Health Policy Issues and Health Programmes in ... - Amazon S3

National Health Programmes: An OverviewIntegrated Management Information SystemOur past experience with the effort for implementing an integrated management informationsystem (MIS) has not been very encouraging. Initially, under the MPW scheme, the integratedmanagement information and evaluation system was launched and, through a series of training/orientation workshops, all or most states were persuaded to adopt it. Later, the MIS wascomputerized and, through the NICNET, it was expected to function. However, it is worthwhile toreview current experience with the MIS, as there appears to be no uniformity of application inmost states.Monitoring and EvaluationQuite closely linked with the MIS is programme monitoring and evaluation. Each programmehas evolved its own system of data generation and reporting to different levels ofadministration. However, currently one of the weak aspects of programmes is the analysis of thedata generated and its meaningful interpretation by programme managers for making rationaldecisions to improve programme implementation. Some programmes have evolvedappropriate monitoring indicators (input and programme performance) and impact indicators(TB, leprosy, and immunization programmes) that are already included in their guidelines.Many programmes have not made such attempts. The purely mechanical transfer of dataupwards from levels below, without its proper utilization, is what is happening in most states.This needs to be corrected soon. Sophisticated computerized data management will becomeeffective only if the programme officers ask for proper analysis of the data generated and basetheir actions on meaningful interpretation of data.Periodical evaluation of national programmes will yield good results, which would be beneficialfor identifying corrective actions based on facts. The Tuberculosis and Leprosy Programmes areregularly reviewed, while the Universal Immunization Programme (UIP) was reviewed at thenational level once in 1989. The Cancer Control Programme is currently being evaluated.Importance of Integrated and Participatory Programme Implementationand PlanningWith the exception of a few programmes, leprosy for example, most national programmeshave been designated as integrated with the general health services at the service deliverylevel. The primary health care staff, the PHC medical officer, and the supporting staff of thePHC are expected to implement the service activities. Because the activities to be performed bythe different staff have not been clearly identified or properly scheduled, there is chaos in theactual functioning of staff at the grass-roots level. Some activities are neglected while othersget overemphasized. One reason for this could be the lack of clear instructions regarding thejob responsibilities of the staff. Another reason is probably the lack of integrated planningwith appropriate coordination of activities under different programmes. Some of theprogrammes are meticulously planned, for example, the UIP in the late 1980s and the currentPulse Polio Programme. In fact, lessons learned for micro-planning from these programmeswere expected to be introduced into the other programmes. So far, however, this does notseem to have happened.25