2086
Uttarakhand 0.4936 0.3824 0.4086 0.6982 0.423
AndhraPradesh 0.4891 0.4061 0.4978 0.697 0.2722
Mizoram 0.487 0.3789 0.5279 0.6311 0.3862
Gujarat 0.4815 0.407 0.5076 0.6809 0.2472
Manipur 0.4791 0.1737 0.5122 0.6031 0.7485
Chhattisgarh 0.476 0.3924 0.329 0.7327 0.3345
Goa 0.47 0.3546 0.5541 0.6121 0.3413
MadhyaPradesh 0.468 0.4015 0.3626 0.7558 0.2046
WestBengal 0.4618 0.4272 0.422 0.6601 0.2286
Haryana 0.4608 0.4312 0.4185 0.5383 0.4233
Himachal Pradesh 0.4595 0.4728 0.3814 0.563 0.3429
Rajasthan 0.4583 0.3644 0.5252 0.636 0.2518
Odisha 0.4575 0.4605 0.393 0.6003 0.279
groupAssam 0.5291 0.4735 0.4305 0.6772 0.4734
A &N Islands 0.5281 0.6321 0.5937 0.5994 0.1705
Chandigarh 0.5189 0.5183 0.506 0.5325 0.5102
Maharashtra 0.4998 0.3889 0.6503 0.6921 0.2136
Telangana 0.4939 0.4088 0.5562 0.7128 0.2086
Uttarakhand 0.4936 0.3824 0.4086 0.6982 0.423
AndhraPradesh 0.4891 0.4061 0.4978 0.697 0.2722
Mizoram 0.487 0.3789 0.5279 0.6311 0.3862
Gujarat 0.4815 0.407 0.5076 0.6809 0.2472
Manipur 0.4791 0.1737 0.5122 0.6031 0.7485
Chhattisgarh 0.476 0.3924 0.329 0.7327 0.3345
Goa 0.47 0.3546 0.5541 0.6121 0.3413
MadhyaPradesh 0.468 0.4015 0.3626 0.7558 0.2046
WestBengal 0.4618 0.4272 0.422 0.6601 0.2286
Haryana 0.4608 0.4312 0.4185 0.5383 0.4233
Himachal Pradesh 0.4595 0.4728 0.3814 0.563 0.3429
Rajasthan 0.4583 0.3644 0.5252 0.636 0.2518
Odisha 0.4575 0.4605 0.393 0.6003 0.279
Puducherry 0.4575 0.3093 0.6167 0.5239 0.4346
Tripura 0.4215 0.3181 0.3432 0.7257 0.1648
UttarPradesh 0.4127 0.3254 0.2882 0.5972 0.3752
Nagaland 0.3948 0.0778 0.5107 0.6792 0.3332
Jammu&Kashmir 0.3898 0.2618 0.4253 0.5434 0.3117
Arunachal Pradesh 0.369 0.0885 0.4202 0.6312 0.3486
AndhraPradesh 0.4891 0.4061 0.4978 0.697 0.2722
Mizoram 0.487 0.3789 0.5279 0.6311 0.3862
Gujarat 0.4815 0.407 0.5076 0.6809 0.2472
Manipur 0.4791 0.1737 0.5122 0.6031 0.7485
Chhattisgarh 0.476 0.3924 0.329 0.7327 0.3345
Goa 0.47 0.3546 0.5541 0.6121 0.3413
MadhyaPradesh 0.468 0.4015 0.3626 0.7558 0.2046
WestBengal 0.4618 0.4272 0.422 0.6601 0.2286
Haryana 0.4608 0.4312 0.4185 0.5383 0.4233
Himachal Pradesh 0.4595 0.4728 0.3814 0.563 0.3429
Rajasthan 0.4583 0.3644 0.5252 0.636 0.2518
Odisha 0.4575 0.4605 0.393 0.6003 0.279
Puducherry 0.4575 0.3093 0.6167 0.5239 0.4346
Tripura 0.4215 0.3181 0.3432 0.7257 0.1648
UttarPradesh 0.4127 0.3254 0.2882 0.5972 0.3752
Nagaland 0.3948 0.0778 0.5107 0.6792 0.3332
Jammu&Kashmir 0.3898 0.2618 0.4253 0.5434 0.3117
Arunachal Pradesh 0.369 0.0885 0.4202 0.6312 0.3486
Delhi 0.3642 0.1938 0.2972 0.5119 0.469
Jharkhand 0.361 0.2332 0.3246 0.6146 0.1876
Meghalaya 0.3523 0.1845 0.1833 0.5612 0.4529
Bihar 0.3514 0.3046 0.2218 0.613 0.1234
Daman&Diu 0.3316 0.1731 0.2795 0.611 0.1822
Dadra&NagarHaveli 0.2553 0.1819 0.3078 0.3952 0.0921
Ministry of Health and Family Welfare
Dashboard: District across India / State -Bihar
Dash Board: Districts across India Dash Board: Districts within a State
Color coding based on quartiles:
 Green (A) : Quartile 4 – Good performing
 Yellow (B) : Quartile 3 - Promising
 Pink (C) : Quartile 2 – Low performing
 Red (D) : Quartile 1 – Very low
performing
Based on HMIS data for 2014-15
Ministry of Health and Family Welfare
Use of HMIS Data (contd.)
o Publications
HMIS data is used in various National & State level publications
National level: ​Health and Family Welfare Statistics in India.
State level: HMIS Bulletin (State UP) Swasthank (State Chhattisgarh)
State & district level “Fact Sheets” are prepared by triangulating data
from HMIS, Population Census and various published surveys.
oParliament Questions & RTI Queries
Ministry of Health and Family Welfare
Thank you

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Data Driven Decision Making in Ministry of Health and Family Welfare

  • 1. Dr Vishnu Kant Srivastava CD (Stat) Health & Family Welfare DATA DRIVEN DECISION MAKING IN HEALTH & FAMILY WELFARE
  • 2. Ministry of Health and Family Welfare DATASET CONTRIBUTED BY THE MINISTRY OF HEALTH AND FAMILY WELFARE OPEN GOVERNMENT DATA (OGD) PLATFORM INDIA (data.gov.in) Resource (Data set) Resource (App) Total Resources Total catalogs Ministry of H&FW 3155 0 3155 201 Deptt. of H&FW 3141 0 3141 187 NIHFW 4 0 4 2 Deptt. of AIDS Control 10 0 10 10 AYUSH 4 0 4 4 Note: Data from NIHFW, NACO and Ayush are uploaded by the contributors/controllers of these Departments
  • 3. Ministry of Health and Family Welfare DEPTT. PUBLICATIONS: - HEALTH AND FAMILY WELFARE STATISTICS IN INDIA - RURAL HEALTH STATISTICS IN INDIA SURVEY DATA - NATIONAL FAMILY HEALTH SURVEY - DISTRICT LEVEL HOUSEHOLD SURVEY - ANNUAL HEALTH SURVEY HEALTH MANAGEMENT INFORMATION SYSTEM (HMIS) - SERVICE STATISTICS AT FACILITY LEVEL UPLOADED BY THE STATES/UTs KEY INDICATORS FROM CENSUS AND SAMPLE REGISTRATION SYSTEM - POPULATION BY SEX, REGION, CRUDE BIRTH RATE, INFANT MORTALITY RATE, NEO- NATAL MORTALITY RATE, UNDER 5 MORTALITY RATE, MATERNAL MORTALITY RATIO(MMR) etc. DETAILS OF DATA UPLOADED IN THE PORTAL by the Deptt. of H&FW
  • 4. Ministry of Health and Family Welfare .Data disseminated by the ORGI, surveys, HMIS are used by the MoHFW to know the : • Estimated number of pregnant women, live births, number of infant for immunisation activities in different States and UTs; • To assess district-wise need to know the pregnant women, live births and infant for immunisation activities, service delivery; • To estimate number of infant deaths, under 5 deaths and maternal deaths to assess the goals to be achieved under Millennium Development Goals (MDG) and Sustainable Development Goals (SDG) which would be monitored from 2017 to 2030; • Data provides valuable input to know the status of different indicators of Maternal Health e.g. Institutional Delivery, Safe Delivery, ANC, nutritional status, anaemia, Child Health Indicators viz status of full immunization, nutritional status, anemia and current use of family planning methods, unmet needs for family planning Uses of data
  • 5. Ministry of Health and Family Welfare Annual Health Survey o Conceived at the behest of the National Commission on Population, PMO and Planning Commission Objective o Providing benchmarks of core vital and health indicators at the district level and map its change on a continual basis to assess the efficacy of various health interventions under National Health Mission. o Implemented through the ORGI in 284 districts of 8 EAG States and Assam
  • 6. Ministry of Health and Family Welfare Geographical Coverage : Annual Health Survey Odisha Chhattisgarh JharkhandMadhya Pradesh Bihar AssamRajasthan Uttar Pradesh Uttarakhand
  • 7. Ministry of Health and Family Welfare NEED FOR AHS o 9 AHS States namely, Rajasthan, Uttar Pradesh, Uttarakhand, Bihar, Jharkhand, Odisha, Madhya Pradesh, Chhattisgarh and Assam constitute: • 50 percent of country’s Population • 60 percent of Births • 71 percent of Infant Deaths • 72 percent of Under 5 Deaths • 62 percent of Maternal Deaths  There is large inter-district variations in these States.  In the absence of District level vital data, State level estimates from Sample Registration System (SRS) are used for formulating district level plans.
  • 8. Ministry of Health and Family Welfare Annual Health Survey Contd… o Baseline during 2010-11 and first updation round in 2011-12 and second updation round in 2012-13. o A component on Clinical Anthropometric and Biochemical (CAB) tests to cover height / length & weight, test for anaemia and fasting blood glucose, blood pressure and salt testing to assess the level of iodine in salt consumed by households. o The survey is funded by MoHFW
  • 9. Ministry of Health and Family Welfare Subject Coverage Following broad areas are covered under AHS:  Childhood Disease  Birth Registration  Breastfeeding & Supplementation  Awareness in Mothers  Abortion  Family Planning Practices  Disability  Morbidity  Personal Habits: adults  Housing & HH Characteristics
  • 10. Ministry of Health and Family Welfare AHS Contd… KEY FEATURES Coverage- All the 284 districts of 8 EAG States and Assam. Sample Units- 20,694 statistically selected sample unit (Census Enumeration Blocks in urban areas and Villages or a part thereof in rural areas) Sample Identification Work- to uniquely identify the sample units on ground, firm up its boundaries, demarcate the localities and prepare a notional map of the sample unit was done by the staff of ORGI.
  • 11. Ministry of Health and Family Welfare KEY FEATURES  Conduct of Field Work - hybrid approach wherein fieldwork has been outsourced and supervision is being done by the ORGI.  Primary Level of Aggregation – District  Periodicity- Annual for 3 years AHS Contd…
  • 12. Ministry of Health and Family Welfare Results  State level Bulletins of all the three rounds containing the district level vital indicators viz. Crude Birth Rate, Crude Death Rate ,Infant Mortality Rate ,Neo-Natal Mortality Rate ,Under Five Mortality Rate ,Maternal Mortality Ratio ,Sex Ratio at Birth ,Sex Ratio(0-4 Years) ,Sex Ratio(All Ages) were released in 2011, 2013 and 2014.  District level fact sheets of all the three rounds containing different indicators on fertility, Mother and child care, Family planning practices , Mortality, disability ,marriage etc. also released  The survey work of CAB component has been completed and the results are available in the form of factsheets AHS Contd…
  • 13. Ministry of Health and Family Welfare National Family and Health Survey (NFHS) NFHS is a large scale nationally represented survey conducted during 1992-93, 1998-99 and 2005-06 and provides state and national level estimates Information on fertility, family planning, morbidity, infant and child mortality, maternal and child health, utilization of health services, and nutrition with an emphasis on women and young children are available Mortality:- • Neonatal, Post natal ,IMR, CMR, Under-5 mortality Fertility:- • CBR, ASFR,TFR, Birth order NFHS (2005-06) also provides population based HIV estimates for six states and provides estimates on a host of social and economic indicators as well
  • 14. Ministry of Health and Family Welfare NFHS-4 as an Integrated Survey • NFHS and DLHS were conducted with a time gap of 4 – 7 years. • In spite of having different sample size, different reference period and definition for some of the indicators included in these surveys, people /media tend to compare the results of NFHS and DLHS, leading to different conclusions. • To avoid / mitigate the problem and to facilitate regular availability of data to assess and monitor performance at more closer interval, the Ministry has decided to conduct one integrated survey in place of different surveys to provide data at the district level and to be named as National Family Health Survey (NFHS).
  • 15. Ministry of Health and Family Welfare NFHS-4 Highlights Coverage of all States/ UTs in two phases. The first phase covers (17 States / Regions)- Andhra Pradesh & Telangana, Assam, Bihar, Goa, Haryana, Karnataka, Madhya Pradesh (East), Madhya Pradesh (West), Maharashtra, Manipur, Meghalaya, Sikkim, Tamil Nadu, Tripura, Uttar Pradesh (East), Uttarakhand, West Bengal, Andaman & Nicobar Islands and Puducherry. The second phase will cover (15 States / Regions) - Arunachal Pradesh, Chhattisgarh, Gujarat, Himachal Pradesh, Jharkhand, Jammu & Kashmir, Kerala, Mizoram, Nagaland, Odisha, Punjab, Rajasthan, Uttar Pradesh (Bundelkhand + Central), Uttar Pradesh (West), Chandigarh, Dadra & Nagar Haveli, Daman& Diu, Lakshadweep and NCT of Delhi.
  • 16. Sample Size under NFHS NFHS Ever-married women Households NFHS(1992-93) 89777 (age 13-49) 88562 NFHS(1998-99) 90000 (age 15-49) 91196 NFHS(2005-06) 1,24,385 (UM- age 15-24) (M- age 15-49) 109,041 NFHS-4 625,014 women (estimated) 568,200 (estimated) Levels of Information 1. National 2. State 3. Socio-economic and demographic background
  • 17. Ministry of Health and Family Welfare • IIPS (INDIAN INSTITUTE OF POPULATION SCIENCES IS THE NODAL AGENCY • The periodicity of the survey was 5 – 6 years. Four rounds conducted in 2012-13, 2007-08 (7,20,320 Households), 2002-04, and 1998-99; • National, State and district level estimates on health and nutrition, performance of reproductive and child health programmes etc. information are made available in these surveys • The fourth round of District Level Household Survey (2012-13) has since been completed, factsheets containing important indicators for 21 States / UTs (Andhra Pradesh, Arunachal Pradesh, Goa, Haryana, Himachal Pradesh, Karnataka, Kerala, Maharashtra, Manipur, Meghalaya, Mizoram, Nagaland, Punjab, Sikkim, Tamil Nadu, Telangana, Tripura, West Bengal, Andaman and Nicobar Islands, Chandigarh and Puducherry) and 18 State Reports are available on the website of the Ministry “nrhm-mis.nic.in”. Reports of the ‘‘Facility Survey’ component of DLHS-4, for 9 States, is also available and to be uploaded on Ministry’s web site shortly DISTRICT LEVEL HOUSEHOLD AND FACILITY SURVEY (DLHS)
  • 18. Health Management Information System (HMIS) (https://nrhm-mis.nic.in)
  • 19. Ministry of Health and Family Welfare Introduction-HMIS “HMIS is an information system specially designed to assist in the management and planning of health programmes, as opposed to delivery of care”- World Health Organization A health management information system is an essential management tool to monitor how far we have travelled, and where the gaps are…
  • 20. Ministry of Health and Family Welfare HMIS: Key Features o Web based MIS where facilities / districts / states are reporting data on a defined periodicity in pre-defined formats o Captures data related to service delivery (performance related) and facility infrastructure o 1.94 lakh facilities across 672 districts of India uploading monthly data on performance indicators o Reports available in public domain
  • 21. Ministry of Health and Family Welfare HMIS data is available on Data portal of India under Open Government Data (OGD) Platform India (https://data.gov.in) Data includes indicators related to: Maternal Health related • ANC related • Delivery care related • Post Natal Care • MTP & Abortion Child Health related • New born details • Immunization related • Child hood diseases Family Planning • Male sterilization • Female sterilization • IUCD & other temporary methods Health Facility services • OPD/ IPD • Surgeries • RKS • Ambulance services Laboratory Testing • Hb • HIV • Malaria Mortality related • Maternal Deaths • Infant deaths • Adolescent & Adult Deaths Availability on Data portal of India
  • 22. List of reports available on HMIS Public Domain Standard reports • Data Reporting Status • Data Itemwise • Data Itemwise Comparison • Performance of Key HMIS Indicators • RCH Reports - Indicator Wise • RCH Reports - State Wise • Min-Max Report • Range wise Report Analytical reports • Scorecard & Dashboard • Factsheet: State & District • CHC Star Rating Shared with Data.gov.in
  • 23. Ministry of Health and Family Welfare Use of HMIS Data o Planning HMIS data is widely used by States in preparing Program Implementation Plans (PIPs) under NHM. Indicators from HMIS (like Institutional Deliveries, C -Section deliveries, Immunization, IPD, OPD, Surgeries, etc.) are used to evaluate the state performance during National Programme Coordination Committee (NPCC) meetings Facility wise data of CHCs is used for rating the facilities. This rating is also a conditionality for approval of funds under NHM
  • 24. Ministry of Health and Family Welfare CHC Star Rating  Based on the available infrastructure at the health facility and the services being provided, the performance of a facility is rated vis-à-vis other facilities.  Data reported by the facilities in Infrastructure and MIS monthly format is used for generating Star rating report.  For Star Rating report the following aspects / categories are considered: • Human Resources available • Infrastructure available • Drugs & Supplies • Service Availability • Client Orientation • Service Utilization Use of HMIS Data: Planning (contd.) CHC Star Rating: Karnataka (2014-15)
  • 25. Ministry of Health and Family Welfare CHC Star Rating (contd.) The rating of the facility is done based on the criteria given below: • If the facility satisfies criteria for HR available & Infrastructure available, facility is eligible for Star Reporting & gets 1 Star. • Facility gets one star each for satisfying criteria for Drugs & Supplies, Service Availability, Client Orientation and Service Utilization • If the facility fails to satisfy criteria for HR available or Infrastructure available, facility is not eligible for Star Reporting with status “NE” (Not Eligible) • If the facility fails to satisfy both of the criteria (i.e. HR available & Infrastructure available) & do not have Drugs and supplies, Service availability and Client Orientation then Star Reporting is not applicable for facility & status of facility will be “NA” (Not Applicable) . Use of HMIS Data: Planning (contd.)
  • 26. Ministry of Health and Family Welfare Use of HMIS Data (contd.) o Monitoring & Evaluation HMIS data is used in various monitoring visits like CRM (Common Review Mission), Supportive supervision, Mission Indradhanush & various field visits Calculation of DLIs (Disbursement Linked Indicators) for NUHM- DLI1- institutional Deliveries, DLI2- Fully immunised children HMIS data is also used in DMU report (Delivery Monitoring Report of PMO)- DLI1, DLI2, male & female sterilisations. HMIS data is used in RFD (Result Framework Document) –Home Deliveries HMIS scorecards are used for evaluating State/ District/ Sub district performance for indicators related to RMNCH+A
  • 27. Ministry of Health and Family Welfare Use of HMIS Data: Monitoring & Evaluation (contd.) Dashboard & Scorecard • Visual presentation in the form of ‘Maps’ for depicting status of different components of services delivered under RMNCH+A strategy for states/districts/ blocks • Compares states/districts/blocks using the Overall Composite Index • Highlight inequities across states, districts and blocks for focusing on areas lagging behind • Two types: Districts across country Districts within a State
  • 28. Ministry of Health and Family Welfare Dashboard & Scorecard: Indicators Total of 16 indicators covering 4 stages of lifecycle: Use of HMIS Data: Monitoring & Evaluation (contd.)
  • 29. Ministry of Health and Family Welfare List of Indicators Sl. No Stages of life cycle Indicators Association Proportion of: 1 Pre Pregnancy / Reproductive age Post-partum sterilization against total female sterilization Positive 2 Male sterilization to total sterilization conducted Positive 3 IUCD insertions to all family planning methods (IUCD plus permanent) Positive 4 Pregnancy care 1st Trimester registration to total ANC registration Positive 5 Pregnant women received 3 ANC check-ups to total ANC registration Positive 6 Pregnant women given 100 IFA to total ANC registration Positive 7 Cases of pregnant women with Obstetric Complications and attended to reported deliveries Positive 8 Pregnant women receiving TT2 or Booster to total number of ANC registered Positive 9 Child Birth SBA attended home deliveries to total reported home deliveries Positive 10 Institutional deliveries to total ANC registration Positive 11 C-Section to reported deliveries Positive 12 Postnatal maternal& new born care Newborns breast fed within 1 hour to live births Positive 13 Women discharged under 48 hours of delivery in public institutions to total no. of deliveries in public institutions Negative 14 Newborns weighing less than 2.5 kg to newborns weighed at birth Negative 15 Newborns visited within 24hrs of home delivery to total reported home deliveries Positive 16 Infants 0 to 11 months old who received Measles to reported live births Positive
  • 30. Ministry of Health and Family Welfare Dashboard & Scorecard: Methodology 1. Generation of 16 indicators 2. Identification of Max value and Min value 3. Calculation of Index value for each district for each indicator • Positive indicator: • Negative indicator: 4. Calculation of Composite index Xid- Min(Xid) Index Value, Xid = ----------------------------------- Max(Xid) – Min(Xid) Max(Xid)- Xid Index Value, Xid = ----------------------------------- Max(Xid) – Min(Xid) Composite Index for dth (d=1,2,......,n) district = 𝑋𝑖𝑑 𝑦 𝑖=1 𝑦 Use of HMIS Data: Monitoring & Evaluation (contd.)
  • 31. Ministry of Health and Family Welfare Dashboard & Scorecard: All India across States (2014-15) Use of HMIS Data: Monitoring & Evaluation (contd.) Color coding based on quartiles:  Green (A) : Quartile 4 – Good performing  Yellow (B) : Quartile 3 - Promising  Pink (C) : Quartile 2 – Low performing  Red (D) : Quartile 1 – Very low performing Overall Index
  • 32. Ministry of Health and Family Welfare Scorecard: All India across States (2014-15) Sikkim 0.6656 0.4678 0.6472 0.7226 0.9188 Kerala 0.627 0.5334 0.695 0.8183 0.3963 Tamil Nadu 0.6225 0.6153 0.6765 0.6747 0.4938 Lakshadweep 0.5812 0.5588 0.4238 0.6857 0.6016 Punjab 0.5705 0.4888 0.6666 0.6782 0.4308 Karnataka 0.5466 0.4943 0.6085 0.7999 0.1495 Assam 0.5291 0.4735 0.4305 0.6772 0.4734 A &N Islands 0.5281 0.6321 0.5937 0.5994 0.1705 Chandigarh 0.5189 0.5183 0.506 0.5325 0.5102 Maharashtra 0.4998 0.3889 0.6503 0.6921 0.2136 Telangana 0.4939 0.4088 0.5562 0.7128 0.2086 Uttarakhand 0.4936 0.3824 0.4086 0.6982 0.423 AndhraPradesh 0.4891 0.4061 0.4978 0.697 0.2722 Mizoram 0.487 0.3789 0.5279 0.6311 0.3862 Gujarat 0.4815 0.407 0.5076 0.6809 0.2472 Manipur 0.4791 0.1737 0.5122 0.6031 0.7485 Chhattisgarh 0.476 0.3924 0.329 0.7327 0.3345 Overall Index Pregnancycare ChildBirth Postnatal maternal & newborncare Composite Index( 2014-15) Pre Pregnancy/ Reproductive age group State/UT Sikkim 0.6656 0.4678 0.6472 0.7226 0.9188 Kerala 0.627 0.5334 0.695 0.8183 0.3963 Tamil Nadu 0.6225 0.6153 0.6765 0.6747 0.4938 Lakshadweep 0.5812 0.5588 0.4238 0.6857 0.6016 Punjab 0.5705 0.4888 0.6666 0.6782 0.4308 Karnataka 0.5466 0.4943 0.6085 0.7999 0.1495 Assam 0.5291 0.4735 0.4305 0.6772 0.4734 A &N Islands 0.5281 0.6321 0.5937 0.5994 0.1705 Chandigarh 0.5189 0.5183 0.506 0.5325 0.5102 Maharashtra 0.4998 0.3889 0.6503 0.6921 0.2136 Telangana 0.4939 0.4088 0.5562 0.7128 0.2086 Uttarakhand 0.4936 0.3824 0.4086 0.6982 0.423 AndhraPradesh 0.4891 0.4061 0.4978 0.697 0.2722 Mizoram 0.487 0.3789 0.5279 0.6311 0.3862 Gujarat 0.4815 0.407 0.5076 0.6809 0.2472 Manipur 0.4791 0.1737 0.5122 0.6031 0.7485 Chhattisgarh 0.476 0.3924 0.329 0.7327 0.3345 Goa 0.47 0.3546 0.5541 0.6121 0.3413 MadhyaPradesh 0.468 0.4015 0.3626 0.7558 0.2046 WestBengal 0.4618 0.4272 0.422 0.6601 0.2286 Haryana 0.4608 0.4312 0.4185 0.5383 0.4233 Himachal Pradesh 0.4595 0.4728 0.3814 0.563 0.3429 Rajasthan 0.4583 0.3644 0.5252 0.636 0.2518 Odisha 0.4575 0.4605 0.393 0.6003 0.279 groupAssam 0.5291 0.4735 0.4305 0.6772 0.4734 A &N Islands 0.5281 0.6321 0.5937 0.5994 0.1705 Chandigarh 0.5189 0.5183 0.506 0.5325 0.5102 Maharashtra 0.4998 0.3889 0.6503 0.6921 0.2136 Telangana 0.4939 0.4088 0.5562 0.7128 0.2086 Uttarakhand 0.4936 0.3824 0.4086 0.6982 0.423 AndhraPradesh 0.4891 0.4061 0.4978 0.697 0.2722 Mizoram 0.487 0.3789 0.5279 0.6311 0.3862 Gujarat 0.4815 0.407 0.5076 0.6809 0.2472 Manipur 0.4791 0.1737 0.5122 0.6031 0.7485 Chhattisgarh 0.476 0.3924 0.329 0.7327 0.3345 Goa 0.47 0.3546 0.5541 0.6121 0.3413 MadhyaPradesh 0.468 0.4015 0.3626 0.7558 0.2046 WestBengal 0.4618 0.4272 0.422 0.6601 0.2286 Haryana 0.4608 0.4312 0.4185 0.5383 0.4233 Himachal Pradesh 0.4595 0.4728 0.3814 0.563 0.3429 Rajasthan 0.4583 0.3644 0.5252 0.636 0.2518 Odisha 0.4575 0.4605 0.393 0.6003 0.279 Puducherry 0.4575 0.3093 0.6167 0.5239 0.4346 Tripura 0.4215 0.3181 0.3432 0.7257 0.1648 UttarPradesh 0.4127 0.3254 0.2882 0.5972 0.3752 Nagaland 0.3948 0.0778 0.5107 0.6792 0.3332 Jammu&Kashmir 0.3898 0.2618 0.4253 0.5434 0.3117 Arunachal Pradesh 0.369 0.0885 0.4202 0.6312 0.3486 AndhraPradesh 0.4891 0.4061 0.4978 0.697 0.2722 Mizoram 0.487 0.3789 0.5279 0.6311 0.3862 Gujarat 0.4815 0.407 0.5076 0.6809 0.2472 Manipur 0.4791 0.1737 0.5122 0.6031 0.7485 Chhattisgarh 0.476 0.3924 0.329 0.7327 0.3345 Goa 0.47 0.3546 0.5541 0.6121 0.3413 MadhyaPradesh 0.468 0.4015 0.3626 0.7558 0.2046 WestBengal 0.4618 0.4272 0.422 0.6601 0.2286 Haryana 0.4608 0.4312 0.4185 0.5383 0.4233 Himachal Pradesh 0.4595 0.4728 0.3814 0.563 0.3429 Rajasthan 0.4583 0.3644 0.5252 0.636 0.2518 Odisha 0.4575 0.4605 0.393 0.6003 0.279 Puducherry 0.4575 0.3093 0.6167 0.5239 0.4346 Tripura 0.4215 0.3181 0.3432 0.7257 0.1648 UttarPradesh 0.4127 0.3254 0.2882 0.5972 0.3752 Nagaland 0.3948 0.0778 0.5107 0.6792 0.3332 Jammu&Kashmir 0.3898 0.2618 0.4253 0.5434 0.3117 Arunachal Pradesh 0.369 0.0885 0.4202 0.6312 0.3486 Delhi 0.3642 0.1938 0.2972 0.5119 0.469 Jharkhand 0.361 0.2332 0.3246 0.6146 0.1876 Meghalaya 0.3523 0.1845 0.1833 0.5612 0.4529 Bihar 0.3514 0.3046 0.2218 0.613 0.1234 Daman&Diu 0.3316 0.1731 0.2795 0.611 0.1822 Dadra&NagarHaveli 0.2553 0.1819 0.3078 0.3952 0.0921
  • 33. Ministry of Health and Family Welfare Dashboard: District across India / State -Bihar Dash Board: Districts across India Dash Board: Districts within a State Color coding based on quartiles:  Green (A) : Quartile 4 – Good performing  Yellow (B) : Quartile 3 - Promising  Pink (C) : Quartile 2 – Low performing  Red (D) : Quartile 1 – Very low performing Based on HMIS data for 2014-15
  • 34. Ministry of Health and Family Welfare Use of HMIS Data (contd.) o Publications HMIS data is used in various National & State level publications National level: ​Health and Family Welfare Statistics in India. State level: HMIS Bulletin (State UP) Swasthank (State Chhattisgarh) State & district level “Fact Sheets” are prepared by triangulating data from HMIS, Population Census and various published surveys. oParliament Questions & RTI Queries
  • 35. Ministry of Health and Family Welfare Thank you

Editor's Notes

  1. One should keep in mind that level of mortality and fertility do not represent estimates for same years as the survey years. In general, 3-4 years retrospective births are clubbed to calculate fertility rate. Similarly, almost 10-years retrospective deaths are considered to calculate IMR, NMR and under-5 mortality. Therefore, fertility and mortality situation at state level shown in the report do not refer to the survey years but two and five-years back respectively.
  2. In NFHS (2005-06), the number of ever-married women were 94,194.
  3. Source : HMIS Standard Reports : As on 30 Dec 2015