Potential Bottlenecks in Implementing MCTS in Odisha.

Potential Bottlenecks in Implementing MCTS in Odisha.IntroductionM early(a) and child docking arranging (MCTS) is the online softw argon apply by the National Health Mission (NHM), pee-peeerly National verdant Health Mission (NRHM), for tele-monitoring Reproductive and peasant Health (RCH) go delivered by the Government of India(1). It is an innovation of Health and Family Welfare (HFW) department supported by the National Health Mission(2). This software was conceived way back in 2008 to cast up the coverage of RCH services. Left verboten and drop out beneficiaries for various services, including immunisation, croupeister be shacked name keen utilize this formation. Using this software, makee wise and even wellness unit wise relevant development can be retrieved from both location by any health or associated authority by logging on to the system victimization the exercisingrname and password willd to him/her(3). It can greatly reduce the death rates of baby and beat and even reduce total fertility rates through with(predicate) an attempt to provide global coverage of services.The origin of the concept is conjugated to the tracking of due beneficiaries in immunization sessions using the tracking bag(4) at the sub-center. The tracking bag consists of 14 pockets, of which 12 are meant for 12 months in the year and two more meant for children with pinpoint and incomplete immunization condition respectively. Due beneficiaries for a particular month are tracked using counterfoils which would be kept in the pockets for the particular month.MCTS utilizes two initializes for capturing info for naked beneficiaries Format I and Format II. The former one is meant for mothers and the latter is for children born(p) of these mothers. Once a woman is detected to be pregnant, she is depicted with the health system in the MCTS register so as to receive all the bump health services and details are captured in the format I. The info are t hen sent every hebdomad, via the supervisors to the hamper aim, for online entropy launching into the MCTS. The same is also done for all newborn babies using format II. Services received by the beneficiaries are supposed to be keep in the acquire and Child Protection (MCP) card provided to the beneficiaries. Subsequently, every week sub-center wise work excogitate is generated from the MCTS and distributed through the supervisors to the sub-center Auxiliary Nurse Mid-Wife (ANM), for providing the services, update the services received and tracking the beneficiaries who could not avail the services.Work thinks are generated for various kinds of services like registration of pregnant woman, antenatal tutorship services, delivery services, post-natal care services for mother and neonatal child, child health services including immunization, family planning services, etc(2). In short the system perfectly tries to track the left out and drop out case wise, and ensure universal d elivery of services(2)(5).Presently MCTS is employ throughout the state and plentifulnesss of gentleman alternatives have been deployed by NHM at block and regularise levels to enter, analyze and track the selective information for the mother and child services. As compared to the proportionate improver in the human resources and other investments, the service coverage has not increased comfortably (for example immunization coverage). Even certain studies on weapons for tracking immunization in developing countries show similar results(6). There has been disparity during data validation exercises using health indicators from sources like Health Management and info System (HMIS)(7) and MCTS. Even no assessment has been under conditionn to fall over the bottlenecks of MCTS. Hence a excogitate was planned to identify and provide suggestions for correcting the bottlenecks in the effectuation of mother and child tracking services in the state of Odisha, if any existed.Object ives of the countTo understand the execute of implementation of Mother and Child Tracking Sytem in Odisha and identify the bottlenecks in the implementation process, if any.To identify feasible solutions and suggest recommendations for the identify bottlenecks.Method of studyThe study was qualitative in nature. It was conducted in one-third UNICEF supported districts (all tribal predominant) of Odisha state (having 30 districts) from August 2013 to November 2013. In-depth inter judgment (IDI) was the line tool for data accrual. Key program implementers involved in the process were listed graduate along with their assumed roles and responsibilities (Table 1). Judgmental sampling method(8) was then used and IDI was done with identify observe informants involved in the implementation of MCTS (block and district level bonkrs and supervisors). A total of 15-24 in-depth interviews (IDI) were planned for the study (regarded as the power point of thematic and theoretical saturation )(8). The end point planned was the point when no new qualitative information was received(9).Three blocks each of these districts were randomly selected and key informants were identified for IDIs. Consent was taken from the interviewers using WHOs informed respond form for qualitative studies(10). Personal interviews were performed with a pre-determined and pre-tested tool with more lots than not open ended and few close ended questions/ probes (Box 1). on with that atonement level of the implementers was demeaned using a continuous scale(11). lots feasible solutions and suggestions as recommended by the informants were also noted along with bottlenecks. info collection, cleaning and analysis was done simultaneously. Recorded data were transcribed one by one by two researchers onto paper, translated to English and then manually analyzed. The qualitative gist analysis method was employed(12)(13)(14) for analysis. Nine major heads were identified for the purpose- human res ource issue, data generation issue, issues with skill, data innovation issues, covering fire events, software issues, supervision, review and pecuniary topics. All other findings were shake off under a ten percent head. After data analysis, brainstorming sessions were carried with the RCH team of UNICEF Field office to put forth other recommendations for the issues noted.reticuloendothelial systemultsA total of 20 interviews were conducted in the study with six to seven interviews on an average from each district. Time for the interviews ranged from negligible of 25 minutes to a maximum of 40 minutes. Block level data managers and block program managers in charge of MCTS in the block were identified as the key informants at the block level. Lady health visitors (LHVs) and Health Supervisor (HS (M)) were likewise admitd in the process. Interviews were also conducted with zone Data Managers (DDM) who was the supervisor of BDMs at the district level.Interviews with the stakehol ders revealed that there has been a lot of improvement in certain service delivery components. Some of these include availableness of a definite work plan (also called due list) for the ANM and accepted Social Health Activist (ASHA) every week, validation of HMIS data, entering data and assessing reports from any place using provided username and password, validation of incentives provided to beneficiaries and to ASHA for various activities, improvement in service delivery for various national health programs, etc.We are able to review the sectors based upon the MCTS data. LHVNow, the health workers have materialized the benefits and use of MCTS and are frequently asking for clarifications, when required. BPMIt was observed that the work plan and reports passed through all the stakeholders of MCTS, including the supervisors. But the involvement in terms of brain of the process and providing mentoring support was poor, as cited by a few. The reports were collected at the end of th e HWF, who would submit reports to their sector level supervisors. Details of the flow mechanism of reports are shown in Fig. 1.On an average satisfaction level regarding implementation of MCTS among block and district level stakeholders was found to be 7 out of 10 (range 4 to 9). Lack in the perfection of the implementation were many, s dizzyly of which were analyzed and placed in Table 2. It was also noted that a BDM had to devote a great proportion of his sentence for data entre thus disturbing the equilibrium between personal and professional life. This was develop up especially for those located in big blocks and universally for everyone nigh on an average 15 days (last week of a month and first week of the following month), at the time of report collection and entry. Verbatim of about of the important issues found during the interview are listed knock off under.Health workers collect their work plans on their own or in some indefinite process. But the collection of upda ted work plans from the workers is being done in sector meetings.LHVWe are facing problem in covering the beneficiaries in outreach areas due to seasonal and migration issues. LHVThe software needs to be improved.BPMHMIS software is better than MCTS with respect to report generation and review monitoring. The MCTS software is oft slower than HMIS and needs high speed internet connectivity.BPMDue to profits connectivity issues, we often ask the BDMs to come to the district NRHM Office and do the data entry here. DDMDiscussion and RecommendationsTracking down beneficiaries to increase the coverage of services can unimpeachably reduce the number of miss outs and drop outs for any services catered, and with stringent implementation as planned can definitely improve service delivery. Moreover the planning component of some of the health programs can be addressed in the process. But it was found that issues always did exist at all levels and all components of this nave model.A unity register needs to be maintained integrating components of mother register and child register, which will reduce the work extend of the health workers. The simple availability of logistics like paper and cartridge for printing can be some of the minor issues, which if addressed can bring out successful results. Similarly, engaging the data entry operators in the tasks they are meant for can provide fibre inputs to the tracking system, not only in terms of improving the data quality, but also an effective plan generation, follow up and tracking of miss out and drop out cases and health review. It will provide a working environment and boost the motivation of these DEOs. Review of MCTS entry, analysis and tracking of follow up of instances should be done block wise with team effort rather than having any single individual accountable. Supervisors should take on an important part in offering mentoring support for tracking, record keeping and updating. An effective model of internal mo nitoring and/or mentoring system for underperforming sub-centers in MCTS implementation (eg. Using Lot Quality Assurance take Method) is needed.Own server can be set up at the state to solve server speed issues. More data entry staff at the block level is needed so as to reduce data entry load in large blocks with immense data load. More number of ANMs or support in the form of extra ANMs is needed in sub-centers with more population. This solution has also been cited in other studies of the same author(15). Data Entry Operators (DEOs) for Rashtriya Swasthya Bima Yojana (RSBY)(16) can be active in data entry activities wherever the data entry load is high. A proper operational research can throw light on the mechanism to identify blocks needing more human resources along with other financial support.All services provided and recorded in MCP card should be fed into MCTS to make effective tracking possible. Customization of the software for integrating and collateral data of othe r related programs like internal Based immature Care(17), Special Newborn Care Unit(18)(19), etc. can also be done. Adequate contingency provision in the NHM PIP should be made. Collaborating with rambling partners to develop SMS based portal for reporting details of a benefactive role can be done and this can also provide real time reporting. Similarly loading the data in a geographical Information System (GIS) based maps can be used increase tracking mechanism one step further(20). Extra incentives for each additional work put to the BDMs, may be provided. Training pharmacists in ODMIS(21) can decrease the workload on BDM at the block level.ConclusionMother and child tracking system is an innovative method of tracking down the beneficiaries name wise, with an objective to bring down the IMR, MMR and TFR. It can help the brass to achieve universal coverage of services. Presently MCTS has helped the service providers to effectively manage miss outs and drop outs for various se rvices like immunization, family planning, maternal and new-born care. ecesis of HMIS and incentives (to beneficiaries and ASHA) is also being done using MCTS. In spite of all positive aspects, practical issues were found to exist and need to be select out. Review, in detail, can sort out many operational and financial issues. Needs of large blocks should be addressed specifically. Server issues need to be addressed along with a provision of SMS based reminders. Real time data entry can make things more convenient. Correct and complete entries in the MCP will help in appropriate utilisation of the software. citeThe authors would like to thank program managers from National Health Mission and health staff of the state government for participating in the study and providing cogitation realities. Dr. Ashish Kumar Sen, being supervisor of the team, had supported the study and provided relevant inputs is also acknowledged.Competing busyThis article was accepted and presented as a con ference paper at the International Telemedicine Conference held at Jaipur in 2013.References1. Achievements of MDG Commitments Made Under NRHM Internet. narrow Information Bureau, Government of India. 2012 cited 2014 Nov 25. lendable from http//pib.nic.in/newsite/erelease.aspx?relid=825202. Operational Manual Mother and Child Tracking System Internet. National Rural Health Mission 2010 cited 2014 Nov 17. operational from https//nrhm-mis.nic.in/Home MCH Tracking System/User manual for MCH Tracking by NIC PDF format.pdf3. 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