Micro data can improve public health systems
Lastmile health care delivery suffers from a dearth of efficiently deployed data, and a lack of coordination
India ranks 154 out of 195 countries in terms of health performance, says the Global Burden of Disease Study. But one should not blame the design of the health system for this adverse report card. The main problems lie in the dearth of efficiently deployed micro-data and the lack of a co-ordinated approach on the issue of last-mile health care delivery.
The health system provides for three kinds of frontline workers for every 1,000 people. These workers are: the Auxiliary Nurse Midwife (ANM), who provides basic health services; the anganwadi worker (AWW), who is responsible for the monitoring of child nutrition, and the Accredited Social Health Activist (ASHA), who mobilises the community. Together, these workers (AAA) could be a powerful force, if they can focus their efforts first on the most at-risk cases within a village.
But this is not happening because of various reasons. First, an ASHA worker visits homes in no order of priority with no focus on critical cases. Second, an anganwadi worker has to spot malnourished children under the age of six. But the cases she has to find are often buried deep in ill-maintained registers. The data the ANM receives from these workers often does not arrive at all. Another problem is the absence of micro-data, which can be efficiently shared by the AAA workers.
Good micro data – well envisaged, efficiently captured and smartly used ---- is arguably one of the biggest needs in health care delivery in India. Currently, an AWW maintains 11 registers, the ANM five, and the ASHA one. Information on a single beneficiary can be spread over multiple registers.
The AAA also need a simple system to monitor health performance of beneficiaries in her village. She needs to be able to look at trends, recognise patterns and ask relevant questions in order to become an effective front line problem solver. This requires an efficient mechanism to share data among the AAA workers.
Some interesting innovations are being tested in states such as Rajasthan, Bihar and Gujarat to enable better data use by frontline health workers. Rajasthan has simplified the registers that an AAA use. An original system of village mapping is being rolled out in which the AAA meet, share information and place bindis of different colours on those houses with the most urgent cases. They develop a household to-visit calendar to prioritise service delivery, rather than go the sequential way. Women come in to the anganwadi centre where the maps are mounted to ask what they have to do to get the red bindi removed from their house. The panchayat takes notice, and monitors progress.