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ANNUAL HEALTH SURVEY FACT SHEET KEY FINDINGS

ANNUAL HEALTH SURVEY FACT SHEET KEY FINDINGS. Dr. C. Chandramouli Registrar General & Census Commissioner, India.

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ANNUAL HEALTH SURVEY FACT SHEET KEY FINDINGS

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  1. ANNUAL HEALTH SURVEYFACT SHEETKEY FINDINGS Dr. C. ChandramouliRegistrar General & Census Commissioner, India

  2. “ Reproductive health and rights are integral to sustainable development and poverty reduction. Investing in universal access to reproductive health is crucial investment in healthy societies and a more sustainable future”. – Ban Ki-moon, Secretary-General, UN on World Population Day, 2012

  3. “ Working for the survival and the well being of women and girls is a human right imperative. And in order to take advantage of women’s full potential in the development of their nations, they must be able to plan their lives and families.” – Babatunde Osotimehin, Executive Director, UNFPA on World Population Day, 2012

  4. AHS provides key indicators on Reproductive and Child Health at District level in 8 EAG States and Assam Vital inputs for evidence based intervention and monitoring

  5. “ There should be an Annual Health Survey of all districts which could be published/monitored and compared against benchmarks” -Dr. Manmohan Singh, Prime Minister of India – In the meeting of National Commission of Population, 2005

  6. OBJECTIVE OF AHS • AHS yields a comprehensive, representative and reliable dataset on core vital indicators including composite ones like IMR, MMR and TFR along with their co-variates (process and outcome indicators) at the district level and maps changes therein on an annual basis. • These benchmarks would help in better and holistic understanding and timely monitoring of various determinants on well-being and health of population particularly Reproductive and Child Health.

  7. Coverage : Annual Health Survey

  8. WHY AHS? • AHS States constitute: • 48 percent of country’s Population • 59 percent of Births • 70 percent of Infant Deaths • 75 percent of Under 5 Deaths • 62 percent of Maternal Deaths • Enable direct monitoring of UN Millennium Development Goals on Child Mortality and Maternal Health at the district(s) level. • Help in identifying high focus districts meriting special attention in view of stark inter-district variations in these States. • Provide critical inputs to assess the milestones of various interventions including NRHM and pave the way for evidence based planning.

  9. KEY FEATURES • Coverage- All the 284 districts of 8 EAG States and Assam. • Sample Units- 20,694 statistically selected sample unit (Census Enumeration Blocks in urban areas and Villages or a part thereof in rural areas) • Sample Identification Work- to uniquely identify the sample units on ground, firm up its boundaries, demarcate the localities and prepare a notional map of the sample unit was done by the staff of ORGI. • Sample Units per district- 73. • Sample Population- About 20.1 million The Largest Sample Survey in the World

  10. KEY FEATURES Contd… • Sample Population per district -About 71 thousand. • Sample Households - 4.1 million households. • Sample households per district - About 14.5 thousand. • Conduct of Field Work - hybrid approach wherein fieldwork has been outsourced and supervision is being done by the ORGI. • Primary Level of Aggregation – District • Periodicity-Annual

  11. Indicators under AHS • In all, 161 indicators are available from AHS baseline: • Fertility- 13  Sex Ratio- 3 • Marriage- 5  Mortality- 7 • Mother & Child Care- 63 • Ante Natal Care: 11  Delivery Care: 8 • Post Natal Care: 5  JananiSurakshaYojana (JSY): 3 • Immunization: 8  Vitamin A & Iron Supplements: 2 • Birth Weight: 2  Childhood Disease: 6 • Birth Registration: 2  Breastfeeding & Supplementation: 12 • Awareness in Mothers: 4 • Abortion- 6  Family Planning Practices- 15 • Disability- 1  Morbidity- 19 • Personal Habits:adults-4  Housing & HH Characteristics- 13 • Others- 12

  12. Indicators under AHS Contd… • Under 1st phase of AHS following 9 indicators have already been released: • Crude Birth Rate (CBR)  Crude Death Rate (CDR) • Infant Mortality Rate (IMR)  Neo-Natal Mortality Rate (NNMR) • Under Five Mortality Rate (U5MR)  Maternal Mortality Ratio (MMR) • Sex Ratio at Birth (SRB)  Sex Ratio (0-4 years) and • Sex Ratio (All ages) • Remaining 152 indicators are being released under present phase of dissemination.

  13. Five Core Themes Covered • The presentation focuses on results pertaining to 5 core themes: • Total Fertility Rate • Family Planning: Current Usage & Total Unmet Need • Ante Natal Care • Delivery & Post Natal Care • Immunization and Breast Feeding Practices

  14. Total Fertility Rate (TFR) • TFR is the average number of children born to a woman during her entire reproductive span. • Uttarakhand & Odisha and UP & Bihar reflects the two extremes. • Significant Rural-Urban variation across all 9 AHS States, the max. in Uttar Pradesh.

  15. Total Fertility Rate (TFR) Contd… • Within a State, the minimum variability of 1.3 reported in Chhattisgarh and the maximum, 3.6 in Uttar Pradesh. • Across 284 districts in 9 AHS States, it ranges from 1.7 in Pitthoragarh (Uttarakhand) to 5.9 in Shrawasti (UP)- a variability of more than 4 children.

  16. Total Fertility Rate (TFR) Contd… • 20 districts namely Kamrup, NC Hills, Nalbari (Assam); Puri, Khordha, Angul, Jajpur, Jagatsinghpur, Baleshwar, Sundargarh, Doegarh, Jharsugdha, Bargarh (Odisha); Nainital, Almora, Bageshwar, Pitthoragarh, Rudraprayag, Chamoli, Uttarkashi (Uttarakhand)have already achieved the replacement level of 2.1. • 46 districts have TFR below the current National average of 2.5 (SRS 2010). • 164 districts have recorded TFR of 3.1 and above, the National level TFR of 2001 (SRS).

  17. Total Fertility Rate (TFR) Contd…

  18. Family Planning: Current Usage • Contraceptive Prevalence Rate (CPR) is the percentage of currently married women aged 15-49 yrs who are using any method of contraception (modern/traditional). • Current usage of any method varies from 37.6 in Bihar to 64.5 per cent in Rajasthan. • Rural – Urban divide is significant in Jharkhand and Bihar.

  19. Family Planning: Current Usage Contd… • Within a State, the least variation is reported in Uttarakhand whereas the most, in Uttar Pradesh. • At district level, current usage of family planning ranges from 21.9 in Sitapur (UP) to 79.2 in Ganganagar (Rajasthan) exhibiting a variability of 4 times.

  20. Family Planning: Current Usage Contd… • As high as 98 districts are reporting less than 50% current usage of any method of family planning. • Only 12 districts namely Damoh, Betul, Jabalpur (MP), Baleshwar (Odisha), Ganganagar, Hanumangarh, Jhunjhunu, Alwar, Udaipur, Dungarpur, Banswara (Rajasthan) and Jhansi (UP) feature in 70% & above category. • 35 out of 37 districts of Bihar have reported less than 50% usage of any method of family planning.

  21. Family Planning: Current Usage Contd…

  22. Family Planning: Current Usage Contd…

  23. Unmet Need for Family Planning • Currently Married Women who are not using any method of contraception but who do not want any more children or want after a period of 2 years are defined as having an unmet need. • Total unmet need varies from a minimum of 19.6% in Rajasthan to 39.2% in Bihar. • Rural- Urban gap is prominent in Jharkhand, Bihar and Uttar Pradesh. • Unmet need for Family Planning is a crucial indicator for assessing the future demand for Family Planning services / supplies.

  24. Unmet Need for Family Planning Contd… • The minimum variability within a State is in Uttarakhand whereas the maximum in Uttar Pradesh. • Baleshwar (6.1%) in Odisha and Sitapur (61.3%) in Uttar Pradesh are the two extremes across 284 districts.

  25. Unmet Need for Family Planning Contd… • Only in 69 out of 284 districts, the total unmet need for family planning is below 20%. • Bihar and Uttar Pradesh dominate in 40% & above category.

  26. Mean Age at Marriage- Female • Mean Age at Marriage is based on the marriages taken place during 2007-2009. • Mean age at marriage of females varies from 19.7 in Rajasthan to 22.0 years in Uttarakhand. • Rural – Urban differential is of at least 1.4 years in all AHS States. This is quite prominent (2.3 years) in Madhya Pradesh & Rajasthan.

  27. Marriages among Females below Legal Age (18 yrs) • Based on marriages taken place during 2007-2009. • Varies from 3.0% in Uttarakhand to 21.9% in Rajasthan. • In rural areas, every 4th marriage among females in Rajasthan and every 5th in Bihar & Jharkhand take place below the legal age. • Rural- Urban differential is quite significant across all AHS State.

  28. Ante Natal Care (ANC) • Any ANC exceeds 80% in all AHS States. • ANC in 1st trimester: 40% in UP & Bihar to 65% in Chhattisgarh and Madhya Pradesh. • Mothers receiving 3 or more ANCs: UP-29.6% to Orissa -76.0 % • Mothers who consumed IFA 100 days or more: 6.5% in UP to 23.8% in Chhattisgarh. • Low performance in IFA consumption is the main reason for sluggish full ANC: 3.9% in UP to 19.5% in Chhattisgarh.

  29. Full Ante Natal Check-up • Full ANC comprise 3 or more ANC, at least one TT injection and consumption of IFA for 100 or more days. • Uttar Pradesh reports the minimum coverage of 3.9%; Chhattisgarh, the maximum 19.5%. • Full ANC coverage in urban areas is remarkably better than the rural areas. • In 5 States, namely Bihar, UP, Rajasthan, Uttarakhand and Jharkhand urban coverage is more than double that of Rural.

  30. Full Ante Natal Check-up Contd… • Bihar has reported the minimum variability among the districts compared to Odisha reporting the maximum. • Less than 1% coverage of full ANC has been reported in Balrampur of Uttar Pradesh; on the other hand Jagatsinghpur of Odisha has reported the maximum 36%.

  31. Full Ante Natal Check-up Contd… • As high as 94 out of 284 districts report less than 5% coverage of full ANC. • Only 15 districts namely Raigarh, Mahasamund, Dhamtari (Chhattisgarh), PurbiSinghbhum (Jharkhand), Indore, Bhopal, Narsimhapur, Balaghat (MP) and Jharsuguda, Mayurbhanj, Jagatsinghpur, Cuttack, Ganjam, Kandhamal, Naupada (Odisha) have reported 25% & above coverage of full ANC.

  32. Ante Natal Check-up

  33. Institutional Delivery • Institutional Delivery: Ranges from 34.9% in Chhattisgarh to 76.1% in MP. • More than 85% of total births have taken place in Govt. Institutions in Madhya Pradesh & Odisha and it is more than 60% in remaining States except Jharkhand & Uttarakhand. • Jharkhand is the only State where more than 50% of the births are taking place in Private Hospitals.

  34. Balrampur, UP Indore, MP • Institutional delivery is below 60% in 170 districts. • Balrampur (UP) recorded the least 16.8% institutional delivery whereas Indore (MP) the most 92.5%, showing a variability of more than 5 times.

  35. Safe Delivery • Safe delivery comprise institutional deliveries and domiciliary deliveries assisted by doctor/nurse/ANM/LHV. • Safe Delivery: 47.1 % in Jharkhand to 82.2% in Madhya Pradesh. • Rural- Urban differential is quite prominent in Jharkhand, Chhattisgarh and Uttarakhand.

  36. Safe Delivery Contd… • Uttarakhand has exhibited the least variability among districts whereas Uttar Pradesh, the most. • Balrampur (UP) has reported the minimum against Indore (MP) reporting the maximum.

  37. Safe Delivery Contd… • About 1/4th of the districts have reported less than 50% of the safe deliveries. • Out of 14 districts reporting 90% & above safe deliveries, 10 belongs to Madhya Pradesh.

  38. JananiSurakshaYojana • Mothers availing JSY: 14.6% in Jharkhand to 61.6% in Odisha. • Rural- Urban differential is acute in the States of Madhya Pradesh, Odisha and Jharkhand.

  39. Post Natal Care • Mothers receiving PNC within 48 hrs of delivery varies from 57% in Assam to 74.5% in Odisha. • At least 1 in every 5 mothers did not receive any post natal check up across all AHS States..

  40. New Born Check up • New born checked up within 24 hrs of birth exceeds 50% in all AHS States. • It varies from 52.6% in Bihar to 74.9% in Odisha. • Significant Rural- Urban divide is noticed in Uttarakhand, Jharkhand, Assam and Chhattisgarh.

  41. Full Immunization • Children are considered fully immunized when they have received vaccination against Tuberculosis, 3 doses of DPT & Polio and 1 dose of measles. • All States except Uttar Pradesh have at least half of their children aged 12-23 months fully immunized. • Uttar Pradesh reports the minimum percentage of children fully immunized whereas Uttarakhand, the maximum. • Rural-Urban gap exceeds 10% in Madhya Pradesh & Jharkhand.

  42. Full Immunization Contd… • The variability among the districts within a State ranges from 32.2% in Uttarakhand to 70.0% in Odisha. • Across all 284 districts, the minimum has been observed in Rayagada of Odisha and the maximum in Kanker of Chhattisgarh.

  43. Full Immunization Contd… • 90 districts are below 50% level of full immunization. • Only 2 districts 1 each from Chhattisgarh & Rajasthan feature in 90% & above category.

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