CEGIS - SPM KA - Assignment 1 - KA Healthcare Data Analysis.pptx

Health strategy

1. Analysis of Karnataka’s performance on NFHS indicators & HMIS data Santosh Deshpande 9167150842

2. Contents of the Presentation 01 Key Indicators considered for evaluation 02 Key Insights from the analysis 03 Analysis of Golden Indicators – IN vs KA 04 Analysis of Golden Indicators – States 05 Analysis of KA HMIS Data & Insights 06 Key Recommendations for Karnataka

3. Key Indicators considered for evaluation Sl. Golden Indicators Coverage Rationale 1 Sex Ratio Sex ratios – General population and ratio at birth Important indicators to assess equality, and India has recorded a positive ratio for the first time 2 Basic facilities Population with electricity, sanitation, drinking water, health insurance Gives an idea about quality of life 3 Fertility rates Total Fertility Rate Important to understand population growth trends 4 Child mortality rates NMR, IMR, U5MR Important Child Health indicators 5 MCH & delivery care indicators Antenatal checks, Spend on delivery, C-section, Public & pvt facilities Important MCH indicators 6 Child vaccination indicators Vaccination coverage, coverage through public & private facilities signify protection from diseases, and impact of child mortality 7 Nutrition Indicators Child nutrition – stunting, wasting, sever wasting, overweight Adult nutrition – BMI, and obesity One of the biggest new-age challenges India is facing 8 Anaemia indicator Percentage anaemic in for children, women and men One of the pressing issues being faced. Governments spending significantly on these. 9 Lifestyle diseases Blood sugar & hypertension indicators for men & women First time included in NFHS. Important from new-age, obesity related challenge perspective 10 Gender-based violence Spousal violence, abuse during pregnancy, sexual violence Important indicators, often have linkage to mother & child health 11 Alcohol & tobacco consumption Alcohol & tobacco consumption in men & women above 15 age-group Important social indicators

4. Key Insights from the analysis Sl. Golden Indicators Coverage Key insights 1 Sex Ratio Sex ratios – General population and ratio at birth KA fares better than national figures. Improvement from N4 to N5 is also better than national performance 2 Basic facilities Population with electricity, sanitation, drinking water, health insurance KA performance is better than national figures, except healthcare financing, where state is lagging and there is no improvement from N4 to N5 3 Fertility rates Total Fertility Rate KA TFR is less, and decreasing, indicating population decline 4 Child mortality rates NMR, IMR, U5MR KA performance is better on absolute percentage. However, improvement from N4 to N5 is lower 5 MCH & delivery care indicators Antenatal checks, Spend on delivery, C-section, Public & pvt facilities KA performance is better. Slight concern in two areas - C Section deliveries & OPEs in public facilities. Both are higher than national numbers, and increase from N4 to N5 is also high 6 Child vaccination indicators Vaccination coverage, coverage through public & private facilities KA performance is better. Over 90% in public facilities. 7 Nutrition Indicators Child nutrition – stunting, wasting, sever wasting, overweight Adult nutrition – BMI, and obesity Child nutrition is challenge - absolute percentages are concerning. Below-normal BMI are less and decreasing, the obesity indicators have increased significantly. Also, KA performance is worse compared to IN. High-risk, wait-to-hip ratio, measured first time, has significant numbers 8 Anaemia indicator Percentage anaemic in for children, women and men Big concern. Increase across categories for IN & KA (8-15% rise). Children - 67% (15% rise), Women - 57%. KA HMIS numbers are still worse - 94% of tested cases 9 Lifestyle diseases Blood sugar & hypertension indicators for men & women Medication- 13-15% for blood sugar & 21-24% for hypertension 10 Gender-based violence Spousal violence, abuse during pregnancy, sexual violence KA shows some inconsistency – 116% rise in spousal violence & decline in physical abuse during pregnancy 11 Alcohol & tobacco consumption Alcohol & tobacco consumption in men & women above 15 age-group Included for the first time. Rural consumption is higher in both cases, for KA & IN

5. Indicator Category Sex Ratio Fertility rate Child Mortality Basic facilities Indicator Sex Ratio General Sex ratio at birth Total fertility rate Neonatal mortality Infant mortality Under5 Mortality Population with Electricity Population with drinking water Population with sanitation Population with cookig fuel Population with healthcare financing support IN Total 1020 929 2 24.9 35.2 41.9 96.8 95.9 70.2 58.6 41 IN NFHS4 991 919 2.2 29.5 40.7 49.7 88 94.4 48.5 43.8 28.7 IN N4 to N5 3% 1% -9% -16% -14% -16% 10% 2% 45% 34% 43% KA Total 1034 978 1.7 15.8 25.4 29.5 99.1 95.3 74.8 79.7 28.1 KA NFHS4 979 910 1.8 18.5 26.9 31.5 98.3 95.3 57.8 54.7 28.1 KA N4 to N5 6% 7% -6% -15% -6% -6% 1% 0% 29% 46% 0% Key observations In both ratios, KA fares better than national figures. Improvement from N4 to N5 is also better than national performance KA TFR is less, and decreasing, indicating population decline All three mortality rates are less than national numbers However, reduction from N4 to N5 is lower than national numbers Performance of KA on Elecctricity , Ddrinking water, Sanitation & Cooking fuel are better than national numbers However, in critical factor like healthcare financing the state is lagging. Also, in this, there is no improvement from N4 to N5 Inference, if any NA NA NA This may be related to poor implementation of Central Govt., schemes like Ayushman Bharat, and State's very own Yeshsvini scheme. The OPEs for delivery are also higher than national numbers, and have increased from N4 to N5 Analysis of Golden Indicators – IN vs KA

6. Indicator Category Family planning MCH & delivery care Child vaccination indicators Indicator FP method use Female sterlization Male sterilization Health-worker IEC on FP Antenatal checkup in 1st trimester Average OPE in public facility Institutional births Institutional births in public facility Private facility birhts with C sec Public facility birhts with C sec Children with full immunzation Children with full immunication with card Children with 3 doeses of DPT & penta Children with vaccination in public facility Children with vaccination in private facility IN Total 66.7 37.9 0.3 23.9 70 2916 88.6 61.9 47.4 14.3 76.4 83.8 86.7 94.5 4.2 IN NFHS4 53.5 36 0.3 17.7 58.6 3197 78.9 52.1 40.9 11.9 62 77.9 78.4 90.7 7.2 IN N4 to N5 25% 5% 0% 35% 19% -9% 12% 19% 16% 20% 23% 8% 11% 4% -42% KA Total 68.7 57.4 35.8 71 4954 97 64.8 52.5 22.6 84.1 88.3 92.1 91.7 7.9 KA NFHS4 51.8 48.6 0.1 19.8 65.9 4824 94 61.2 40.3 16.9 62.6 72.7 77.9 88.2 11.4 KA N4 to N5 33% 18% -100% 81% 8% 3% 3% 6% 30% 34% 34% 21% 18% 4% -31% Key observations Usage of FP methods is lower, however the increase from N4 to N5 is significanlty higher, especially Health-care IEC (81%) KA performance on MCH & Delivery care indicators is better than national numbers. However, two areas where there is a slight concern - C Section deliveries & OPEs in public facilities. Both are higher than national numbers, and increase from N4 to N5 is also high KA performance is better than national numbers. Notable is that more than 90% are done in public facilities. Even in urban areas, average is 87% and 82% for IN and KA Inference, if any The numbers for Health-care IEC, may be one of the reasons from better performance on other FP indicators. Also, from HMIS data, over 1.5 cr condoms have been distributed, reflecting the efforts towards FP Globally, C-sec deliveries are on the rise. In India & KA, though the rates in public facilities are lower than private ones, indicating a possibility of unnecessary procedures, in line with several anecdotal cases visible in public domain. Numbers from KA HMIS align with these findings. Over 4.35 lakh immunisation sessions are organizedd , and total 1.45 cr vaccinations are recorded, which is about 70% of the required. However, numbers reported for DPT and Hepatitis are very low in KA HMIS Analysis of Golden Indicators – IN vs KA

7. Indicator Category Anaemia in Children, Women & Men Child Nutrition Adult Nutrition Indicator Children (<5) with anaemia Non-pregnant Women (15-49) with anaemia Pregnant Women (15-49) with anaemia All Women (15-49) with anaemia All Women (15-19) with anaemia Men (15-49) with anaemia Men (15-19) with anaemia Children (<5) stunded Children (<5) wasted Children (<5) severly wasted Children (<5) underweight Children (<5) overweight Women with below normal BMI Men with below normal BMI Women with Obese BMI Men with Obese BMI Women with high risk wait-to-hip ratio Men with high risk wait-to-hip ratio IN Total 67.1 57.2 52.2 57 59.1 25 31.1 35.5 19.3 7.7 32.1 3.4 18.7 16.2 24 22.9 56.7 47.7 IN NFHS4 58.6 53.2 50.4 53.1 54.1 22.7 29.2 38.4 21 7.5 35.8 2.1 22.9 20.2 20.6 18.9 NA NA IN N4 to N5 15% 8% 4% 7% 9% 10% 7% -8% -8% 3% -10% 62% -18% -20% 17% 21% NA NA KA Total 65.5 47.8 45.7 47.8 49.4 19.6 26.5 35.4 19.5 8.4 32.9 3.2 17.2 14.3 30.1 30.9 45.1 38.9 KA NFHS4 60.9 44.8 45.4 44.8 45.3 18.3 24.5 36.2 26.1 10.5 35.2 2.6 20.7 16.5 23.3 22.1 NA NA KA N4 to N5 8% 7% 1% 7% 9% 7% 8% -2% -25% -20% -7% 23% -17% -13% 29% 40% NA NA Key observations Anaemia is a big concern for the country For both IN & KA, anaemia across categories has increased, though KA performance is better than IN level Anaemic children has reached 67%, while in women it is 57%. Numbers in children has seen 15% rise at IN level, and 8% in KA level. KA HMIS numbers are still worse - out of PWs registered & tested for anaemia, 94% reported to have Hb below 7, and only 4% have undergone any treatment, as per records Child nutrition numbers, at both IN and KA level, are concerning. While the performance from N4 to N5 has improved, absolute percentages are still a worry While the under-nourishment indicator of below-normal BMI are less and decreasing, the obesity indicators have increased significantly. Also, KA performance is worse compared to IN, as obseity numbers are higher and have increased at a higher rate from N4 to N5. High-risk, wait-to-hip ratio was measured for the first time, and significant numbers are reported at both IN 7 KA levels, however KA fares a little better. Inference, if any Government has been working towards anaemia -free nation, however, the numbers speak otherwise, and give an indication that efforts arent tielding results. The numbers, as per some reports, are 15-10% in excess compared to global bechmarks . While malnutrition has been a chellenge , the rise in overweight indicator are significant, indicating childhood obesity issues, arising mostly from sedatary lifestyle and lower physical activity Obesity is going to be the next big challenge for India, and KA. The indicator numbers direct towards an increasingly obese nation, mostly owing to lifestyle issues, unhealthy food choices. Understandably, numbers for Urban are worse compared to Rural, for both IN & KA Analysis of Golden Indicators – IN vs KA

8. Indicator Category Lifestyle Health Women Empowerment Gender based violence Alcohol & Tobacco Consumption Indicator Women with high blood sugar level, taking medicines Men with high blood sugar level, taking medicines Women with high blood pressure, taking medicines Men with high blood pressure, taking medicines Women owning house/ land (joint/ alone) Women with active bank acocunt Women with active mobile phone Married women (18-49) faced spousal violence Married women (18-49) faced physical violence during pregnancy Women (18-29) facing sexual violence by 18 Women (>15) consuming tobacco Men (>15) consuming tobacco Women (>15) consuming alcohol Men (>15) consuming alcohol IN Total 13.5 15.6 21.3 24 43.3 78.6 54 29.3 3.1 1.5 8.9 38 1.3 18.8 IN NFHS4 NA NA NA NA 38.4 53 45.9 31.2 3.9 1.5 NA NA NA NA IN N4 to N5 NA NA NA NA 13% 48% 18% -6% -21% 0% NA NA NA NA KA Total 14 15.6 25 26.9 67.6 88.7 61.8 44.4 5.8 11 8.5 27.1 0.9 16.5 KA NFHS4 NA NA NA NA 51.8 59.4 47.1 20.6 6.5 10.3 NA NA NA NA KA N4 to N5 NA NA NA NA 31% 49% 31% 116% -11% 7% NA NA NA NA Key observations Blood sugal levels & hypertensions were included for the first time. 13-15% of the population is on blood sugar medication, and 21-24% is for hypertention Significant rise in women with bank acccount, owing to digitization and UPI At IN level, there is decline is gender-based violence, while at KA, the data shows some inconsistency (116%), while data for physical abuse during pregnency sshows decline Alcohol & tobacco consumption is included for the first time. Urban-Rural analysis reveals that both tobacco & alcohol consumtion is higher in rural areas, for both IN & KA Inference, if any A combined reading of the lifestyle health indicators and obesity related indicators give a sense that obsesity will be an added challenge for the nation NA NA NA Analysis of Golden Indicators – IN vs KA

9. Analysis of Indicators – KA vs IN vs KL* *- considered indicators with % values only In most cases, KA performed better than IN, and lower than KL

10. Sl. No Key indicator Analysis as per HMIS Inference, if any 1 Type of facility 75% are HWC/SC reporting HMIS use at sub-center level is encouraging 2 ANC registration within 1st trimester 80% of the total registered   3 Copleted TT shots & took TT booster 72% and 29% Significant improvement needed for booster target 4 PW with 4 or more ANC checks 89% of the registered   5 Tested for Hb & among found anaemic among tested, and treated among + ive 89% and 94% and 4% Anaemia is a significant challenge. 65% children & 48% women in KA are anaemic as per NFHS5. Numbers have increased avg 7% from NFHS4 6 No. of institutional deliveries 75% of the register pregnant cases   7 Male - Female child births 51% & 49% respectively Compared to NFHS5, data seems to be aligned, with 978 as sez ratio at birth for KA 8 Underweight children 10% of the children born & weighed are underweight (<2.5kg at birth)   9 Family planning Significant activity in family planning, with >2.79 lakh instances of support - >99% targeted for women, except condom distribution (1.55 Cr) There is a need to increase male sterilization efforts. In NFHS also, female sterilization is 57%, while male sterilization is 0% (aligns with HMIS data - 722) 10 Pregnancy kits vs Condoms 1.5 cr vs 7.61 lakhs PKT distribution needs to rampedd up 11 Immunization coverage 71% of the expected vaccination is covered Vaccination for DPT and Hepatitis is very low (<1%). This needs to be ramped up significantly 12 Male-female vaccination ratio 52% and 48% respectively Aligns with the child birth ratio, indicating consistency 13 Immunization efforts More than 4.35 lakh sessions held   14 Vitamin A coverage More than 70% of the expected coverage achieved   15 Diabetes & Hypertension numbers 23 and 24 lakh patients reported to diabetic and having hupertension NFHS5 data also indicates significant population suffering from this - (15% & 26%). Critical, concerted efforts are needed Analysis of Indicators – KA HIMS

11. Key Recommendations for Karnataka

12. Thank you