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by @SocialWellNet

By @GaraiAtanu

When India introduced the Mother and Child Tracking System as national MIS for its maternal and child health program in December 2009, most states were running their own MIS applications. Several states like Tamil Nadu, Kerala, Rajasthan, and others were running for more than 5 years.

In its initial years, states heavily inflated data they reported in MCTS to showcase their performance in MCH programs. District units started reporting exaggerated figures especially towards the end of the financial year, in the month of March. Even within the government health administration, few relied upon MCTS data for program monitoring. Roll out of MCTS across India took almost 4 years, from 2010 to 2013.

MCTS is a name-based tracking system which capture information on maternal and child health. I did a review of MCTS back in 2012 when it was capturing following key data points(1):

Pregnant Women

  • Location details (state, district, block, address)
  • Identification details (Name, date of birth, phone, Janani Suraksha Yojana, caste)
  • Health provider details (HSC, ANM, ASHA, linked facility for delivery)
  • ANC details (LMP, ANC dates, TT, IFA, anemia, complications)
  • Pregnancy outcome (place, delivery date, JSY benefits)
  • PNC details (dates)
  • Infant details

Children

  • Location details (state, district, block, address)
  • Identification details (Name, date of birth, phone, Janani Suraksha Yojana, caste)
  • Health Provider details (HSC, ANM, ASHA)
  • Immunization details (Dates for BCG, OPV, DPT, hepatitis, measles, MR Vitamin A)

In our visits to a number of health centers and focus group discussions with providers, we found a delay in submission of data, as much as 2 to 3 months. Evidently, with such delays, health services may not be benefitted from a name-based tracking system such as MCTS.

Public Health Foundation of India evaluated MCTS around the same time in Rajasthan and Uttar Pradesh, using data quality assessment (DQA) method to evaluate data quality, along with an assessment survey for assessing implementation challenges(2). The assessment found that data was mostly incomplete – beneficiary profile was mostly incomplete in Rajasthan and beneficiaries were excluded in Uttar Pradesh.

While Rajasthan had registered all sampled women and 85% of sampled children registered in MCTS, their profiles were 64% complete. In comparison, MCTS in Uttar Pradesh excluded 21% of sampled pregnant women and 43% of sample children. Profile data in Uttar Pradesh were 38% complete for women and 56% for children. The study underlined several causes that contribute to these limitations in data quality:

  • Suboptimal field level data collection,
  • Consolidation and transfer processes,
  • Inconsistent training levels for health staff, and
  • Lack of clear monitoring and supervision guidelines.

Besides, the study highlighted limitations in human resources, connectivity, and power supply challenged a smooth implementation.

Another study conducted during September 2013 – March 2014 in Haryana emphasized upon same infrastructural challenges that were experienced in 2009 (3). The study, in addition, reported an interesting observation on the reach and usage of SMS that MCTS generates based on the profile and transactional data entered in the system. The study found that only 18% of the beneficiaries reported to have received SMS while only 6% could understand the content in those SMS.

We can conclude this discussion from these 5 key takeaways:

  1. While MCTS has brought uniformity in MCH indicators and reporting across India, we need significant improvements in timeliness and completeness in data reporting through MCTS portal.
  2. Though MCTS has been in existence for more than 7 years now, we are still fixated in making data input work. As a result, health providers and beneficiaries have never truly experienced the benefits of having an effective name-based tracking system.
  3. There have been significant public investments in human resources (data entry and analysis), connectivity, and infrastructure built at district and block levels for smooth implementation of MCTS. This calls for a cost-effectiveness analysis with an alternate technology strategy such as using mHealth.
  4. Both reach and usage of SMS that MCTS broadcasts need rigorous evaluation. Most programs designed to provide customized reminders and motivational messages have adopted voice calls. We must take a hard look at this strategy before sending millions of messages.
  5. MCH is one area where thousands of NGOs and innovators are working in India and globally. Both operationally and technologically, MCTS offers little scope to these agencies either to leverage its data in their work or to contribute data to MCTS.

Sources:

  1. Delivery quality health, nutrition, and WASH in Uttar Pradesh: An ICT strategy recommendation for 2013-2017 (unpublished report prepared by Garai, Atanu).
  2. Gera, Rajeev et al. “An in-Depth Assessment of India’s Mother and Child Tracking System (MCTS) in Rajasthan and Uttar Pradesh.” BMC Health Services Research 15 (2015): 315. PMC. Web. 17 Feb. 2017.
  3. Nagarajan P, Tripathy JP, Goel S. Is mother and child tracking system (MCTS) on the right track? An experience from a northern state of India. Indian J Public Health. 2016 Jan-Mar;60(1):34-9.
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What are the key takeaways from evaluations of India’s Mother and Child Tracking System?