A study on the implementation of Mother and child tracking system in Chilakaluripeta Cluster,
Guntur district, Andhrapradesh.(Code: ABO30110403)
By
Dr. M. Siva Durga Prasad Nayak (PG),Dr. A. Krishnaveni Professor,Dr. S. AppalaNaidu Professor & HOD,Dr. P. J. Srinivas Assistant Professor,Department of Community Medicine,Andhra Medical College,Visakhapatnam.
Background
In India Maternal mortality& Infant mortality rates are very high when compared to developed countries. Understanding the role of computers in public health, Indian government started an e-governance tool, Mother& child tracking system (MCTS) in 2010.
Background
Success of any e-governance tool implementation depends on four pillars.
Aim& Objectives
Aim:
To formulate suggestions for better implementation of MCTS.
Objectives:
1. To Study the status of availability of infrastructure and skilled personnel related to MCTS.
2. To identify technical errors if any in the design of MCTS website.
3. To study knowledge and practices of ANMs regarding MCTS.
4. To study the e-governance characteristics in MCTS.
Methodology
Study design: It is an observational cross-sectional study conducted at Chilakaluripeta Cluster, Guntur District which has 1CHNC office, 4PHCs& 34sub-centers .
Study period: October to November 2012.
Study tools: Computer, Internet connection, Mobile phone, CHNC records.
Study Procedure: We had taken prior permission from DM&HO Guntur, obtained username, password& got access of MCTS website.
We reviewed tracking procedure, MCTS website& collected information through phone calls to ANMs.
Methodology
Inclusion Criteria: All the ANMs working in Chilakaluripeta Cluster were included in the study.
Exclusion Criteria: ANMs who were not responded are excluded from study.
51 ANMs Responded
64 ANMs Contacted
Health providers64 ANMs 156 ASHAs
Chilakaluripeta Cluster4 PHCs 34 Sub Centres
Results:- status of availability of infrastructure
Name of Institution Working Computer Working Internet Connection
Edlapdu PHC Present Present
Ganapavaram PHC Present Present
Kavuru (NRT) PHC Present Present
Nadendla PHC Present Present
Chilakaluripeta CHNC Present Present
Availability of Working Computers and internet connections were 100% in Chilakaluripeta Cluster
Results:- status of availability of Skilled personnel
Name of Institution Data Entry Operator/ LD Computer
Alternative arrangements for Data Entry with in Institution
Chilakaluripeta CHNC Present Not Required
Nadendla PHC Present Not Required
Ganapavaram PHC Absent Present
Edlapdu PHC Absent Present
Kavuru (NRT) PHC Absent Absent
Data-entry operators were seen in 40% of institutions, alternative arrangements were made in another 40% institutions
Results:- Technical Errors in design of MCTS webportal
No CAPTCHA was seen, login was not blocked even after 5 failed attempts
CAPTCHA: Completely AutomatedPublic Turing test to tell Computers and Humans Apart
Results:- Technical Errors in design of MCTS webportal
Possibility for duplicate data:
There are four types of possibilities for duplicate data entry
1) Duplicate entry of health providers:
a) ANMS details
b) ASHAS details
2) Duplicate entry of beneficiaries:
a) Pregnant Mother
b) New born children
Duplicate entry of health providers is most common type which
will effect the tracking of registered mother and children.
Results:- Technical Errors in design of MCTS webportal
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
ANMs ASHAs Total
64156 220
2845 73
Total Number of Duplicate Registrations
Total Number of Registerations in portal
201 293
One fourth of health providers registrations were duplicated.
92
Results:- Technical Errors in design of MCTS webportal
Other minor Observations
2% health providers enter Land line numbers instead of Mobile Numbers.
No option to link health facilities for immunization of a child which is available in Maternal services data entry (linking health facility for deliveries).
No separation of Temporary residents and Usual residents in the reports of services delivered by Health facilities.
SMS, Content& IVR modules are not working.
Results:- Knowledge of health workers regarding MCTS
2427
Number of ANMs know about procedure of MCTS
Number of ANMs don’t know about procedure of MCTS
Total : 51 47% ANMs knew about the procedure of MCTS
Results:- Practices of health workers regarding MCTS
43
44
Data entry practices of ANMs
Entering Data Monthly
Entering Data Fortnightly
Entering Data Weekly 51
Receiving SMS
ANMs Reciving SMS regularly
Majority of ANMs entering data monthly and all are receiving SMS regularly
Results:- Healthworkers opinion regarding MCTS
51 1010Felt as Helpful in their duties
Felt as Extra burden to routine duties
All the ANMs felt that MCTS is helpful& one fifth of them stated that MCTS is an extra burden to them.
Results:- Availability of funds for implementing MCTS
There is no separate allocation of funds for implementation of MCTS program.
ANMs are utilizing untied funds for activities like Data entry, printing reports etc.
Medical officers utilizing Hospital Development society funds for building and maintenance of infrastructure like Computers and Broadband connection.
Results:- E-governance application characteristics in MCTS
For Successful implementation of any E-governance project, the application must have some characteristics. They are…
I. Unique Working styleII. Regional language supportIII. Target group size must be very highIV. Mission Critical application character
Results:- E-governance application characteristics in MCTS
Unique Working styleHealth department is mainly service oriented department.So it needs a system that will facilitate better delivery of services rendered by the department.
MCTS completely fulfilled this.
Results:- E-governance application characteristics in MCTS
Greetings from NRHM !!ANM: Amalleswari (28-39340)District: Guntur DistrictHealthblock: ChilakaluripetaPHC: NadendlaSubcentre: Satuluru-1Services due during NOV-2012Names of Children due for vaccination:BCG:DPT, OPV, HepB 1st dose:DPT, OPV, HepB 2nd dose:DPT, OPV, HepB 3rd dose:Measles:
Greetings from NRHM !!ANM: Amalleswari (28-39340)District: Guntur DistrictHealthblock: ChilakaluripetaPHC: NadendlaSubcentre: Satuluru-1Services due during NOV-2012Names of pregnant women due for service:IFA:TT Booster:Delivery:PNC:
Results:- E-governance application characteristics in MCTS
Regional language supportMCTS is now running as Government to Government modelof E-governance and not integrated with citizens directly.But if we want to change it as Government to Citizen model ofE-governance tool, then MCTS should have regional languagesupport which is not existing presently.
Note: MCTS project (e-mamta) in Gujarat state had regional language support.
Results:- E-governance application characteristics in MCTS
Target group size must be highTarget group of MCTS includes all pregnant women from conception to till 42 days after delivery and all children up to 5 years of age. Target group size of MCTS is very large.
Results:- E-governance application characteristics in MCTS
Mission-Critical application character MCTS is online entry of services delivered by health facilities. But at the same time we are keeping the same records in
field registers at local level. So there is no problem for delivery of Government services if
the project faced any disturbances.
Conclusions
Objective 1:Availability of infrastructure -100% .Skilled persons availability - 40%.
Objective 2:Login page of MCTS website had some technical errors.Scope for duplicate registrations .No separation of Temporary residents and Usual residents in the reports.SMS, Content& IVR modules are not working.
Conclusions
Objective 3:47% ANMs knew about the procedure of MCTS.Majority of ANMs entering data monthly & receiving SMS.
Objective 4:MCTS had Unique working style character.Target group of MCTS is very large.Had Mission Critical application character. But Regional language support was not observed in MCTS.
Suggestions for better implementation of MCTS program
There is a need to
Increase skilled personnel availability, Rectify identified technical errors in the portal, Increase knowledge of ANMs about tracking procedure, Provide regional language support& Integrate more with beneficiaries for better impact of MCTS
program.
References
1) http://pib.nic.in/newsite/PrintRelease.aspx?relid=903432) http://www.who.int/mediacentre/factsheets/fs348/en/index.html3) http://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate4) http://pib.nic.in/newsite/PrintRelease.aspx?relid=856695) https://goaonline.gov.in/portalweb/login/E-governance.jsp6) http://www.csi-sigegov.org/egovernance_pdf/5_33-41.pdf7) http://e-mamta.gujarat.gov.in/8) http://nrhm-mcts.nic.in
Special thanks to
To Dr. M. Gopi Naik, District Medical & Health Officer, Guntur and to Dr. Sivakumar, Senior Public Health Officer, Chilakaluripeta Cluster for giving permission to conduct research and for giving suggestions.
To all the ANMs who were participated in the study for giving information.
Hoping this research will be benefited to target group of MCTS Program…..
Thank you
