performance monitoring plan

PERFORMANCE MONITORING PLAN (PMP) September 2014

PROGRAM MANAGEMENT & MONITORING UNIT (PMMU) PLANNING WING MINISTRY OF HEALTH AND FAMILY WELFARE GOVERNMENT OF THE PEOPLE’S REPUBLIC OF BANGLADESH

HEALTH, POPULATION AND NUTRITION SECTOR DEVELOPMENT PROGRAM (HPNSDP) July 2011 - June 2016

PERFORMANCE MONITORING PLAN (PMP)

PROGRAM MANAGEMENT & MONITORING UNIT (PMMU) PLANNING WING MINISTRY OF HEALTH AND FAMILY WELFARE GOVERNMENT OF THE PEOPLE’S REPUBLIC OF BANGLADESH September 2014

TABLE OF CONTENTS TABLE OF CONTENTS............................................................................................................................................................ 2

LIST OF ACRONYMS AND ABBREVIATIONS ................................................................................................................ 3 ACKNOWLEDGEMENTS ....................................................................................................................................................... 4

PREFACE .......................................................................................................... ERROR! BOOKMARK NOT DEFINED.

SECTION I. INTRODUCTION ............................................................................................................................................... 6

A. BACKGROUND ................................................................................................................................................................. 6 B. GUIDING PRINCIPLES OF THE PMP ......................................................................................................................10 C. BUDGETING FOR PERFORMANCE MONITORING............................................................................................ 10 SECTION II. HPNSDP RESULTS FRAMEWORK (RFW) ........................................................................................... 12

SECTION III. MANAGING FOR RESULTS .....................................................................................................................14

A. COLLECTING PERFORMANCE DATA ....................................................................................................................14 B. CONDUCTING EVALUATIONS AND SPECIAL STUDIES ................................................................................. 15 C. ANNUAL PROGRAM REVIEW (APR) ......................................................................................................................16 D. REPORTING PERFORMANCE RESULTS ..............................................................................................................19 E. ASSESSING DATA QUALITY ......................................................................................................................................19 F. PLAN FOR DATA ANALYSIS, REVIEW AND REPORTING .............................................................................. 20 G. REVIEWING AND UPDATING THE PMP...............................................................................................................21 SECTION IV. INDICATOR REFERENCE SHEETS (IRS): RFW-LEVEL INDICATORS ................................... 22

A. GOAL LEVEL INDICATORS ............................................................................................................................................23 B. COMPONENT 1: SERVICE DELIVERY IMPROVED ................................................................................................31 C. COMPONENT 2: STRENGTHENED HEALTH SYSTEMS ...................................................................................... 47 SECTION V. INDICATOR REFERENCE SHEETS (IRS): OPERATIONAL PLAN LEVEL INDICATOR........ 64

ANNEX I: HPNSDP RFW INDICATOR MATRIX........................................................................................................ 158 ANNEX II: OP-LEVEL INDICATOR (REVISED) LIST .............................................................................................. 163

ANNEX III - DATA QUALITY ASSESSMENT CHECKLIST ..................................................................................... 171

ANNEX IV - DATA QUALITY ASSESSMENT TOOL ................................................................................................. 172

ANNEX V: SURVEY MATRIX FOR 2011-2017.......................................................................................................... 175

REFERENCES ........................................................................................................................................................................ 176

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LIST OF ACRONYMS AND ABBREVIATIONS ADP AIDS AMC ANC APIR APR ARI ASFR BCC BCG BDHS BHFS BMMS CBHC CC CCSD CDC CPR CSBA DGHS DH DHS DOTS DP DPT DSF EmOC ESD FMAU FP FPFSD FWA FWV GOB HA HEF HEP HIS-eH HIV HPNSDP HRM HSM IEC IDU IFM IMCI IMR IRT IST IUD IYCF LD LLP

Annual development program Acquired immune deficiency syndrome Alternative Medical Care Antenatal care Annual program implementation report Annual program review Acute respiratory infection Age-specific fertility rates Behavior change communication Bacille-Calmette-Guerin vaccine against tuberculosis Bangladesh demographic and health survey Bangladesh health fertility survey Bangladesh maternal mortality survey Community Based Health care Community clinic Clinical Contraception Service Delivery Communicable Disease Control Contraceptive prevalence rate Community-skilled birth attendant Directorate general of health services District hospital Demographic and health survey Directly observed treatment short course Development Partner Diphtheria, pertussis, and tetanus vaccine Demand side financing Emergency obstetric care Essential Services Delivery Financial management and audit unit Family planning Family Planning Field Service Delivery Family welfare assistant Family welfare visitor Government of Bangladesh Health assistant Health Economics and Financing Health Education and Promotion Health Information Systems and e-Health Human immunodeficiency virus Health, population nutrition & population sector program Human Resources Management Hospital Services Management Information, Education and Communication Injection drug user Improved Financial management Integrated management of childhood illness Infant mortality rate Independent Review Team In-Service Training Intrauterine device Infant and young child feeding practices Line Director Local level planning

MA MARP MCRAH

Medical assistant Most-at-risk-population Maternal, Child, Reproductive and Adolescent Health MDGs Millennium Development Goals M&E Monitoring and evaluation MICS Multiple indicator cluster survey MIS Management Information Systems MNCAH Maternal, Neonatal and Child, Adolescent Health Care MOHFW Ministry of health and family welfare MMR Maternal mortality ratio MR Menstrual regulation NASP National AIDS/STD Programme NCDC Non-Communicable Disease Control NEC National Eye Care NES Nursing Education and Services NGO Nongovernmental organization NIPORT National Institute for Population Research and Training NN Neonatal mortality NNP National Nutrition Project NNS National Nutrition Services OP Operational plan ORS Oral rehydration salts PAD Project appraisal document PAP Prioritized action plan PER Public expenditure review PFD Physical Facilities Development PIP Program Implementation Plan PLSM Procurement, Logistics and Supplies Management PME Planning, Monitoring and Evaluation PMMU Program management & monitoring unit PMR Planning, Monitoring and Research PNC Postnatal care PSE Pre-Service Education PSSM Procurement, Storage and Supply Management RFW Results Framework RHMIS Routine health management information system RTI Reproductive tract infection SACMO Sub-assistant community medical officer SBA Skilled birth attendant SDAM Strengthening of Drug Administration and Management SWAp Sector-wide Approach SWPMM Sector-Wide Program Management and Monitoring TB-LC TB and Leprosy Control TFR Total fertility rate TRD Training, Research and Development TT Tetanus toxoid UESD Utilization of essential service delivery UHC Upazila health complex UP Union parishad USAID United States Agency for International Development WHO World Health Organization

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ACKNOWLEDGEMENTS This Performance Monitoring Plan (PMP) of the Health, Population and Nutrition Sector Development Program (HPNSDP) 2011-16 has been drafted by a team comprising Gabriela Escudero, Mizanur Rahman and Rashida-E-Ijdi from MEASURE Evaluation, USA, and finalized by Karar Zunaid Ahsan, Abdul Waheed Khan, M Helal Uddin and MM Reza from the Program Management and Monitoring Unit (PMMU) of the Planning Wing of the Ministry of Health and Family Welfare. The team would like to acknowledge the valuable comments and contributions of the reviewers Dr. Peter Kim Streatfield and Dr. Shams El Arifeen from the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B). The overall review and constructive feedbacks from the Monitoring and Evaluation Task Group (METG) in the Ministry of health and Family Welfare are also gratefully acknowledged.

The team also acknowledges Dr. M Khairul Hasan, Line Director of Sector-wide Program Management and Monitoring operational plan, and Ms. Shereen Akhter, Senior Assistant Chief of Planning Wing, Ministry of Health and Family Welfare for their review and valuable inputs towards the finalization of this PMP. The team would also like to thank Ms. Niru Shamsun Nahar, Joint Chief (Planning), Ministry of Health and Family Welfare, for her continuous support and overall guidance to complete the task of developing a PMP for the HPNSDP successfully.

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SECTION I. INTRODUCTION A. BACKGROUND Bangladesh Sector-Wide Programs (SWAp) in Health, Nutrition and Population (HNP) Sector The Government of Bangladesh (GOB) introduced SWAp to effectively manage the Health, Nutrition and Population (HNP) Sector. The overall purpose of SWAp and its management was to improve the performances of the HNP sector and hence, improve the health of the people of Bangladesh. The first SWAp, Health and Population Sector Program (HPSP 1998-2003), marked a shift from a multiple project approach to a single sector program. This not only ensured the Government’s leadership in preparing and implementing a program that was sustainable, but also created opportunities for better coordination, harmonization and alignment of multiple donor funded projects and resources.

The implementation of the two SWAps, e.g., HPSP and Health, Nutrition and Population Sector Program (HNPSP 2003-2011) led to significant positive changes in the health system. Uniform financial accounting procedures were developed and implemented. Significant progress was made in standardizing and unifying disbursement procedures and reducing transaction costs associated with managing multiple donor funds. Based on the satisfactory results brought in by the two SWAps, the MOHFW has decided to continue with the SWAp in health sector.

The provision in the National Constitution and guiding principles such as Vision 2021, Millennium Development Goals (MDG), and the 6th Five Year Plan (FYP), the sector wide program planning and management initiatives of the Ministry of Health and Family Welfare (MOHFW) are manifested in the Bangladesh Health, Nutrition and Population (HNP) sector strategy and the Program Implementation Plan (PIP) for the period July 2011- June 2016- titled as the Health, Population and Nutrition Sector Development Program (HPNSDP). The preparation process of the 3rd SWAp upholds and accumulates the related sectors, agencies under the MOHFW and development partners (DPs) in consultations. The experiences and lessons learned from the previous two SWAps are also considered in the preparation process.

Program Management and Monitoring Unit (PMMU) The MOHFW established the Program Management and Monitoring Unit (PMMU) in the Planning Wing of MOHFW in order to improve management, monitoring and evaluation systems of HPNSDP. The PMMU has also been set up for increasing the capacity of MOHFW to effectively monitor performance of the program. The mission of PMMU is to monitor and manage implementation of the HPNSDP, all thirty-two Operational Plans, and promote evidence-based decision-making. It will monitor utilization of fund allocation and disbursement, and will provide assessments of the HPNSDP performance. It will strengthen the monitoring capacities within MOHFW and the Directorates to efficiently use the routine data systems for decision making. It will also assist in improving the routine health management information systems (RHMIS) so that critical 6

information needed to monitor and evaluate the HPNSDP is routinely available, and that this information is complete and of good quality.

The PMMU produces the Annual Program Implementation Report (APIR) to feed into the annual program reviews (APR) of HPNSDP and advises the MOHFW on essential steps to take with respect to overall improvement of the HPNSDP implementation and other related actions. 1 A monitoring and evaluation framework, with a set of well-defined and commonly agreed upon indicators to track progress in specific areas, is the foundation for APR.

The USAID-funded Technical Assistance Support Team (TAST) to the PMMU works directly with the Planning Wing of MOHFW to manage and monitor the performance of HPNSDP. The TAST undertakes activities to strengthen the monitoring and evaluation systems and capacities within the MOHFW and the Directorates to efficiently use high quality routine health survey and evaluation information for evidence-based decision making.

The TAST, contracted by MEASURE Evaluation, supports the PMMU in strengthening and institutionalizing monitoring and evaluation within the MOHFW. The TAST also facilitates policy dialogue between the GOB and DPs, and provides technical assistance on policy matters and program implementation. In addition, the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) provides a defined operational support to the TAST and PMMU for facilitating M&E activities.

Monitoring and Evaluation of HPNSDP 2011-16

The HPNSDP’s Program Goal is to ensure quality and equitable health care for all citizens of Bangladesh by improving access to and utilization of essential health, population and nutrition services, particularly by the poor. The HPNSDP is seeking to accomplish this goal through the achievement of 14 intermediate results under two components during a five-year program that is being implemented from July 2011 to June 2016 (see Table 1).

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See TOR for the PMMU for more information regarding specific responsibilities and tasks.

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Table 1. Results of HPNSDP Component 1: Result 1.1 Result 1.2 Result 1.3 Result 1.4 Component 2 Result 2.1 Result 2.2 Result 2.3 Result 2.4 Result 2.5 Result 2.6 Result 2.7 Result 2.8 Result 2.9 Result 2.10

Service delivery improved Increased utilization of essential HNP services: maternal, neonatal, and child health; family planning and reproductive health; nutrition services; and communicable diseases Improved equity in essential HNP service utilization (MDGs 1, 4, 5, and 6) Improved awareness of healthy behavior (MDG 1, 4 and 5) Improved primary health care and community clinic (PHC-CC) systems Strengthened Health Systems

Strengthened planning and budgeting procedures Strengthened monitoring and evaluation systems Improved human resources – planning, development and management Strengthened quality assurance and supervision systems Sustainable and responsive procurement and logistic system Improved infrastructure and maintenance Sector management and legal framework Decentralization through LLP procedures SWAp and improved DP coordination (deliver on the Paris Declaration) Strengthened Financial Management Systems (funding and reporting)

The HPNSDP’s Results Framework (RFW) indicators are the basis of this PMP and are shown in the RFW Matrix (Annex I). The matrix documents the definitions, data collection procedures and sources, and HPNSDP targets. Operational level indicators are contained in the Operational Plans agreed to and approved by the MOHFW and its partners (see Annex II). The purpose of these indicators is to monitor operational progress on a relatively frequent basis. The Operational Plans will be consulted for more detail on the specific indicators for each program area.

Under the overall guidance of the Planning Wing of MOHFW, the Performance Monitoring Plan (PMP) has been developed by PMMU TAST with the technical support from MEASURE Evaluation and ICDDR,B. PMMU TAST has done extensive review of documents to draft the PMP, which will be periodically reviewed and updated following extensive discussion with the Planning Wing, selected Line Directors, DPs and technical agencies. The purpose of this document is to create and strengthen the monitoring framework within which practices for monitoring the performance of the HPNSDP are refined and shared. It also ensures that the indicators selected for measuring progress and the mechanisms for monitoring them are transparent.

The PMP document is organized as follows:  Section I introduces the PMP and provides background information;  Section II presents the Results Framework, indicators, and logical consistency of the framework;

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



Section III describes how the PMMU Team manages its program for results and covers issues such as responsibilities for various performance management tasks, including data collection, reporting, and analysis; Section IV contains Performance Indicator Reference Sheets (PIRS) for all result-level indicators, RFW and OP-level indicators.

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B. GUIDING PRINCIPLES OF THE PMP 2 The PMP is an important tool for monitoring, managing and documenting program performance. It enables timely and consistent collection of comparable performance data in order to make informed program management decisions.

A tool for self-assessment: This PMP has been developed to enable the MOHFW to actively and systematically assess HPNSDP performance results and take corrective action when necessary. At its core are practical tools such as indicator reference sheets and quality assurance checklists.

Performance-informed decision making: The PMP is designed to inform management decisions. The indicators chosen, when analyzed in combination, will provide data to demonstrate program performance. Transparency: To increase transparency, indicator and data quality assessments will be conducted, and any known limitations documented in the PMP.

Economy of effort: When selecting indicators, efforts were made to streamline and minimize the burden of data collection and reporting as much as possible given the complexity of the HPNSDP program. Data collection for each of the indicators will be reviewed with partners to eliminate duplication to the extent possible. In addition, the principle of “management usefulness” was applied to ensure that only data useful for decision making would be collected.

Participation: Finally, the PMP has been developed in a participatory manner with involvement of policy planners and Line Directors. The PMP Indicator Reference Sheets (IRS) document plans for continued stakeholders’ involvement in the analysis of performance data.

C. BUDGETING FOR PERFORMANCE MONITORING Specific Operational Plans like SWPMM, MISs, PME, PMR, and TRD, which are primarily responsible for performance monitoring of HPNSDP, have been allocated resources for monitoring and evaluation in all funding mechanisms negotiated in the health sector to date. Besides there are other OPs (e.g. CDC, MNCAH, TB/LC, NASP) as well which invest in generating routine data for implementation monitoring. However, the total cost of the stated OPs does not include HR and other investments covered by the non-development budget. The OPs primarily involved in performance monitoring (i.e. SWPMM, MISs, PME, PMR, and TRD) account for around 4% of HPNSDP development budget estimated as per the Program Implementation Plan for 2011-2016.

There is almost always a trade-off between cost and data quality. This trade-off was taken into consideration when selecting indicators and methods for data collection, and efforts were made to select the most cost-effective approaches. This being said, while HPNSDP has access to data 2

Adapted from the USAID, ADS 203.3.2.2

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collected from an established national routine health information system, specific activities aimed at improving that system are being piloted/ implemented and it may be necessary to develop new data collection structures and procedures to reflect changes as may be introduced as a result.

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SECTION II. HPNSDP RESULTS FRAMEWORK (RFW) The performance of HPNSDP, as measured by the goal level indicators in the results framework, is to reduce mortality and fertility, which will be measured by neonatal, infant, childhood, and maternal mortality and fertility rates. The reduction in mortality and fertility will be achieved by citizens’ improved healthy behavior, greater utilization of HNP services, and improved equity in HNP service utilization. These can be measured by exclusive breastfeeding rates, child immunization, institutional delivery, contraceptive use, and quintile specific comparison of health care utilization, mortality and fertility rates. The outputs of improved health behavior, greater use of services, and enhanced equity in turn will be due to the effects of service delivery provided by certain service-providing Operational Plans (OPs) of HPNSDP.

The service-delivery improvement components will have synergistic effects on the abovementioned outcomes. Several indicators (e.g., Number of Community Clinics [CC] with increasing number of service contacts over time and Percentage of upgraded union-level facilities able to provide basic emergency obstetric care [EmOC] services) will allow monitoring of the servicedelivery improvement interventions. The interventions of the health-system strengthening component will also have synergistic effects on service-delivery improvement resulting in better outcomes of health behavior and thus, achieving the overall goal of HPNSDP. The PMP has appropriate indicators at different levels that allow a measurement of effects, outcomes, and impacts.

The results based on the complete set of indicators at different levels of the health system -service-delivery, service-improvement, and the systems strengthening/reforms -- over the years of HPNSDP implementation will generate a chain of evidence of program performance. An illustrative diagram of the performance monitoring and evaluation plan is displayed in the next page.

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Figure 1. Graphical representation of HPNSDP RFW

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SECTION III. MANAGING FOR RESULTS MOHFW/PMMU and implementing partners of HPNSDP have specific roles and responsibilities in the overall performance monitoring system. The following table outlines these responsibilities for each of the major steps in the monitoring process, which are further discussed in detail in this section. Table 2. Steps in managing for results in HPNSDP

Major Steps Generating performance data Reviewing performance information Reporting performance results (Annual and Biannual HPNSDP Progress Reports, APIR) Assessing data quality Reviewing and updating the PMP Conducting evaluations and special studies

Responsibility Field-level staff from DGHS/DGFP, MIS Line Directorates, LDs PMMU/Planning Wing, MISs and Implementing agencies, DPs PMMU/Planning Wing

PMMU/Planning Wing, MIS Line Directorates PMMU/Planning Wing

Planning Wing, NIPORT, PMR and Development Partners

In addition, the Monitoring and Evaluation Task Group (METG) comprising Planning Wing staff, selected LDs, and relevant DP representatives, and chaired by the Additional Secretary of MOHFW, works towards establishing effective communication and better information/data sharing mechanisms among the MOHFW, agencies and DPs for proper monitoring and implementation of HPNSDP 3.

A. COLLECTING PERFORMANCE DATA

1. Levels of Performance Data – The MOHFW will measure performance data at two levels:

 Results-level indicators refer to indicators of program results that measure

performance against the goal level, intermediate, and lower-level results in the Results Framework and also serve as the basis for annual performance reporting. While many indicators rely on survey-based data, data from the routine health information system will be used during years when recent survey data are not available. This PMP primarily focuses on the indicators included in the Results Framework. Section IV of this document has detailed out indicator reference sheets (IRS) of the HPNSDP RFW indicators.

 Operational Plan-level indicators refer to indicators that provide useful data for 3

ongoing and continuous management of activities by the 32 Line Directorates. These

TOR of M&E Task Group

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Performance Monitoring Plan (PMP)

indicators generally provide more operational data than results-oriented data. Operational-level data can therefore be used to monitor program performance. These indicators are drawn from the Operational Plans approved by the MOHFW and its partners. The Results Framework of HPNSDP does not include collection of data at the operational level and as such, these data will be found in individual Operational Plan Progress reports and information systems. All indicators, however, including operational-level indicators, will be tracked within the PMMU database. Section V of this document has detailed out indicator reference sheets (IRS) of the HPNSDP OP-level indicators.

2. Data Collection Responsibilities

The routine health information system and Line Directors provide much of the data which serves as the basis for results-level monitoring and reporting. The PMMU will provide general oversight to ensure timely and accurate reporting of results. The PMMU will also take the lead in completion of annual data quality assessment. Ultimate responsibility, however, for routine data collection and reporting will rest with Line Directors, based on the data generated from the field. Specific responsibility for reporting on each indicator is included in the Indicator Reference Sheets.

B. CONDUCTING EVALUATIONS AND SPECIAL STUDIES Performance indicators only “indicate” progress and cannot be used to determine “why” a certain result occurs. Evaluations and special studies/surveys to collect data at the population level are ways in which the PMMU and other OPs like PMR, TRD and NCDC can complement routine performance monitoring efforts with more rigorous, in-depth analysis on topics of special interest. Some special studies/surveys such as the Bangladesh Demographic and Health Survey (BDHS) provide data for population-level indicators suitable for evaluation of program impact. Planned and potential future evaluations and special studies/ surveys are shown below, and Annex V shows a full list of probable studies/surveys.

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Table 3. Major surveys/studies planned for HPNSDP Subject of Evaluations/ Special Studies/ Surveys

Methodology

Timeline

Responsibility

Bangladesh Demographic and Health Survey (BDHS)

Nation-wide survey

2011, 2014

NIPORT & other partners

Utilization of Essential Service Delivery Survey (UESD)

Nation-wide survey

2013, 2015

NIPORT

Bangladesh Maternal Mortality and Health Care Survey (BMMS) Bangladesh Health Facility Survey

Bangladesh Urban Health Survey (BUHS) Non-communicable Disease Risk Factor Survey

Nation-wide survey

Nation-wide survey Nation-wide survey Nation-wide survey

2010, 2016 2011, 2013, 2015 2013

2010, 2014

NIPORT and other partners NIPORT

NIPORT and other partners NCDC and other partners

C. ANNUAL PROGRAM REVIEW (APR) The Planning Wing, Line Directors and Development Partners together will be monitoring performance data during the course of a financial year once an annual program implementation report (APIR) on HPNSDP is prepared by the PMMU. Depending on the results of these reviews, the Line Directors may need to adjust their programming and implementation activities. The PMMU will also conduct six-monthly program reviews of all OP activities. The PMMU will develop a program review record that includes all of the aspects of performance outlined below. Line Directors, MIS Line Directorates and other partners are involved in preparing the information for this review and attend the meetings to provide input as required. Recommendations are generated to feed into the subsequent APR for implementation.

The APR of the HPNSDP is a management instrument, designed for both the GOB and the DPs, to monitor progress in the implementation of the program and to verify that management and policy responsibilities are met. It focuses on implementation of service delivery and reform objectives and suggests a course of action related to achieving the HPNSDP goals and objectives, and provides recommendations on risk management strategies and financing of the program. The overall objectives of the APR:

• To review the implementation of the HPNSDP program and take stock of quantitative and qualitative progress and achievement of goals, targets, reforms, fund utilization and to recommend revisions to these for the remaining period of the program; and

• To review the financing arrangements and assess how well GOB and DP support meets the priorities and requirements of the HPNSDP.

The APR is carried out under the guidance of a joint GOB-DP APR Steering Committee (SC), headed by the Joint Chief (Planning), MOHFW, and is comprised of the following members 4:

4

TOR of APR Steering Committee

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I. II. III. IV. V. VI. VII.

Planning Wing, MOHFW DGHS (Planning, Monitoring and Research); DGFP (Planning, Monitoring and Evaluation); WB HNP Task Team Leader; HNP Consortium Chair; Two representatives from the HNP Consortium; One representative of Economic Relations Division of the Ministry of Finance; and VIII. One representative of Implementation, Monitoring and Evaluation Division of the Ministry of Finance.

The APR Steering Committee is primarily responsible for the following: i. ii. iii. iv. v. vi.

oversee/facilitate the APR planning and implementation process; ensure the timely submission of key reports requested for the APR; agree on Terms of Reference for the APR Consultancy Team; facilitate the Field Visits and agree on criteria for selection of locations; organize the Policy Dialogue and agree on selection of Moderator; and ensure that the wrap up discussions on the aide memoire are carried out in the spirit of partnership

APR Process

The APR process includes several steps (technical work, field visits, stakeholder consultation and policy dialogue), as detailed below: I.

II.

Annual Program Implementation Report (APIR) (see Section III-D for details) and Sixmonthly Progress Report are prepared by the MOHFW and made available to International Review Team (IRT) prior to the Technical Review (See more on APIR below.). The Technical Review is carried out by an IRT of international and national consultants that (i) collects, reviews, and analyzes data generated routinely within the health delivery system as well as additional analytical studies and qualitative data, (ii) conducts fact-finding activities, and (iii) reviews components and sub-components of programs. •

•

•

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The IRT reviews available information and assists the Task Groups in analyzing data and recommends next steps. The IRT prepares a report that is discussed in the Task Groups and, based on these discussions, an action plan is prepared that is followed up in the next year.

The IRT assesses implementation of the HPNSDP and provides a detailed analysis of selected core objectives of the program to assess how technical strategies have been backed by human resources, political economy, procurement, financing, institutional and monitoring and evaluation strategies. The IRT makes recommendations for strategies, implementation, and financing for the remaining part of the program. The IRT assesses the need for extending the program and provides an opinion if such extension would enhance chances Performance Monitoring Plan (PMP)

III.

IV.

V. VI.

for achieving the development objective of the program. It suggests options as what to do differently in the coming years in order to make sure that the intended reforms of the program are indeed implemented.

The APR aims to provide forums for field level discussions on implementation realities. Seven member groups are formed (3 MOHFW, 3 DPs and 1 IRT) consisting of senior level policy makers, development partners and IRT. The field visits focus on services to understand bottlenecks and identify solutions to health service delivery and utilization issues. Specific focus is also given on improving strategies and utilization of services aimed at improving the nutritional status of poor women and children. The process is managed by the APR SC. Brief reports on issues identified in the visit is included in the IRT Report.

Stakeholder Consultation Process: To elicit views of various stakeholder groups including the NGOs, an agency is contracted to conduct focus group discussions (FGD) with HPNSDP related users and providers. Stakeholder consultations are conducted in six divisions feeding into a discussion at the division level. The field visit team (comprised of DP, GOB and IRT members) is observed at the stakeholder discussion at the Divisional level. Based on FGDs, the agency prepares a Stakeholder Consultation Report that is an important input into the APR process.

Independent Risk Assessment and Management Report is prepared by the IRT Team Leader.

The Team Leader prepares the Independent Technical Report drawing on various inputs including the reports mentioned in (I), (II), and (III) above and from the other sources of information.

VII. The issues identified in the technical work and field visits are taken in the agenda for discussion in the task groups and the coordination committees. Each task group identifies a set of actions with timelines and responsibilities. These actions are consolidated for further discussion and endorsement at a high level Policy Dialogue to take place between senior representatives of , other actors in the HNP sector and the DPs. Key Objectives of the Policy Dialogue are defined by the APR SC, which includes: • discussion on key findings and recommendations proposed in the IRT report; • discussion on MOHFW and Donor Comments on IRT’s report; • prioritization of HPNSDP issues; and • agreement on Proposed Actions required for moving the HPNSDP program forward.

VIII. The Aide Mémoire for the APR is jointly written by GOB and DP with assistance from the PMMU TAST. A drafting committee delivers the first draft for discussions in the APR Steering Committee. The final Aide Mémoire is discussed and agreed upon in an interministerial meeting with the DPs. IX. Following the policy dialogue and agreed aide Memoire, the Annual Work Plans (AWP) of 32 OPs are developed for the following year.

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The two APRs for HPNSDP were conducted during September - November 2012 and 2013, with a focus both on institutional and service delivery aspects. Both the APRs reviewed implementation of HPNSDP in the light of an up-to-date results framework using the latest data, indicators and targets as provided in the APIR and assessed progress of the program including independent perspectives on the DAAR indicators 5 and the GAAP 6). The APRs also reviewed the financing arrangements and assessed how well the GOB and DP support had met the priorities and requirements of the HNP sector. The 2012 APR recommended a revision of OP-level indicators and put this activity as a prioritized action plan (PAP) item (#11). PMMU initiated the revision of OP indicators and shared the final revised list (a total of 158 indicators in the revised list as against 342 in the original list) with the DPs. Revised OP-level indicators have already been approved and notified by the MOHFW for implementation by the line Directors.

D. REPORTING PERFORMANCE RESULTS: THE ANNUAL PROGRAM IMPLEMENTATION REPORT (APIR)

The MOHFW uses performance information not only to assess program progress but also as the basis of its resource request for subsequent years from the World Bank. Performance information is also used to share knowledge and enhance learning throughout the MOHFW and among partners. The PMMU is responsible for submitting an annual report on HPNSDP performance against expected results, including both its successes and areas identified for improvement. The PMMU prepares a template every year for collection of raw data from the Line Directors (LDs) and the annual program implementation report (APIR) is prepared based on LD’s feedback. The APIR is prepared in accordance with the specific guidance provided by the Planning Wing. The report uses two main sources of information: (a) Result Framework indicator data; and (b) the program review process described earlier. The PMP is a key document in preparing the report since it contains information on all Result Framework indicators, including indicator and data quality assessments, responsibilities for data collection and analysis, and the management utility of each indicator.

E. ASSESSING DATA QUALITY Data Quality Assessment Procedures: The PMMU integrates data quality assessment into ongoing activities (e.g., combining a random check of data for routine health information systems with regularly scheduled site visit). This minimizes the costs associated with data quality assessment. When conducting data quality assessments, team members use the Data Quality Checklist [included in Annex III]. This checklist is only illustrative and it will be fully developed before data collection from LDs. Findings are written up in a short memo and shared with relevant LDs and the MOHFW. If the PMMU determines existence of any data limitation for performance indicators (either during initial or periodic assessments), it corrects the limitations to the extent possible. The PMMU documents any actions taken to address data quality problems in the appropriate Indicator Reference Sheet(s). If data limitations prove too 5 6

Disbursement for Accelerated Achievement of Results Governance and Accountability Action Plan

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intractable and damaging to data quality, the PMMU seeks alternative data sources, or develops alternative indicators.

Known Data Limitations and Significance (if any): While indicator specific data limitations have been identified in the indicator reference sheets – this section seeks to identify data limitations based on data collection methods and details the actions taken or planned to address these limitations. Table 4. Limitations in data collection process and mitigation measures

Data Collection Limitation Lack of consistent terms Accurate attribution of results to MOHFW supported program activities Underreporting results Lack of objective and consistent application of evaluation criteria Uncertainty related to definition of indicator

Action Planned to Address Data Limitation When possible, standardize data collection forms for uniformity of terms used and data tracked. Indicators are clearly defined to the extent possible to capture results achieved through MOHFW and partners’ activities.

Results will be reported differently to capture full impact of program efforts.

Review regularly with program managers/firstline staff to ensure adherence to evaluation criteria that have been established for data collection. Clearly defined indicators using unambiguous terms.

Date of Future Data Quality Assessments: At a minimum, data quality assessments will be performed at an interval of three years from the date of the most recent data assessment for all RFW indicators (for some, it may be more often). The dates planned for each indicator in the PMP are indicated on the Indicator Reference Sheets. Procedures for Future Data Quality Assessments: The M&E Advisor, along with the M&E Specialist (from the TAST) and other PMMU/MOHFW staff in coordination with relevant MIS Line Directorates, will perform site visits, monitor databases and evaluate, using different tools such as data checklists, interviews with providers and clients as well as semiannual meetings cooperating agencies and national/international partners. If deemed necessary, additional external evaluations of data quality will be commissioned.

F. PLAN FOR DATA ANALYSIS, REVIEW AND REPORTING Data Analysis: In general, data analysis will be done by the contractor, cooperating agency or national/international partner responsible for carrying out the activity as identified in the indicator reference sheets. As appropriate, the PMMU will also be involved in the review, analysis, and validation of the data compiled and presented to the Planning Wing, MOHFW and DPs. Activities carried out for ensuring data accuracy will be captured in the data quality assessment sheets. User-friendly raw data will also be provided to other partners, as appropriate, should additional secondary data analysis be requested. 20


Presentation of Data: Data will be presented in a variety of formats including tables, graphs and charts. Key findings will be summarized in power point presentations, brochures and posters. The data will be presented at national dissemination workshops sponsored by MOHFW, as appropriate. It will also be used as the basis for capacity building activities in monitoring and evaluation with MOHFW staff at all levels of the health system.

Review of Data: Initially, those responsible for the data collection for performance indicators (as identified in the PMP within the individual indicator reference sheets) will review the data with the appropriate contractor, cooperating agency, or partner responsible for data consistency and quality (generally at intervals of 6 months).

Reporting of Data: Data will be presented in the annual report. Data will also be reported for budget justification, annual strategy meeting presentations, mission strategy/portfolio reviews and other external presentations.

G. REVIEWING AND UPDATING THE PMP The PMP serves as a “living” document that the PMMU uses it to guide HPNSDP performance monitoring and management efforts. As such, it is updated as necessary to reflect changes in strategy and/or activities. PMP implementation is an ongoing process of review, revision, and re-implementation. The PMP is reviewed and revised as necessary, and when reviewing the PMP, the PMMU considers the following issues:   

Are the performance indicators measuring the intended results?

Are the performance indicators providing the information needed?

How can the PMP be improved? (or “Are the performance indicators requiring the PMP to be improved?”)

In case of major changes to the PMP regarding indicators or data sources, the rationale for adjustments will be documented. For changes in minor PMP elements, such as indicator definition or responsible individual, the PMP is updated to reflect the changes.

21


SECTION IV. INDICATOR REFERENCE SHEETS (IRS): LEVEL INDICATORS

RFW-

The following section contains detailed Indicator Reference Sheets (IRS) for each result-level indicator. If current result-level indicators are refined and/or additional indicators developed, the PMMU creates new indicator sheets based on this template. Each reference sheet provides information on:  Indicator definition, unit of measurement, and any data disaggregation requirements;

 PMMU data acquisition method, data sources, timeline for data acquisition, and PMMU staff

responsible for data acquisition;

 Plans for data analysis, review, and reporting;

 Any data quality issues, including any actions taken or planned to address data limitations; and  Notes on baselines, targets, and data calculation methods.

A complete table of performance data (baselines, targets, and actual) for all result-level indicators is at the end of each sheet. Note on Baselines and Targets

Baselines for a few indicators will be determined at the end of FY 2011-12, i.e., June 2012. In some cases, over the years of HPNSDP, targets for some indicators may be reset based on the recent trends in performance. This target resetting will be done during the APR.

22


A. GOAL LEVEL INDICATORS Goal Indicator 1: Infant Mortality Rate (IMR) A. Description Definition: The probability of an infant (children under one year of age) dying before the first birthday expressed per 1,000 live births during 5 years preceding the survey. Associate term: Live birth: The complete expulsion or extraction from its mother of a product of human conception, irrespective of the duration of pregnancy, which, after such separation, breaths or shows any other evidence of life such as beating of the heart, pulsation of umbilical cord, or definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached (WHO, 1950 & 1992). Numerator: Number of infant deaths during the five-year period preceding the survey X 1,000 Denominator: Total number of live births during the 5 years preceding the survey. Unit of Measure: Deaths per 1000 live births

Disaggregated by: Residence (urban/rural), administrative divisions, wealth quintile

Justification/Management Utility: The infant mortality rate measures death in the first year of life. It captures both deaths that are a result of genetic and structural malformations and birth delivery complications (most frequently in the first month of life) and those that are associated more with external social or environmental conditions (in the remaining months of the first year of life). A strengthened health system could lead to reductions in IMR by promoting (a) greater utilization of health services, and (c) improved awareness of healthy behavior. Is this an Annual Report Indicator? No

B. Plan for Data Acquisition

Data Collection Method and Date: National household surveys (BDHS 2011, 2014 and BMMS 2015). Data Source(s): BDHS and BMMS

Method of Data Acquisition by PMMU: PMMU will gather the required indicators from the published reports. Frequency and Timing of Data Acquisition by PMMU: 2011, 2014, 2015 Individual(s) Responsible at PMMU: PMOs

Individual(s)/Directorates Responsible for Providing Data to PMMU: NIPORT Location of Data Storage: MEASURE DHS, NIPORT

C. Data Quality Issues

Date of Initial Data Quality Assessment: BDHS and BMMS have their own data quality assurance schemes, and they are known for their data quality. Known Data Limitations and Significance (if any): Changes in mortality occur slowly and therefore, it is difficult to capture the short-term effects of the HPN program interventions. Actions Taken or Planned to Address Data Limitations: NA Date(s) of Future Data Quality Assessments: N/A

Procedures for Future Data Quality Assessment: N/A

D. Performance Indicator Values

Year

Actual Notes

2011 (Baseline) 52, BDHS 2007

2012

2013

2014

2015

43, BDHS 2011

43, BDHS 2011

43, BDHS 2011

-

For BDHS 2011 IMR calculated for 3 years.

2016 (Target) 31

E. Other Notes

Comments: The mortality estimates are not rates but are true probabilities calculated according to the conventional life-table approach. [BDHS 2007, p-99] The sheet last updated on: August 20, 2015 23


Goal Indicator 2: Under-5 Mortality Rate (U5MR)

A. Description Definition: The probability of dying between birth and the fifth birthday expressed per 1,000 live births during five-year periods of time preceding the survey. Associate Term: Live birth: The complete expulsion or extraction from its mother of a product of human conception, irrespective of the duration of pregnancy, which, after such separation, breaths or shows any other evidence of life such as beating of the heart, pulsation of umbilical cord, or definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached. Numerator: Number of deaths among live-births between birth and the fifth birthday during the five-year periods of time preceding the survey X 1,000 Denominator: Total number of live births during the 5 years preceding the survey. Unit of Measure: Rate per 1,000 Disaggregated by: Residence (urban/rural), administrative divisions, wealth quintile Justification/Management Utility: This is a Millennium Development Goal indicator (MDG 4). This indicator measures the risk of dying in infancy and early childhood. It reflects the socio-economic, environmental and nutrition status of children and the conditions in which they live, including their health care. This indicator may be used as a measure of children’s well-being and the level of effort being made to maintain child health. Specifically, under-5 mortality can be reduced through (a) greater utilization of health services provided by the agencies of MOHFW, (b) enhanced equity in health service utilization, and (c) improved awareness of healthy behavior. These are, in turn, affected by a strengthened health system resulting from the various HPN activities contained in the 32 operational plans. Is this an Annual Report Indicator? No B. Plan for Data Acquisition Data Collection Method & Date: National household surveys such as the BDHS 2011, 2014 and BMMS 2015. Data Source(s): BDHS, BMMS Method of Data Acquisition by PMMU: PMMU will gather the required indicators from the published reports. Frequency and Timing of Data Acquisition by PMMU: Indicator values will be recorded whenever reports are available in 2011, 2014, 2015. Individual(s) Responsible at PMMU: PMOs Individual(s)/Directorates Responsible for Providing Data to PMMU: NIPORT Location of Data Storage: MEASURE DHS, NIPORT C. Data Quality Issues Date of Initial Data Quality Assessment: Data quality of this indicator will not be assessed for this indicator since this will come from surveys. BDHS and BMMS have their own data quality assurance schemes and they are known for their data quality. Known Data Limitations and Significance (if any): Survey data are subject to recall error, and surveys estimating under-five deaths require large samples, which are costly. Indirect estimates rely on estimated life tables (see comments below) and efforts must be ensured that these estimates are appropriate for the population covered. The timeframe of under-five mortality rate obtained from BDHS or BMMS refers to 5 years preceding the survey. It may be difficult to capture the short-term effects of the HPN interventions. However, the under-five mortality estimate from the 2014 BDHS and 2015 BMMS will represent the time period 2011-1016 when the HPNSDP was implemented. Actions Taken or Planned to Address Data Limitations: Caution will be exercised to interpret the results of observed changes. Date(s) of Future Data Quality Assessments: N/A Procedures for Future Data Quality Assessment: N/A D. Performance Indicator Values Year Actual Notes

2011 (Baseline) 2012 65, BDHS 2007 53, BDHS 2011 For BDHS 2011 IMR calculated for 3 years.

2013 53, BDHS 2011

2014 53, BDHS 2011

2015 -

2016 (Target) 48

E. Other Notes Comments: The mortality estimates are not rates but are true probabilities calculated according to the conventional life-table approach. [BDHS 2007, p-99] This sheet last updated on: August 20, 2015 24


Goal Indicator 3: Neonatal Mortality Rate (NMR)

A. Description Definition: The probability of dying within the first month of life (first 28 completed days of life, 0-27 days) expressed per 1,000 live births during five-year periods of time preceding the survey. NMR is often broken down into early neonatal mortality (number of deaths within the first 7 completed days of life, 0-6 days) and late neonatal mortality rate (number of deaths within 7-27 completed days of life). Associate Term: Live birth: The complete expulsion or extraction from its mother of a product of human conception, irrespective of the duration of pregnancy, which, after such separation, breaths or shows any other evidence of life such as beating of the heart, pulsation of umbilical cord, or definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached (WHO, 1950 & 1992). Numerator: Number of deaths among live-births during first month of life (first 28 completed days of life, 0-27 days) over five-year periods of time preceding the survey X 1,000 Denominator: Total number of live births during the 5 years preceding the survey. Unit of Measure: Rate per 1,000 Disaggregated by: Residence (urban/rural), administrative divisions, wealth quintile Justification/Management Utility: NMR is the key outcome indicator for newborn care and directly reflects prenatal, intrapartum and neonatal care. Early neonatal deaths are more closely associated with pregnancy-related factors and maternal health, whereas late neonatal deaths are associated more with factors in the newborn’s environment. A strengthened health system resulting from the efforts of HPN activities contained in the 32 operational plans can help reduce neonatal mortality by promoting (a) greater utilization of health services provided by the agencies of MOHFW, (b) enhanced equity in health service utilization, and (c) improved awareness of healthy behavior specifically as it relates to antenatal care. Is this an Annual Report Indicator? No B. Plan for Data Acquisition Data Collection Method & Date: National household surveys such as BDHS 2011, 2014 and BMMS 2015. Data Source(s): BDHS and BMMS Method of Data Acquisition by PMMU: PMMU will gather the required indicators from the published reports. Frequency and Timing of Data Acquisition by PMMU: Indicator values will be recorded whenever reports are available in 2011, 2014, 2015. Individual(s) Responsible at PMMU: PMOs Individual(s)/Directorates Responsible for Providing Data to PMMU: NIPORT Location of Data Storage: MEASURE DHS, NIPORT C. Data Quality Issues Date of Initial Data Quality Assessment: Data quality of this indicator will not be assessed for this indicator since this will come from surveys. BDHS and BMMS have their own quality assurance schemes and they are known for their data quality. Known Data Limitations and Significance (if any): NMR is sensitive to changes in data quality. For example, a rise in the NMR may indicate deterioration in newborn health outcomes, or it may indicate an improvement in the reporting of neonatal deaths. The timeframe of neonatal mortality rate obtained from BDHS or BMMS refers to 5 years preceding the survey. It would be difficult to translate the short-term effects of the current programs from the observed changes in the rate. However, the under-five mortality estimate from the 2014 BDHS and 2015 BMMS will represent the time period 2011-1016 when the HPNSDP was implemented. Actions Taken or Planned to Address Data Limitations: Assessing data quality is essential in any analysis of NMR and BDHS has the built-in mechanisms and capacity to do so. Caution will be exercised to interpret the results of observed changes. Date(s) of Future Data Quality Assessments: N/A Procedures for Future Data Quality Assessment: N/A D. Performance Indicator Values Year Actual Notes

2011 (Baseline) 2012 37, BDHS 2007 32, BDHS 2011 For BDHS 2011 IMR calculated for 3 years.

2013 32, BDHS 2011

2014 32, BDHS 2011

2015 -

2016 (Target) 21

E. Other Notes Comments: Mortality during the neonatal period accounts for a large proportion of child deaths, and is considered to be a useful indicator of maternal and newborn neonatal health and care. This indicator monitors the quality of care for the neonate. This sheet last updated on: August 20, 2015 25


Goal Indicator 4: Maternal Mortality Ratio (MMR) A. Description Definition: It is the ratio of maternal deaths to live births over a certain period of time, expressed per 100,000 live births. Associate Terms: Maternal death is a death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes, expressed per 100,000 live births. Live birth: The complete expulsion or extraction from its mother of a product of human conception, irrespective of the duration of pregnancy, which, after such separation, breaths or shows any other evidence of life such as beating of the heart, pulsation of umbilical cord, or definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached.

Note: MMR is estimated on the basis of limited exposure time and a small number of events, thus having large potential sampling errors (95% intervals around each estimate). MMR is different from MMRate which is the annual number of maternal deaths occurring among women of reproductive age (expressed per 100,000 women).

Numerator: All maternal deaths occurring among ever-married women (ages 15-49 years) within 3 year period preceding the survey X 100,000 Denominator: Total number of live births occurring within the same reference period Unit of Measure: Deaths per 100,000 live births Disaggregated by: Residence (urban/rural), wealth quintile Justification/Management Utility: This is a Millennium Development Goal indicator (MDG 5). Maternal mortality is widely acknowledged as a general indicator of the overall health of a population, the status of women in society and the functioning of the health system. High maternal mortality ratios are therefore markers of problems of health status, gender inequalities and health service delivery in a country. A strengthened health system, through the various HPN activities, can contribute to reductions in maternal mortality by promoting (a) greater utilization of health services provided by the agencies of MOHFW, (b) enhanced equity in health service utilization, and (c) improved awareness of healthy behavior. Is this an Annual Report Indicator? No B. Plan for Data Acquisition Data Collection Method & Date: National household survey BMMS (2010 and 2015) Data Source(s): BMMS Method of Data Acquisition by PMMU: PMMU will gather the required indicators from the published reports. Frequency and Timing of Data Acquisition by PMMU: Indicator values will be recorded whenever reports are available in 2010 and 2015. Individual(s)/Organization Responsible to PMMU: PMOs Individual(s)/Directorates Responsible for Providing Data at PMMU: NIPORT Location of Data Storage: MEASURE Evaluation, NIPORT C. Data Quality Issues Date of Initial Data Quality Assessment: Data quality of this indicator will not be assessed for this indicator since this will come from surveys. BMMS has its own data quality assurance mechanism. Known Data Limitations and Significance (if any): Maternal death is a relatively rare event, large sample sizes are needed if household surveys are used. This is very costly and may still result in estimates with large confidence intervals, limiting the usefulness for cross-country or overtime comparison. Actions Taken or Planned to Address Data Limitations: Caution will be exercised to interpret the results of observed changes. Date(s) of Future Data Quality Assessments: N/A Procedures for Future Data Quality Assessment: N/A D. Performance Indicator Values Year Actual Notes

2011 (Baseline) 194, BMMS 2010

2012 194, BMMS 2010

2013 194, BMMS 2010

2014 194, BMMS 2010

2015 -

2016 (Target) Aug) Data Source(s): Planning Wing, six monthly (Jul-Dec > Feb), (Jul-Jun >Aug) Method of Data Acquisition by PMMU: PMMU will request LDs concerned of DGHS/DGFP and other agencies for the performance reports of six monthly and annually as a part of APIR. Frequency and Timing of Data Acquisition by PMMU: Annual/Six monthly Individual(s) Responsible at PMMU: PMOs/Senior Assistant Chief/ Assistant Chief Individual(s)/Directorates Responsible for Providing Data to PMMU: All the LDs under HPNSDP of different agencies such as DGHS/DGFP MIS. Location of Data Storage: PMMU C. Data Quality Issues Date of Initial Data Quality Assessment: N/A Known Data Limitations and Significance (if any): N/A Actions Taken or Planned to Address Data Limitations: N/A Date(s) of Future Data Quality Assessments: N/A Procedures for Future Data Quality Assessment: N/A D. Performance Indicator Values Year Actual

Notes

2011 (Baseline) NA

2012 2013 2014 2015 2016 (Target) 100% (FY 2011-12 annual 100%, 100%, 100% performance will be Planning Wing Planning disseminated under APIR 2013 Wing 2014 2012), Planning Wing 2012 PMMU plans to help LDs to prepare six monthly programmatic and, financial reports. PMMU has developed a software for tracking monthly programmatic/ financial progress. PMMU is in the process of developing a six monthly data collection format for each of the 32 OPs. Combining these reporting mechanisms, six monthly reports will be prepared by line directors which can be shared with stakeholders. As the program started in January 2012, the Annual Report was prepared for Annual Program Review – for the remainder of the program, such reports will be prepared both for six-monthly and annually. Target is set to be achieved by 2013.

Comments: NA This sheet last updated on: August 20, 2015

50

E. Other Notes


Proportion of service provider positions functionally vacant at Upazila/District level and below, by category

Component 2: Strengthened Health Systems Result 2.3: Improved human resources – planning, development and management Indicator 2.3.1 Proportion of service provider positions functionally vacant at Upazila/ District level and below, by category A. Description Definition: Percent of sanctioned service provider positions which are functionally vacant in health facilities at the District, Upazila and below levels at the time of survey, by category of service provider. Where, Service provider categories include: Physicians, Nurses, FWV/SACMO/MAs. Service provision levels include: District Hospital, Upazila Health Complex, Maternal and Child Welfare Centre, Union Health and Family Welfare Centre, Union sub-centres and Community Clinics. Numerator: Number of functionally vacant service providers positions, by category of position and by health facility level X100 Denominator: Total number of sanctioned service provider positions, by category and by health facility level. Unit of Measure: Percent Disaggregated by: Service provision level, Service provider categories Justification/Management Utility: Vacancy of health service providers by type and by facility is a chronic management problem in different service delivery-related units of MOHFW, and this should be improved. Data on this indicator obtained both from BHFSs and/or routine HIS will help monitor the situation, and inform policy planners and managers on the progress. Is this an Annual Report Indicator? Currently obtained every two years B. Plan for Data Acquisition Data Collection Method & Date: annual, every 2 years Data Source(s): DGHS/DHFP MIS, BHFS Method of Data Acquisition by PMMU: PMMU will gather data from BHFS reports; and will request line directors annually for the data Frequency and Timing of Data Acquisition by PMMU: 2011, 2013, 2115; and annually from routine HIS Individual(s) Responsible at PMMU: PMOs Individual(s)/Directorates Responsible for Providing Data to PMMU: DGHS/DGFP MIS Location of Data Storage: NIPORT, MIS-DGFP/DGHS C. Data Quality Issues Date of Initial Data Quality Assessment: N/A Known Data Limitations and Significance (if any): N/A Actions Taken or Planned to Address Data Limitations: N/A Date(s) of Future Data Quality Assessments: N/A Procedures for Future Data Quality Assessment: N/A D. Performance Indicator Values Year Actual

Notes

2011 (Baseline) Physicians: 45.7%, Nurses: 24.7%, FWV/SACMO/MA: 16.9%, BHFS 2009

2012 2013 2014 Physicians: 46.1%, Physicians: 46.1%, Physicians: 29.9%, Nurses: 19.6%, Nurses: 19.6%, Nurses: 12.8%, FWV/SACMO/MA: FWV/SACMO/MA: FWV/SACMO/MA: 21.2%, BHFS 2011 21.2%, BHFS 2011 11.7%, BHFS 2014 ‘Physicians’ includes consultants and general physicians, according to BHFS 2011. FVW/SACMO/MA are termed as paramedics in the 2011 BHFS.

Comments: NA This sheet last updated on: September 20, 2014

51

E. Other Notes

2015 -

2016 (Target) Physicians: 22.8%, Nurses: 15.0%, FWV/SACMO/MA: 8.5%

This target is set for a 50% reduction from baseline levels [PIP-Appendix, p-308]


Number of additional providers trained in midwifery at Upazila health facilities Component 2: Strengthened Health Systems Result 2.3. : Improved human resources – planning, development and management Indicator 2.3.2: Number of additional providers trained in midwifery at Upazila health facilities A. Description Definition: Number of midwives trained as per national training curriculum to be posted in Upazila health facilities six monthly and annually. The objective is to have people who are specifically trained as midwives and are then posted at Upazila health facilities and working as midwives. This comes from the Prime Minister’s announcement of deploying 3,000 midwives to government health facilities to reduce maternal mortality. Unit of Measure: Number Disaggregated by: Administrative division Justification/Management Utility: Preparing the health workforce to work towards the attainment of a country’s health objectives represents one of the most important challenges for its health system. Methodologically, there are no gold standards for assessing the sufficiency of the health workforce to address the health care needs of a given population. It has been estimated however, in the World Health Report 2006, that countries with fewer than 23 physicians, nurses and midwives per 10,000 populations generally fail to achieve adequate coverage rates for selected primary health care interventions as prioritized by the MDG framework. Is this an Annual Report Indicator? Yes B. Plan for Data Acquisition Data Collection Method & Date: Annual Data Source(s): HRD/MOHFW, RHIS Method of Data Acquisition by PMMU: PMMU will gather information from line directors Frequency and Timing of Data Acquisition by PMMU: Annual Individual(s) Responsible at PMMU: PMOs Individual(s)/Directorates Responsible for Providing Data to PMMU: HRM/MOHFW, NES-LD Location of Data Storage: PMMU C. Data Quality Issues Date of Initial Data Quality Assessment: N/A Known Data Limitations and Significance (if any): N/A Actions Taken or Planned to Address Data Limitations: N/A Date(s) of Future Data Quality Assessments: N/A Procedures for Future Data Quality Assessment: N/A D. Performance Indicator Values Year Actual Notes

2011 (Baseline) NA

2012 115


52

2013 596, APIR 2013

2014 1,102, MPIR 2014

E. Other Notes

2015 -

2016 (Target) 3,000


Number of comprehensive EmOC facilities with functional 24/7 services covering all districts

Component 2: Strengthened Health Systems Result 2.3. : Improved human resources – planning, development and management Indicator 2.3.3. Number of comprehensive EmOC facilities with functional 24/7 services covering all districts A. Description Definition: The number of health facilities providing 24/7 comprehensive EmOC services distributed so that all districts have at least one CEmOC. 24/7 CEmOC includes: Availability of three injections: magnesium sulfate, oxytocin and an antibiotic (Obstetric First Aid); availability of functional vacuum extractor and ability to deliver babies using forceps, assuming provision of manual removal of placenta is present if all other conditions are fulfilled (Basic EmOC); provision of cesarean section with presence of 1 pair of anesthetists-OB/GYN specialist (however to run 24/7, three pairs are considered ideal) to provide round the clock service and presence of blood bank (CEmOC). [BHFS 2009, p-39] Unit of Measure: Number Disaggregated by: Facility type (DH, UHC,MCWC, UnHFWC) Justification/Management Utility: It is important to extend the 24/7 comprehensive EmOC services to the communities, as close as possible, in order to effectively reduce maternal mortality. This can be done by ensuring that every district has at least one 24/7 EmOC facility. Is this an Annual Report Indicator? Annual B. Plan for Data Acquisition Data Collection Method & Date: Routine HIS Data Source(s): MIS/EOC, BHFS Method of Data Acquisition by PMMU: PMMU will gather information from the survey reports/Routine HIS Frequency and Timing of Data Acquisition by PMMU: Annually Individual(s)/ Organization Responsible at PMMU: PMOs Individual(s)/Directorates Responsible for Providing Data to PMMU: MNCAH & MCRAH LDs Location of Data Storage: PMMU C. Data Quality Issues Date of Initial Data Quality Assessment: N/A Known Data Limitations and Significance (if any): N/A Actions Taken or Planned to Address Data Limitations: N/A Date(s) of Future Data Quality Assessments: N/A Procedures for Future Data Quality Assessment: N/A D. Performance Indicator Values Year Actual Notes

2011 (Baseline) 132 (MIS/DGHS 2009)

2012 85, MNCAH LD, 2012 MNCAH suggested to revise the baseline to 78 Upazilas for 2009


53

2013 75, APIR 2013

E. Other Notes

2014 101, MPIR 2014

2015 -

2016 (Target) 204 DGHS Voice of MIS Feb, 2009


Case fatality rate among admitted children with Pneumonia in Upazilla Health Complex Component 2: Strengthened Health Systems Result 2.4: Strengthened quality assurance and supervision systems Indicator 2.4.1: Case fatality rate among admitted children with pneumonia in Upazila health complex A. Description Definition: Percent of under five year children admitted for pneumonia at Upazila health complexes who died at the hospital in the previous six months. Where, Case Fatality Rate refers the ratio of the number of deaths caused by specified disease to the number of diagnosed cases of that disease. Numerator: Number of under five children who died at Upazila health complexes after admission for pneumonia in the past six monthly X 100 Denominator: Total number of under five children admitted in Upazila health complexes with pneumonia in the last six months. Unit of Measure: Percent Disaggregated by: Facility type, Sex Justification/Management Utility: Case fatality of any disease in a facility can be reduced with appropriate and timely care provided to patients. UHCs will be fully equipped for treating child pneumonia. Therefore, case fatality rate for pneumonia should decline over the years with improved management of UHCs. Is this an Annual Report Indicator? No B. Plan for Data Acquisition Data Collection Method & Date: DGHS MIS will gather data from UHCs and report the indicator six monthly. Data Source(s): DGHS MIS online reporting in-door system, Health Bulletin Method of Data Acquisition by PMMU: PMMU will gather indicators from Health Bulletin that is published annually Frequency and Timing of Data Acquisition by PMMU: Annual /Six monthly Individual(s) Responsible at PMMU: PMOs Individual(s)/Directorates Responsible for Providing Data to PMMU: Director MIS DGHS Location of Data Storage: PMMU C. Data Quality Issues Date of Initial Data Quality Assessment: N/A Known Data Limitations and Significance (if any): N/A Actions Taken or Planned to Address Data Limitations: N/A Date(s) of Future Data Quality Assessments: N/A Procedures for Future Data Quality Assessment: N/A D. Performance Indicator Values Year Actual Notes

2011 (Baseline) 2012 2013 2014 2015 2016 (Target) 8%, Health Bulletin NA NA 0.93%, 6.2% 2009 MIS/DGHS 2014 Calculated from sex distribution of causes of death in each age cluster of children who attended outpatient and emergency departments of IMCI facilities. [Ref: PIP-Appendix, p-308]; Recently (July 2013) initiated online reporting tool for DGHS captures this and will be able to report update next year. DHIS-2 Tabular Report [Online] available at: //103.247.238.82:8080/mishealth/dhis-web-caseentry/app/index.html Calculated as the reduction of the case fatality rate after the implementation of the WHO’s standard acute respiratory infection case management guidelines found to be 23%. [Ref: Theodoratou et al 2010]


54

E. Other Notes


% of health facilities, by type, without stock-outs of essential medicines at a given point in time

Component 2: Strengthened Health Systems Result 2.5: Sustainable and responsive procurement and logistic system Indicator 2.5.1: % of health facilities, by type, without stock-outs of essential medicines at a given point in time A. Description Definition: Percent of health facilities, by type, which have at least 75% of union level essential drug kit (10 drugs) available in the facilities at district level and below at the time of survey. Stock-out refers to having less than 75% of the list of Union level essential drug kit. Essential medicines include: Union level essential drug kits include the following drugs: (1) Amoxicillin (2) Amoxicillin syrup (3) Paracetamol tab (4) Paracetamol syrup (5) Iron tablets (6) Vitamin A (7) Tetracycline opthalmic ointment (8) Chlorpheniramin (9) Cotrimoxazole (10) Benzyl benzoate. For estimating the drug availability index for UnHFWCs and USC/RD, this short list of 10 drugs are used. [BHFC 2009, p29] Types of health facilities include: District Hospital, Upazila Health Complex, Maternal and Child Welfare Centre, UHFWC, Union sub-centres. Numerator: Number of health facilities, by type, with at least 75% of their essential medicine stock at the time of survey X 100 Denominator: Total number of health facilities, by type, surveyed Unit of Measure: Percent Disaggregated by: Facility type Justification/Management Utility: The maintenance of a minimal stock of essential drugs in a facility is a fundamental requirement. Some facilities face stock-out problems which affect the quality of care. Stock out of essential drugs should be prevented. A strong procurement and logistics system should have minimal stock-out problem. Reduction in this indicator over time will indicate a responsive procurement and logistic system of HNSDP. This indicator can monitor the stock-out problem. Is this an Annual Report Indicator? No B. Plan for Data Acquisition Data Collection Method & date: National facility surveys Data Source(s): BHFS Method of Data Acquisition by PMMU: PMMU will gather the indicator from surveys whenever the reports are available. Frequency and Timing of Data Acquisition by PMMU: 2011, 2013, 2115 Individual(s)/Organization Responsible at PMMU: PMOs Individual(s)/Directorates Responsible for Providing Data to PMMU: DGHS, DGFP Location of Data Storage: PMMU C. Data Quality Issues Date of Initial Data Quality Assessment: Surveys have their own mechanism of data quality assurance. Known Data Limitations and Significance (if any): One limitation of BHFS is its sample size of health facilities considered in the surveys. This indicator may not be robust for different types of facilities as the number of facilities by type is small for certain types. Actions Taken or Planned to Address Data Limitations: Caution will be exercised in the interpretation of the indicator for certain type of facilities with a small sample in the survey. Date(s) of Future Data Quality Assessments: N/A Procedures for Future Data Quality Assessment: N/A D. Performance Indicator Values Year Actual Notes

2011 (Baseline) 66.1%, BHFS 2009 Defined as at least 75% of union level essential drug kit (10 drugs) available in the facilities at district level and below. [Ref: PIP-Appendix, p 308]

2012 74%, BHFS 2011

Comments: NA This sheet last updated on: August 20, 2015 55

2013 74%, BHFS 2011

E. Other Notes

2014 73.6%, BHFS 2014 Defined as at least 75% of 8 union level essential drugs available in the facilities at district level and below (excluding CC).

2015 -

2016 (Target) 75%


% of Facilities without stock-outs of contraceptives at a given point in time

Component 2: Strengthened Health Systems Result 2.5: Sustainable and responsive procurement and logistic system Indicator 2.5.2: % of facilities without stock-outs of contraceptives at a given point in time A. Description Definition: Percent of health facilities, by type, whose contraceptive stock has been continuously available and not expired for the past 30 days at the time of survey. Health facilities include: District Hospital, Upazila Health Complex, Maternal and Child Welfare Centre, UHFWC, and Union sub-centers. Contraceptive stock includes: oral contraceptive pills, male condoms, injectables (DMPA), and IUD has been continuously available and not expired for the past 30 days at the time of survey. Stock-out refers to running out of inventory, i.e. the demand or requirement for an item(s) cannot be fulfilled from existing inventory. Numerator: Number of health facilities, by type, with their contraceptive stockX100 Denominator: Total number of health facilities, by type, surveyed. Unit of Measure: Percent Disaggregated by: Type of facilities Justification/Management Utility: The stock-out of contraceptive products is a challenge of contraceptive security and it should be prevented in order to reduce unmet need for contraception. A strong procurement and logistics system should have minimal contraceptive stock-out. Reduction in this indicator over time will indicate a responsive procurement and logistic system of HNSDP. Is this an Annual Report Indicator? No B. Plan for Data Acquisition Data Collection Method & Date: BHFSs every 2 yrs Data Source(s): BHFS Method of Data Acquisition by PMMU: PMMU will collect the data from BHFS whenever the reports are available Frequency and Timing of Data Acquisition by PMMU: BHFS 2011, 2013, 2015 Individual(s) Responsible at PMMU: PMOs Individual(s)/Directorates Responsible for Providing Data to PMMU: NIPORT, DGFP Location of Data Storage: PMMU C. Data Quality Issues Date of Initial Data Quality Assessment: One limitation of BHFS is its sample size of health facilities considered in the surveys. This indicator may not be robust for different types of facilities as the number of facilities by type becomes small for certain type. Known Data Limitations and Significance (if any): The survey agencies have their own data quality assessment procedures. Actions Taken or Planned to Address Data Limitations: N/A Date(s) of Future Data Quality Assessments: N/A Procedures for Future Data Quality Assessment: N/A D. Performance Indicator Values Year Actual Notes

2011 (Baseline) 58.1%, BHFS 2009 Defined as four family planning supplied (condom, oral pill, DMPA, IUD) available in the facilities at district level and below. [Ref: PIP, p-308]

2012 55.1%, BHFS 2011


56

2013 55.1%, BHFS 2011

2014 60.2%, BHFS 2014

2015 -

2016 (Target) 70%

E. Other Notes


% of Facilities (excluding CCs) having separate, improved toilets for female clients Component 2: Strengthened Health Systems Result 2.6: Improved infrastructure and maintenance Indicator 2.6.1: % of facilities (excluding CCs) having separate, improved toilets for female clients A. Description Definition: Percent of health facilities (excluding Community Clinics), by type, that have separate and improved toilets for female clients (used by females only). Improved toilet requires separate latrines for females with functional water source. Types of health facilities include: District Hospital, Upazila Health Complex, Maternal and Child Welfare Centre, Union sub-centres. Numerator: Number of health facilities, by type, that have separate toilets with functional water source for female clients X 100 Denominator: Total number of health facilities, by type, surveyed. Unit of Measure: Percent Disaggregated by: Facility type (shown above) Justification/Management Utility: Separate toilet for females is a basic infrastructure that every health facility should have but Bangladesh has not been able to establish this. Also, females are reluctant to come to health facilities where separate toilets are not available. The utilization of services from facilities is likely to increase with the increased percentage of facilities with toilets for females. Is this an Annual Report Indicator? No B. Plan for Data Acquisition Data Collection Method & Date: Every 2 years Data Source(s): BHFS Method of Data Acquisition by PMMU: PMMU will gather indicators from survey reports whenever they are available Frequency and Timing of Data Acquisition by PMMU: BHFS 2011, 2013, 2015 Individual(s) Responsible at PMMU: PMOs Individual(s)/Directorates Responsible for Providing Data to PMMU: NIPORT, DGHS, DGFP Location of Data Storage: PMMU C. Data Quality Issues Date of Initial Data Quality Assessment: The survey agencies have their own data quality assessment procedures. Known Data Limitations and Significance (if any): One limitation of BHFS is its sample size of health facilities considered in the surveys. This indicator may not be robust for different types of facilities as the number of facilities by type becomes small for certain type. Actions Taken or Planned to Address Data Limitations: Exercise caution to interpret the changes in indicators by type of facilities. Date(s) of Future Data Quality Assessments: N/A Procedures for Future Data Quality Assessment: N/A D. Performance Indicator Values Year Actual Notes

2011 (Baseline) 51.0%, BHFS 2009

2012 44.5%, BHFS 2011

2013 44.5%, BHFS 2011


57

E. Other Notes

2014 47.6%, BHFS 2014

2015 -

2016 (Target) 75%


Regulatory framework for accreditation of health facilities including hospitals (both in the public and private sectors) reviewed and updated

Component 2: Strengthened Health Systems Result 2.7: Sector management and legal framework Indicator 2.7.1: Regulatory framework for accreditation of health facilities including hospitals (both in the public and private sectors) reviewed and updated. A. Description Definition: The 1982 Regulatory Act for accreditation for all health facilities will be reviewed and updated for implementation in both public and private sector hospitals Here, reviewed and updated refers, starting with a framework for facilitating accreditation of public hospitals and then extend to private hospitals. Unit of Measure: Yes/No Disaggregated by: None Justification/Management Utility: The accreditation of health service facilities should be done based on the most updated criterion. It is necessary to review and update the regulatory framework for accreditation by the MOHFW, titled “Medical Practices and Private Clinics and Laboratories (regulation) Ordinance (Act IV of 1982)”. This activity will improve the quality of services provided at the public- and private-sector facilities and thus, positively affecting the health of the people. Is this an Annual Report Indicator? No (One time) B. Plan for Data Acquisition Data Collection Method & Date: PMMU will gather the updated document. Data Source(s): PMMU Method of Data Acquisition by PMMU: PMMU will collect the document from the Joint Secretary, Hospital Administration, MOHFW Frequency and Timing of Data Acquisition by PMMU: One time Individual(s) Responsible at PMMU: PMOs Individual(s)/Directorates Responsible for Providing Data to PMMU: Joint Secretary, Hospital Administration, MOHFW, Director (Hospital), DGHS Location of Data Storage: PMMU C. Data Quality Issues Date of Initial Data Quality Assessment: Not applicable Known Data Limitations and Significance (if any): Reviewed and updated of the framework does not ensure enforcement and implementation. Actions Taken or Planned to Address Data Limitations: Not applicable Date(s) of Future Data Quality Assessments: Not applicable Procedures for Future Data Quality Assessment: Not applicable D. Performance Indicator Values Year Actual

2011 (Baseline) 1982 Regulatory Act

2012 Accreditation of public hospitals is under process, HSM OP 2012

Notes

Comments: NA This list last updated on: August 20, 2015

58

2013 Accreditation document finalized; MOU with 2 private hospitals signed, APIR 2013

E. Other Notes

2014 Accreditation document developed, shared with stakeholders, and submitted to MOHFW, MPIR 2014

2015 -

2016 (Target) Reviewed (by 2012)


Number of Districts/Upazilas having functional LLP procedures Component 2: Strengthened Health Systems Result 2.8: Decentralization through LLP procedures Indicator 2.8.1: Number of Districts/Upazilas having functional LLP procedures A. Description Definition: The number of Districts and Upazilas with increased delegation of administrative and financial power to exercise LLP procedures. Where functional LLP procedures refer to the Local Level Planning (LLP) introduced with an aim to increase the quality and coverage of ESP service delivery with a particular focus on pro-poor and gender issues through the development of a sustainable local level planning. Upazila will prepare their LLP on the basis of need to address improving access by the target population (Poor, Women, and Children) to quality services, equity, VAW and overall improvement of health care in the UHC and below. LLP will implement the work plan that is developed locally at the Upazila level based on local need and resources. There will be cost centers at the Upazila level which will be administered by the local managers from DGHS and DGFP. Unit of Measure: Number Disaggregated by: District Justification/Management Utility: The primary aim of the local level planning (LLP) initiative is to enhance decentralization of decision-making processes in health service delivery system. The managers in Upazilas with LLP can make certain administrative and financial decisions that help quicken project implementation. It is expected that as more Upazilas have functional LLP procedures in place, more Upazilas will be decentralized and thus project implementation will be faster. Note: DGHS and DGFP Planning Units are responsible for developing local level plans (LLP) annually and incorporating their budget and activities into the respective OPs of the relevant LDs and serve as constant links to the PW of MOHFW for carrying out program planning and budgetary exercises effectively. [Strategic plan for HPNSDP, p-34] Is this an Annual Report Indicator? Yes B. Plan for Data Acquisition Data Collection Method & Date: PMMU will send a format requesting PME & PMR line directors in DGHS and DGFP for the data. Data Source(s): Respective agencies, Planning Units of DGHS and DGFP Method of Data Acquisition by PMMU: As mentioned above Frequency and Timing of Data Acquisition by PMMU: Annual Individual(s) Responsible at PMMU: PMOs/ Senior Assistant Chief/Assistant Chief Individual(s)/Directorates Responsible for Providing Data to PMMU: Line Directors PME Units Location of Data Storage: PMMU C. Data Quality Issues Date of Initial Data Quality Assessment: N/A Known Data Limitations and Significance (if any): N/A Actions Taken or Planned to Address Data Limitations: N/A Date(s) of Future Data Quality Assessments: N/A Procedures for Future Data Quality Assessment: N/A D. Performance Indicator Values Year Actual Notes

2011 (Baseline) NA

2012 7 districts (including 14 pilot upazilas)

2013 14 Upz (PME OP) and 42 Upz (PMR OP), APIR 2013

2014 188 upz (PME OP) and 28 upz (PMR OP), MPIR 2014

2015 -

2016 (Target) Piloting completed and reviewed for scaling up

E. Other Notes Comments: Need clarification on ‘increased delegation’, what are the admin and financial exercises allowed for facility etc. This sheet last updated on: August 20, 2015

59


Number of non-pool DPs submitting quarterly expenditure reports Component 2: Strengthened Health Systems Result 2.9: SWAp and improved DP coordination (deliver on the Paris Declaration) Indicator 2.9.1: Number of non-pool DPs submitting quarterly expenditure reports A. Description Definition: The number of non-pool Development Partners submitting quarterly expenditure reports. Where, Non-pooled funds refer to direct project aid from DPs using separate, agency-specific disbursement channels. Numerator: Number of non-pool DPs submitting quarterly expenditure reports in a given year Denominator: Total number of non-pool DPs investing in the health sector in Bangladesh Unit of Measure: Number Disaggregated by: DPs Justification/Management Utility: This will enable the MOHFW to monitor the parallel investments by DPs in Bangladesh’s health sector improve coordination between the MOHFW and DPs. Is this an Annual Report Indicator? No B. Plan for Data Acquisition Data Collection Method & Date: The Planning Wing, MOHFW will send a format to DPs and request them to send the information in the format quarterly/six monthly. Data Source(s): Planning Wing, DPs expenditure statements Method of Data Acquisition by PMMU: See data collection method Frequency and Timing of Data Acquisition by PMMU: Quarterly/Six monthly Individual(s) Responsible at PMMU: PMOs Individual(s)/Directorates Responsible for Providing Data to PMMU: Senior Assistant Chief (M&E), Planning Wing Location of Data Storage: PMMU C. Data Quality Issues Date of Initial Data Quality Assessment: Quarterly/Six monthly meeting of SWAP TG Known Data Limitations and Significance (if any): Non-reporting and duplication of DPA expenditure Actions Taken or Planned to Address Data Limitations: Meeting held with Non-Pool DPs and LDs Date(s) of Future Data Quality Assessments: N/A Procedures for Future Data Quality Assessment: N/A D. Performance Indicator Values Year Actual Notes

2011 (Baseline) Irregular

2012 1 out of 15

2013 2014 3 out of 16 DPs, Planning 14 out of 16 DPs, Wing 2013 Planning Wing 2014 In 2012, among the non-pool DPs only USAID submit quarterly expenditure report


60

2015 -

2016 (Target) 100%

E. Other Notes


% of project aid fund (e.g. development budget) disbursed annually and quarterly Component 2: Strengthened Health Systems Result 2.10: Strengthened Financial Management Systems (funding and reporting) Indicator 2.10.1: % of project aid fund (e.g. development budget) disbursed annually and quarterly A. Description Definition: Percent of project aid from the Development Partners that is disbursed (pool, non-pool & government) quarterly and annually on HPNSDP, as reported to the MOHFW. Numerator: Amount disbursed by DPs and GOB (development), per quarter and year X 100 Denominator: Total RPA of Annual Development Program (ADP) released by GOB for a particular period (halfyearly/annually). Unit of Measure: Percent Disaggregated by: OP Justification/Management Utility: Program implementation is sometimes delayed due to availability of funds with line directors. The activities that depend on funds from development budget cannot be implemented if the funds are not disbursed to them. Experience suggests there may be delays in the process of disbursement. This indicator “% of project fund disbursed” will help monitor the progress in disbursement and help identifying reasons for under-spending by the OPs. Is this an Annual Report Indicator? Yes B. Plan for Data Acquisition Data Collection Method & Date: PMMU will provide a format to FMAU to report this indicator Data Source(s): FMAU & WB Method of Data Acquisition by PMMU: PMMU will request FMAU to send the data Frequency and Timing of Data Acquisition by PMMU: Half-yearly & annually Individual(s) Responsible at PMMU: PMOs Individual(s)/Directorates Responsible for Providing Data to PMMU: FMAU Location of Data Storage: PMMU C. Data Quality Issues Date of Initial Data Quality Assessment: N/A Known Data Limitations and Significance (if any): N/A Actions Taken or Planned to Address Data Limitations: N/A Date(s) of Future Data Quality Assessments: N/A Procedures for Future Data Quality Assessment: N/A D. Performance Indicator Values Year Actual Notes

2011 (Baseline) 79.4%, FMAU 2009/10 Taken from HPSDP Strategic Document, p-57

2012 60%, (FY 2011 – 12), APIR 2012 Estimated as the total fund allocation for the 32 OPs as the proportion of estimated budget in the PIP for FY 2011-12.


61

2013 99%, APIR 2013

Estimated as the PA fund released against FY 2012-13 RADP allocation for PA.

E. Other Notes

2014 94%, MPIR 2014

Estimated as the PA fund released against FY 2013-14 RADP allocation for PA.

2015 -

2016 (Target) 100% (by 2013)


% of OPs with spending >80% of ADP allocation (annually) Component 2: Strengthened Health Systems Result 2.10: Strengthened Financial Management Systems (funding and reporting) Indicator 2.10.2 : % of OPs with spending >80% of ADP allocation (annually) A. Description Definition: Percent of Operational Plans that spend more than 80% of their Annual Development Program (ADP) allocation in a given year. Numerator: Number of OPs spending >80% of their ADP allocation in a given year X 100 Denominator: Total number of OPs. Unit of Measure: Percent Disaggregated by: By Operational Plans Justification/Management Utility: There can be under-spending of budget of various OPs due to unresolved programmatic and management issues. This would help to identify the causes of slow progress of Ops. Some procedural interventions can deal with issues to ease up procedures that impede the speed of implementation of planned activities. The percentage of spending can be a good indicator of program implementation. Is this an Annual Report Indicator? Yes B. Plan for Data Acquisition Data Collection Method & Date: On-line ADP review report in July of each year Data Source(s): Planning Wing (PW), MOHFW Method of Data Acquisition by PMMU: PMMU will request PW to send the data Frequency and Timing of Data Acquisition by PMMU: Annual Individual(s) Responsible at PMMU: PMOs/ Senior Assistant Chief/ Assistant Chief Individual(s)/Directorates Responsible for Providing Data to PMMU: PW, MOHFW Location of Data Storage: PMMU C. Data Quality Issues Date of Initial Data Quality Assessment: N/A Known Data Limitations and Significance (if any): Difference in data obtained from LDs and IBAS Actions Taken or Planned to Address Data Limitations: FMAU should work with MoF & CAG (Comptroller and Audit General). Date(s) of Future Data Quality Assessments: N/A Procedures for Future Data Quality Assessment: N/A D. Performance Indicator Values Year Actual Notes

2011 (Baseline) 44.7%, FMAU 200910 Baseline taken from HPNSDP Strategic document, p-71-72

2012 59.4% (with 80% or more), 50% (with >80%); Planning Wing 2012


62

2013 78.1%, APIR 2013

E. Other Notes

2014 69%, MPIR 2014

2015 -

2016 (Target) 100% (by 2013)

Target set as 100% to ensure efficient fund utilization


% of serious audit objections settled within the last 12 months Component 2: Strengthened Health Systems Result 2.10: Strengthened Financial Management Systems (funding and reporting) Indicator 2.10.3: % of serious audit objections settled within the last 12 months A. Description Definition: Percent of bank-identified serious audit objections settled within the last 12 months of APR reporting. Where serious audit objection refers, Numerator: Number of serious active/unresolved audit objections resolved within the last 12 months X 100 Denominator: Total number of (new + previous) unresolved audit objections given by FAPAD at any time in the last 12 months. Unit of Measure: Percent Disaggregated by: None Justification/Management Utility: An audit objection is an indication of poor financial-management discipline. A settlement of an audit objection can reflect an improvement of discipline in financial management system. Therefore an increase in the percentage of audit objections settled will reflect an improvement in the financial management of the HPNSDP. Is this an Annual Report Indicator? Yes B. Plan for Data Acquisition Data Collection Method & Date: PMMU will request FMAU for this information for each fiscal year Data Source(s): Audit Statement produced by FMAU or World Bank Method of Data Acquisition by PMMU: See data collection method above Frequency and Timing of Data Acquisition by PMMU: Once every year in the month of July Individual(s) Responsible at PMMU: PMOs/ Senior Assistant Chief/ Assistant Chief Individual(s)/Directorates Responsible for Providing Data to PMMU: FMAU, MOHFW/ LD, IFM Location of Data Storage: PMMU C. Data Quality Issues Date of Initial Data Quality Assessment: A qualitative assessment will be made through discussion among members of Audit Committee, MOHFW. Known Data Limitations and Significance (if any): N/A Actions Taken or Planned to Address Data Limitations: N/A Date(s) of Future Data Quality Assessments: N/A Procedures for Future Data Quality Assessment: N/A D. Performance Indicator Values Year Actual Notes

2011 (Baseline) 7%, FMAU 2007/2008

Baseline used from APIR 2009

2012 39%, FMAU 2012


63

2013 61.0%, World Bank 2013

E. Other Notes

2014 34%, World Bank 2014

2015 -

2016 (Target) >80%


SECTION

V.

INDICATOR REFERENCE SHEETS (IRS): OPERATIONAL PLAN LEVEL INDICATOR

Operational level indicators are contained in the Operational Plans agreed to and approved by the MOHFW and its partners. The purpose of these indicators is to monitor operational progress on a relatively frequent basis. Depending on the activity, this is either monthly or quarterly.

The following section contains detailed Indicator Reference Sheets (IRS) for each OP-level indicator. The original OP-level indicator lists of HPNSDP was revised following the 2012 Annual Program Review (APR) of HPNSDP and the revised lists were approved by MOHFW in October 2013. The IRSs in this document is based on the revised OP-indicators. Each reference sheet provides information on:  Indicator definition, unit of measurement, and any data disaggregation requirements;

 PMMU data acquisition method, data sources, timeline for data acquisition, and PMMU staff

responsible for data acquisition;

 Plans for data analysis, review, and reporting;

 Any data quality issues, including any actions taken or planned to address data limitations; and  Notes on baselines, targets, and data calculation methods.

A complete table of performance data (baselines, targets, and actual) for all OP-level indicators is at the end of each sheet. Note on Baselines and Targets

Baselines for the most of the indicators are be determined at the end of FY 2011-12, i.e., June 2012. In some cases, over the years of HPNSDP, targets for some indicators may be reset based on the recent trends in performance. This target resetting will be done during the APR. Note on Performance Indicator Values The performance indicator values of the OP-level indicators are provided within the IRS.

64


OP 1: Maternal, Neonatal, Child and Adolescent Health (MNCAH) Indicators for OP MNCAH 1. Number of health facilities providing 24/7 C-EOC 2. Number of CSBA trained 3. Number of Upazilas having DSF program 4. Proportion of women age 15-49 yrs received TT-5 doses of TT during their last pregnancy 5. Proportion of children aged 12-23 months vaccinated by all scheduled vaccines by 12 months of age 6. Number of UHCs having an IMCI & Nutrition Corner Indicator Reference Sheets for Indicators under OP: MNCAH are given below:

Name of OP: MNC&AH

Indicator No: 01

Directorate/Agency: DGHS Indicator: Number of health facilities providing 24/7 C-EOC Definition: Number of health facilities providing 24/7 comprehensive emergency and obstetric care (C-EOC).

Where, Health facilities or C-EOC providers are DHs, UHCs and MCWCs at the primary and secondary levels. 24/7 C-EOC includes: Availability of three injections: magnesium sulfate, oxytocin and an antibiotic ( Obstetric First Aid); manually remove the placenta, remove retained products (e.g. manual vacuum extraction, dilation, and curettage), perform assisted vaginal delivery (e.g. vacuum extraction, forceps delivery), perform basic neonatal resuscitation (e.g. with bag and mask)- [Basic EmOC]; provision of caesarean section; and perform blood transfusion [C-EmOC]; presence of 1 pair of anesthetists-obgyn specialist (however to run 24/7, three pairs are considered ideal) to provide round the clock service. Numerator: Number of health facilities with at least one skilled attendant available 24 hours a day, 7 days a week to provide comprehensive EOC (C-EOC) Denominator : NA Unit of Measurement: Number of MCH, DH and UHCs Frequency: Monthly Justification/ Management Utility: This indicator is used to ensure timely access to care for women experiencing complications at the time of delivery at UHC level or below. Source: HIS, Administrative report (facility records), birth registers, specialized surveys Performance Indicator value: Year Actual Notes

2011 (baseline) 78

2012 85

2013 75 Development of recently trained Obs & Anes doctor is under process, shortly the number will be 110.

2014 (Target) 132

2014 Total: 183 101 UHCs, 59 DH & 23 MCH

2015 -

2016 (Target) 204

Known Data Limitation: This indicator does not address other barriers to access at C-EmOC facilities, such as travel time to location, stockouts of necessary drugs, or inadequate equipment and supplies. Date of last Update: August 20, 2015

Name of OP: MNC&AH Indicator no.: 02 Directorate/Agency: DGHS Indicator: Number of CSBA trained Definition: Number of FWAs & FeHAs trained as community based skilled birth attendants (CSBAs) in the last one year.

The idea is to provide home based maternal health services in addition to their designated functions in promoting family planning or immunization. Numerator: Number of FWAs & FeHAs trained as community based skilled birth attendants (CSBAs). Denominator: NA Unit of Measurement: Number of persons Frequency: Monthly Justification/ Management Utility: FWAs are responsible for health promotion in the community level but they 65


are not trained for conducting delivery. Through their works FWAs have a great access and acceptability to the community people. To promote conducting delivery by trained provider, this government cadre can play an important role if they are trained. CSBA training is provided to FWAs so that they can conduct delivery. If the number of CSBA increases, we can expect that number of delivery at home conducted by trained provider will increase which will help to reduce maternal and child mortality and morbidity. Source: Administrative report/OGSB Performance Indicator value: Year Actual Notes

2011 (baseline) 7,089 (2012) Baseline revised on Jan 1, 2013

2012 445 (will be completed in Sep/2012)

Known Data Limitation: N/A Date of last Update: August 20, 2015

2013 992

2014 (Target) 9,000

Total till June 2013 is 7,710.

2014 8,932

Excluding 1010 of BRAC

2015 -

2016 (Target) 13,500 Explore private involvement to achieve this target

Name of OP: MNC&AH Indicator No: 03 Directorate/Agency: DGHS Indicator: Number of Upazilas having DSF program Definition: Number of Upazilas having demand side financing (DSF) initiative program to improve access and utilization of quality maternal health services.

Under this program, voucher holders have to be poor as per defined poverty criteria, validated by local government representative. Where the voucher holders are them who are residents of the union under DSF program, are currently pregnant (first or second pregnancy), functionally landless (owning less than 0.15 acres/ 607 sq.m/ 6534 sq. feet of land), extremely low and irregular income [less than Tk. 2500 (about $38.50)] per household per month, lack ownership of other productive assets could be eligible for the voucher program, compared to universal scheme. Voucher entitles for ANC 1-3, PNC, safe delivery, treatment of complications including CS, transportation reimbursement, blood and urinary laboratory tests. [MNCAH OP] Numerator: Number of Upazilas having demand side financing (DSF) initiative program to improve access and utilization of quality maternal health services. Denominator: NA Unit of Measurement: Number of Upazilas covered by DSF programme Frequency: Quarterly Justification/ Management Utility: Maternal health voucher scheme, a demand side financing initiative, is a tool to address maternal and neonatal mortality through increasing awareness in seeking demand for maternal health services among poor pregnant women. Source: Administrative report (DSF monitoring report) Performance Indicator Value: Year

Actual Notes

2011 (baseline)

(2012)

53

2012 Enrollment of New 20 Upazilas are in process

2013 73

In total

2014 (Target) 93

2014

2015

53

-

2016 (Target) 133

Known Data Limitation: None Comment: At the Upazila level, The Upazila DSF committee is the operational control hub of the project. It ensures that operational guidelines are put into practice, including the provider reimbursement procedures. It manages the voucher reimbursement for services provided by public provider in the Upazila. It reimburses and disburses funds from the seed fund account as per government order issued by the office of the Joint Chief Planning, MOHFW. Date of last Update: August 20, 2015

Name of OP: MNCAH Indicator no: 04 Directorate/Agency: DGHS Indicator: Proportion of women age 15-49 yrs received-5 doses of TT during their last pregnancy Definition: Proportion of pregnant women age 15-49 yrs received five doses of tetanus toxoid reported monthly. Expressed as a percentage of all live births since the number of pregnant women is generally not available. Numerator: Number of doses of TT2+TT3+TT4+TT5 given to pregnant women in a reference period (usually a 66


year). Denominator: Total number of live births took place in that period of time. Here number of live births serves as a proxy for the number of pregnant women.

Where data on the numbers of live births for the denominator are unavailable, evaluators can calculate total estimates live births using census data for the total population and crude birth rates in a specified area. Total expected births=population X crude birth rate

In settings where the crude birth rate is unknown, the WHO recommends using 3.5 percent of the total population as an estimate of the number of pregnant women (number of live births or pregnant women= total population X 0.035) [WHO, 1999a and c.] Unit of Measurement: Percent of women age 15-49 yrs fully immunized of TT Frequency: Monthly/Yearly Justification/ Management Utility: This indicator measures the percentage of women and births protected against tetanus at the time of delivery among the general population. Neonatal tetanus is usually fatal. A woman immunized with at least two doses of tetanus toxoid according to the WHO schedule 1 develops antibodies that protect her infant against tetanus in the first two months of life. Tetanus-toxoid immunization is therefore an integral part of the ANC package offered to women in most developing countries. This indicator is also considered as an alternative output measure since it has the advantage of reflecting not only the accessibility of prenatal care, but also the quality of care received. Source: RHIS – available through EPI report, Coverage Evaluation Survey (CES) Performance Indicator Value: Year

Actual Notes

2011 (baseline) 42.3% (2011)

Updated baseline: 80% Nationally 75 % at district level (cMYP 2011-2016)

2012 42.3%, CES-2011

2013 Survey on going (CES 2013)

2014 (Target) 45%

2014 43.6%, CES 2013

2015 -

2016 (Target) 70%

Known Data Limitation: Both the service statistics and survey data underestimate the true extent of TT2+ coverage because both exclude doses of vaccine administered at times other than specified in the definition of the numerator even though the doses offer protection. For example, the doses for the childhood or massimmunization campaign are omitted. Comment: For prevention of neonatal and maternal tetanus, WHO recommends giving women a series of five doses of tetanus-toxoid vaccine with a minimum interval between each dose. Each dose increases the level and protection against tetanus. Each dose counts as a dose towards a five-dose schedule even if given before the recommended interval. A woman who receives five doses of tetanus toxoid is fully immunized and is protected against tetanus throughout her childbearing years. WHO recommended Tetanus-Toxoid series is described in the following table: TT Time of Dose given Level of Protection Duration of Protection TT1 At first contact Nil None TT2 Four weeks after TT1 80% 3 years TT3 At least 6 months after TT2 95% 5 years TT4 At least one year after TT3 99% 10 years TT5 At least one year after TT4 99% 30 years Date of last Update: August 20, 2015 Name of OP: MNC&AH Indicator no.: 05 Directorate/Agency: DGHS Indicator: Proportion of children aged 12-23 months vaccinated by all scheduled vaccines by 12 months of age Definition: Proportion of children aged 12-23 months vaccinated by all scheduled vaccine by 12 month of age. Where all scheduled vaccine in Bangladesh under EPI programme includes: BCG-one dose against tuberculosis, Pentavalent - three doses against diphteria, pertussis, tetanus, Hep-B, Hib, Four doses of oral Polio vaccine (OPV) against poliomyelitis, and One dose of measles vaccine against measles. Numerator: Number of children aged 12-23 months who have received BCG, three doses of Pentavalent, four doses of OPV and one dose of measles vaccine X 100 Denominator: Number of living children between age 12 to 23 months of age 67


Unit of Measurement: Percent of children aged 12-23 months vaccinated by all scheduled of all vaccine Frequency : Yearly(Survey) Justification/ Management Utility: The indicator provides a measure of the coverage and the quality of the child health care system in the country. Immunization is an essential component for reducing under-five mortality. Government in developing countries usually finances immunization against measles and diphtheria, pertussis (whooping cough) and tetanus (DPT) as part of the basic health package. Health and other programs targeted at those specific causes are one practical means of reducing child mortality. Source: Coverage Evaluation Survey (CES) Performance Indicator Value: Year

Actual Notes

2011 (baseline)

80.2% (CES 2011)

Updated baseline: 90% Nationally 85% at district level (cMYP 2011-2016)

2012 80.2 %; CES 2011

2013 Survey on going (CES 2013)

2014 (Target) 85%

2014 80.7%; CES 2013

2015 -

2016 (Target) 90%

Known Data Limitation: In many countries, lack of precise information on the size of the cohort of children under one year of age makes immunization coverage difficult to estimate. Date of last Update: August 20, 2015

Name of OP: MNC&AH Indicator no.: 06 Directorate/Agency: DGHS Indicator: Number of UHCs having an IMCI & Nutrition Corner Definition: Number of facilities (UHC, DH, MCH) that have expanded their integrated management of children illness (IMCI) activities. Where expansion of facility base IMCI refer a) out-patient service for sick under 5 children, and b) have strengthened referral care including ETAT in all UHCs/DHs. Numerator: Number of facilities (UHC, DH, MCH) that have expanded their IMCI activities. Denominator: N/A Unit of Measurement: Number of UHCs Frequency : Monthly Justification/ Management Utility: Increase access and utilization of IMCI services at facilities and communities and increase availability and access to essential and sick newborn care. Source: Admin record/ IMCI MIS Performance Indicator Value: Year Actual Notes

2011 (baseline) 2012 NA NA Baseline revised on 1-Jan-2013

Known Data Limitation: None Date of last Update: August 20, 2015

68

2013 NA

2014 (Target) 150

2014 150

2015 -

2016 (Target) 480


OP 2: Essential Services Delivery (ESD) Indicators for OP ESD 1. Number of Upazilas under Upazila Health System (UHS) piloting 2. Number of UHCs with personnel trained on MWM 3. Number of Urban Dispensaries functional with HR and supplies 4. Update of National Protocol for Mental Health Care 5. Satellite clinics taking place in CHT as per work plan

Indicator Reference Sheets for Indicators under OP ESD are given below:

Name of OP: ESD Indicator No.: 01 Directorate/Agency: DGHS Indicator: Number of Upazilas under Upazila Health System (UHS) piloting Definition: Number of Upazilas introduced with Upazila Health System (UHS). Numerator: Number of Upazilas introduced with Upazila Health System (UHS). Denominator: N/A Unit of Measurement: Number of Upazila Frequency: Quarterly Justification/ Management Utility: The UHS comprises linking a community with the district through the functional UHS. Where UHS is the structure or form of organization with the manifestation of a set of activities such as community involvement, integrated and holistic health care services, inter-sectoral collaboration and a strong ‘bottom-up’ approach to planning, policy development and management. The organization and management of the entire health system proposed to be Upazila based, meaning that policy areas such as health sector financing, utilization of the UHCs, the relationship with the private sector and governance should be UHSbased or UHS-centered. [ESD OP] Source: Administrative record Performance Indicator Value: Year Actual Notes

2011 (baseline) N/A

2012 0


2013 3 Upazilas

2014 (Target) 3 Upazilas

2014 3 Upazilas

2015 -


Name of OP: ESD Indicator no: 02 Directorate/Agency: DGHS Indicator: Number of UHCs with personnel trained on MWM (Medical Waste Management) Definition: Number of UHCs with trained personnel (field staff and manager) on medical waste management (MWM). Here, only UHCs with functional disposal pits and logistics will be selected for training. Mainly nurses and ayas carry out segregating and collection of MW and the doctors are responsible for their monitoring. Numerator: Number of UHCs (having functional disposal pits and logistics) with trained personnel (field staff and manager) on medical waste management (MWM). Denominator: N/A Unit of Measurement: Number Frequency: Quarterly Justification/ Management Utility: Medical wastes produced in the hospitals carry a high risk of infection than any other waste particularly for the service provider and waste handlers. The medical waste is capable of transmitting diseases either through direct contact or by contaminating soil, air and water. If not properly handle medical waste is a risk to individuals, community and the environment. In the Upazila health complexes (UHCs), training of the medical staffs for MWM has been imparted to about 60 percent of the UHCs of the country and the process is in progress. [ESD OP] Source: Administrative records Performance Indicator Value: Year Actual

69

2011 (baseline) 206 Upazilas

2012 0 Upazila

2013 22 Upazilas


2014 260 Upazilas

2015 -



Notes

(OP report)


Name of OP: ESD Indicator no: 03 Directorate/Agency: DGHS Indicator: Number of Urban Dispensaries functional with HR and supplies Definition: Number of Urban Dispensaries functional with human resources and supplies (equipped with necessary facilities to use as the outlet centers of the tertiary hospitals). Here, functional refers coverage, quality and equity of service delivery in response to demand. Numerator: Number of Urban Dispensaries (equipped with necessary facilities to use as the outlet centers of the tertiary hospitals) functional with HR and supplies strengthen, in terms of coverage, quality and equity of service delivery in response to demand. Denominator: N/A Unit of Measurement: Number Frequency: Quarterly Justification/ Management Utility: Urban dispensaries under the DGHS are established to provide outdoor patient services including EPI and maternal and child health (MCH) to the urban population. Services in the urban dispensaries under the DGHS will be improved by introducing an effective referral system in the facilities, so that the population could receive better services. MOHFW also provides health services through secondary and tertiary hospitals that will continue to be strengthened in terms of coverage, quality and equity of service delivery in response to demand. [ESD OP] Source: Administrative records Performance Indicator Value: Year Actual Notes

2011 (baseline) 17 (2012)

2012 17

2013 17 Cumulative


2014 (Target) 33 Cumulative

2014 17 Cumulative

2015 Cumulative

2016 (Target) 33

Name of OP: ESD Indicator no: 04 Directorate/Agency: DGHS Indicator: Update of National Protocol for Mental Health Care Definition: Update of National Protocol for Mental Health Care for Health Care Providers to adequately address the counseling and treatment of mental health including autism and other neurodevelopment disorders. Where, update of National Protocol for Mental Health includes developing training module, treatment guideline for different level health workers (doctors, nurses, paramedics and field staffs.) for identification, counseling and treatment of mental illness at primary level.

Providing mental health services refers identify and counsel on substance abuse of mental and emotional cases, provide and follow up simple treatment as per feasibility and refer serious cases to an appropriate facility. [ESD OP] Numerator: Update of National Protocol for Mental Health Care for Health Care Providers to adequately address the counseling and treatment of mental health including autism and other neurodevelopment disorders. Denominator: N/A Unit of Measurement: Protocol updated and available Frequency: Once Justification/ Management Utility: Due to the emerging size of the mental health problems amid changing life styles and in pursuance of the government’s strong commitment for adequately addressing the counseling and treatment of mental health, partnerships with the media and NGOs are required to raise public awareness about appropriate attitude and behavior towards mental and autistic cases. Source: Administrative record Performance Indicator Value Year

Actual

70

2011 (baseline)

N/A

2012

Done

2013

Not done

2014 (Target)

Draft finalized

2014 Not done (It is premature to update as the protocol

2015 -

2016 (Target)

Protocol updated


was developed very recently)

Notes


Name of OP: ESD Indicator no: 05 Directorate/Agency: DGHS Indicator: Satellite clinics taking place in CHT as per workplan Definition: Satellite clinics/medical camps are taking place in Chittagong Hill Tracts (CHT) as per workplan. i.e. At least one satellite clinic are taking place in each Upazila per month. Here Satellite clinics are referred as an temporary establishment where patients get one-stop services from a group of health care professionals operated at a distant site. Satellite clinics are an effective way to provide basic primary healthcare services to people living in hard to reach areas especially for women and children. Numerator: At least one satellite clinic/medical camp is taking place per month in each Upazila in Chittagong Hill Tracts (CHT) to render health services for preventive and curative. Denominator: NA Unit of Measurement: Number of satellite clinics/medical camps - 1 in each Upazila per month Frequency: Monthly Justification/ Management Utility: To bring tribal population of Chittagong Hill Tracts and others in the northern hilly regions and some costal districts mainstreamed under the existing health services network of the Government. Source: Administrative record Performance Indicator Value Year

Actual Notes

2011 (baseline) N/A

Revised indicator

2012

2013

-

2

Known Data Limitation: NA Date of last Update: August 20, 2015

71

2014 (Target) 100/year

2014 68 satellite clinics conducted

2015 -

2016 (Target) 200/year


OP 3: Community Based Health Care (CBHC) Indicators for OP CBHC 1. Patients per CCs per day 2. Number of CC referrals 3. Number of community clinic management committee meeting held 4. Number of CHCPs provided Basic training 5. Number of a) Community Management Groups (CG) and b) Community Support Groups trained 6. Number of ANCs in CCs (includes nutrition counseling) Indicator Reference Sheets for Indicators under OP CBHC are given below:

Name of OP: CBHC Indicator No: 01 Directorate/Agency: DGHS Indicator: Patients per CCS per day Definition: Number of patients coming to community clinics (CCs) each day to seek preventive and curative health services per day. Here, the community clinics (CC), are one stop service center for primary health care (PHC), provides services on: 1. Maternal and neonatal health care services, 2. Integrated Management of Childhood Illness (IMCI), 3. Reproductive Health & Family Planning services, and 4. EPI, ARI & CDD. The Community Clinics are staffed with CHCP, HA and FWA to provide both preventive and curative services without any reported stock out of more than 50% of listed medicine on the reporting date of the reported month. Currently requisite medicines are 29 CC level listed medicines. Numerator: Total number of patients provide with preventive and curative health services (by CHCP, HA & FWA) per day, on the reporting day of the reported month. Denominator: NA Unit of Measurement: Average number of patients in CC Frequency: Monthly Justification/ Management Utility: This indicator is required to refer/identify need of staff and medicine at CCs and also to provide information on functionality of it. i.e. if average number of patients increases per month that indicates that CC is able to provide services. The objective is to increase utilization of Community Clinic by 200% by 2016 (from 19 patients per day to 40 patients per day) – [CBHC OP] Source: Administrative records (Monthly monitoring report) Performance Indicator Value: Year Actual Notes

2011 (baseline) 19/CC/day (2010)

2012 NA

2013 NA (Revised indicator)


2014 (Target) 35/CC/day

2014 38/CC/day

2015 -

2016 (Target) 40/CC/day

Name of OP: CBHC Indicator No: 02 Directorate/Agency: DGHS Indicator: Number of CC referrals Definition: Number of patients referred from community clinics to UHFWC & UHC for better management of diseases. Patients identified with illness like TB, Malaria, Pneumonia, life threatening influenza, obstetrical emergencies should be referred to higher facilities for better treatment. The objective is to increase number of patients referred to higher level health services with valid reason by about 160% by 2016 (47 patients per month to 75 patients per month). Numerator: Number of patients referred from community clinics to UHFWC & UHC for better management of diseases. Denominator: NA Unit of Measurement: Number of patients referred Frequency: Monthly Justification/ Management Utility: Basically CC is the first tier one stop service center for Primary Health Care with emphasis on Maternal & Neonatal Health. It is to be mentioned that normal delivery is being conducted in 72


some CCs through SBA and CSBA (trained FW A/Female HA) particularly where DSF (Demand Side Financing) & MNH program is going on. The main objective is to institutionalize all the 18000 community clinics under an integrated Upazila and District health system to establish a challenging but effective referral linkage between CCs with second & third level hospitals. Regarding the referral process all the service providers of the field, Community Clinic and all other relevant health facilities of different levels will be well oriented and equipped. [CBHC OP] Source: Monthly monitoring report (CC MIS) Performance Indicator Value: Year

Actual Notes

2011 (baseline) 1.85% of total patients attended (2010)

2012 NA

2013 NA

(Revised)


2014 (Target) 2.50% of total patients attended

2014 2.08% of total patients attended

2015 -

2016 (Target) 3.00% of total patients attended

Name of OP: CBHC Indicator No: 03 Directorate/Agency: DGHS Indicator: Number of community clinic management committee meeting held Definition: Number of community clinic management committee meeting held in a given period of time. Here, CC management committee meeting held per quarter (at least 4 meetings per year) with participation of nominated local community, meeting minutes recorded and implemented. Number of meeting minutes will be the means of collecting information for this indicator. CC management committee consists of 9 to 13 members (at least 4 will be female). President (01): elected UP member, Vice President (02): land donor or his/her representative and one is elected by community people. Among President and Vice-president one must be female treasurer (01): selected by community group members, Member secretary (01): CHCP is be Member Secretary (without voting power). Members (08): selected/elected from different group of people of the CC catchments area (poor, landless, freedom fighter, social worker, female UP member, religious leader, adolescents etc. [CBHC OP] Numerator: Number of community clinic management committee meeting held in a given period of time. Here, CC management committee meeting held per quarter (at least 4 meetings per year) with participation of nominated local community, meeting minutes recorded and implemented. Number of meeting minutes will be the means of collecting information for this indicator. Denominator: NA Unit of Measurement: Number of meetings per quarter Frequency: Quarterly Justification/ Management Utility: Community clinic management committee will monitor performance and supply of logistic, and refer to national level supervising authority. Source: Monthly monitoring report (meeting minutes) Performance Indicator Value: Year Actual Notes

2011 (baseline) 5,000 (2010)

2012 5,000

2013 11,380


2014 (Target) 25,000

2014 28,860/Quarter

2015 -

2016 (Target) 30,000 Including 4,500 Community Clinic units

Name of OP: CBHC Indicator No: 04 Directorate/Agency: DGHS Indicator: Number of CHCPs provided Basic training Definition: Number of recruited community health care providers (CHCP) are provided with Basic training (12 weeks training) to ensure quality service delivery at community clinics in rural areas. Numerator: Number of recruited community health care providers (CHCP) is provided Basic training (12 weeks training) in a given period of time. Denominator: NA Unit of Measurement: Number of persons Frequency: Monthly Justification/ Management Utility: By 2016 under this SWAp 13,500 community clinics have to be established 73


located in the rural areas of Bangladesh with at least 1 Community Health Care Provider (CHCP) and requisite medicine to ensure quality of services. Source: Administrative record (Monthly monitoring report) Performance Indicator Value: Year

Actual Notes

2011 (baseline) 8,848

(2012)

2012

2013

8,848

13,225

Shifted as the baseline

Cumulative


2014 (Target) 13,240

Cumulative

2014 Basic training have been provided to all the CHCPs

2015 -

2016 (Target) 13,500

Cumulative

Name of OP: CBHC Indicator No: 05 Directorate/Agency: DGHS Indicator: Number of a) Community Management Groups (CG) and b) Community Support Groups trained Definition: Number of trainings given to the following two groups: a) Community management Groups (CG) & b) Community Support Groups (CSG) in a given period of time. These capacity development trainings are provided of CG & CSG to establish solar panel, renovation for MNH services including conduction of normal delivery at CCs & many other CC activities. Numerator: Number of CGs & CSGs received training in a given period of time. Denominator: NA Unit of Measurement: Number of groups Frequency: Monthly Justification/ Management Utility: Community clinic is a unique example of Public Private Partnership an all the CCs are constructed on community donated land, construction done by the govt. medicine and all necessary logistics are supplied by government including service providers but management is both by Govt. & community. Source: Monthly monitoring report/Administrative report Performance Indicator Value: Year

Actual Notes

2011 (baseline) CG: 2,900 CSG: 6,141 [Mid 2012]

2012 NA

2013 CG: 12,063 CSG:

CGS is newly included


2014 (Target) CG: 13,000 CSG: 39,000 Cumulative

2014 CG: 12,577 CSG: 37,731 For CGs, all functional CC till date

2015 -

2016 (Target) CG: 16,000 CSG: 48,000 Cumulative

Name of OP: CBHC Indicator No: 06 Directorate/Agency: DGHS Indicator: Number of ANCs in CCs (including nutrition counseling) Definition: Number of anti-natal care including nutrition counseling, provided to the Community Clinics in a given period of time. According to the logical framework at least 10 pregnant women should receive ANC (4th visit) per month per community clinic.

Nutrition counseling, delivered by Health Assistants, Family Welfare Assistants and CHCPs in addition to their usual duties, will be carried out through group counseling, one-to-one counseling during home visits to pregnant women, new mothers, growth falters (i.e. pregnant women, infants & young children). [CBHC OP] Numerator: Number of patients received anti-natal care from the community clinic in a given period of time. Denominator: NA Unit of Measurement: Number per month Frequency: Monthly Justification/ Management Utility: The community level will be the focus of all area based Community Nutrition activities/interventions. CCs will be the main contact points for nutrition services. Nutrition services will be provided in all community clinics in an integrated way with EPI, Satellite clinic and other health and 74


family planning programs. Source: HIS/CC monitoring report Performance Indicator Value: Year Actual Notes

2011 (baseline) 2012 2/month NA N/A, revised indicator


75

2013 NA

2014 (Target) 6/month

2014 10/month

2015 -

2016 (Target) 10/month


OP 4: TB and Leprosy Control (TB-LC) Indicators for OP TB-LC 1. TB case notification rate (all forms) 2. Treatment success rate among detected New Smear Positive (NSP) TB cases 3. Multi Drug Resistance (MDR) patients identified and managed 4. Sustaining Leprosy Elimination at the national level and reducing the new cases at least 10% per year Indicator Reference Sheets for Indicators under OP TB-LC are given below:

Name of OP: TBLC Indicator No: 01 Directorate/Agency: DGHS Indicator: TB case notification rate (all forms) Definition: The proportion of estimated new and relapse tuberculosis (TB) cases detected in a given year under the internationally recommended tuberculosis control strategy. The term ‘case notification’ means the process of reporting diagnosed TB cases to WHO. Annual case notifications are reported annually by countries to WHO using a web-based data collection system. The TB case notifications reported by countries follow the WHO recommendations on case definitions and recording and reporting; they are internationally comparable and there is no need for any adjustment. The term ‘rate’ is used for historical reasons; the indicator is actually a ratio (expressed as percentage) and not a rate. The term ‘all forms (of tuberculosis)’ refers: Pulmonary (smear-positive and smear-negative) and extrapulmonary TB. Tuberculosis (TB): An infectious bacterial disease caused by Mycobacterium tuberculosis, which most commonly affects the lungs. It is transmitted from person to person via droplets from the throat and lungs of people with the active respiratory disease. In healthy people, since the person’s immune system acts to ‘wall off’ the bacteria. The symptoms of active TB of the lung are coughing, sometimes with sputum or blood, chest pains, weight loss, fever and night sweats. TB is treatable with a six-monthly course of antibiotics. Numerator: The number of new and relapse TB cases diagnosed and treated in national TB control programmes and notified to WHO (World Health Organization). Denominator: WHO’s estimated number of incident TB cases for the same year. Unit of Measurement: Cases per 100,000 population/year Frequency: Yearly (Survey) Justification/ Management Utility: It provides an indication of the effectiveness of national tuberculosis (TB) programmes in finding, diagnosing and treating people with TB. The proportion of estimated new smear-positive cases of TB detected (diagnosed and then notified to WHO) by national TB control programmes provides an indication of the effectiveness of national TB programmes in finding and diagnosing people with TB. Source: World Health statistics-2011, NTP Annual Report Performance Indicator Value: Year Actual Notes

2011 (baseline) 99/100,000

2012 65%

2013 69%

2014 (Target) 112/100,000

2014 119/100,000

2015 -

2016 (Target) 120/100,000

Known Data Limitation: Limitations of the indicator are that it can only be used at the national level and that it can only be used on an ‘annualized’ basis. In addition, there are certain limitations inherent in the calculation of DOTS coverage and in WHO’s estimate of incidence. Date of last Update: August 20, 2015

Name of OP: TB-LC Indicator No: 02 Directorate/Agency: DGHS Indicator: Treatment success rate among detected New Smear Positive (NSP) TB cases Definition: Treatment success rate among detected national strategic plan (NSP) Tuberculosis (TB) cases is the percentage of new, registered smear-positive (infectious) cases that were cured or in which a full course of treatment was completed. Smear-positive is defined as a case of TB where Mycobacterium tuberculosis bacilli are visible in the patient's 76


sputum when examined under the microscope. A new case of TB is defined as a patient who has never received treatment for TB, or who has taken anti-TB drugs for less than 1 month.

At the end of the treatment, each patient is assigned one of the following six mutually exclusive treatment outcomes: cured; completed; died; failed; defaulted; and transferred out with outcome unknown. The proportion of cases assigned to these outcomes, plus any additional cases registered for treatment but not assigned to an outcome, add up to 100% of cases registered. Numerator: Number of new smear-positive pulmonary TB cases registered in a specified period that were cured plus the number that completed treatment. Denominator: Total number of new smear-positive pulmonary TB cases registered in the same period. Unit of Measurement: Percent Frequency: Yearly (Survey) Justification/ Management Utility: This indicator measures a program’s capacity to retain patients through a complete course of chemotherapy with a favorable clinical result. It is an outcome indicator (in the logical framework sense), and it is noteworthy because it is the only outcome indicator that can be used at all levels (e.g., from operational level to international level). There is a direct and immediate link between this outcome of treatment success and the impact of reduced TB mortality which is influenced by variety of factors (e.g., uninterrupted drug supply, supportive environment for the patient etc.). Source: NTP Annual report (Quarterly reports on treatment outcomes, TB register, TB treatment card) Performance Indicator Value: Year Actual Notes

2011 (baseline) 92% 2009, NTP MIS report

2012 92%

2013 92%

2014 (Target) Sustain

2014 93%

2015 -

2016 (Target) Sustain

Known Data Limitation: Treatment success rates can be low for a number of reasons. Several factors affect the likelihood of treatment success, including the severity of disease (often related to the delay between onset of disease and the start of treatment), HIV infection, drug resistance, malnutrition and the support provided to the patient to ensure that s/he completes treatment. Even where treatment is of high quality, reported treatment success rates will only be high when the routine information system is also functioning well. The treatment success rate will be affected if the outcome of treatment is not recorded for all patients (including those who transfer from one treatment facility to another). Where treatment success rates are low, the causes of the problem can only be identified by determining which of the unfavorable treatment outcomes is most common. Date of last Update: August 20, 2015

Name of OP: TB-LC Indicator No: 03 Directorate/Agency: DGHS Indicator: Multi Drug Resistance (MDR) patients identified and managed Definition: Number of multidrug-resistant (MDR) TB patients identified and managed by the national and regional MDR TB reference labs on quarterly basis. The term multidrug-resistant tuberculosis (MDR-TB) is defined as tuberculosis that is resistant to at least isoniazid (INH) and rifampicin (RMP), the two most powerful first-line treatment anti-TB drugs. MDR-TB develops in otherwise treatable TB when the course of antibiotics in interrupted and the levels of drug in the body are insufficient to kill 100% of bacteria. Here, MDR patients are managed through ensuring quality of lab services and diagnosis of MDR TB by the established national and regional reference lab. Numerator: Number of multidrug-resistant (MDR) TB patients identified and managed by the national and regional MDR TB reference labs on quarterly basis. Denominator: NA Unit of Measurement: Number (Cumulative) Frequency: Quarterly Justification/ Management Utility: Cases of MDR TB have been reported in every country surveyed. It commonly develops in the course of TB treatment and are most commonly for the above cases: doctors giving inappropriate treatment, or patients missing doses or failing to complete their treatment, drug supplies may run out or become scarce. MDR-TB is spread from person to person as readily as drug-sensitive TB and in the same manner. Even with the patent off second line anti-tuberculosis medication the price is still high and therefore a big problem for patients living in poor countries to be treated. With patients not treated, the spread of TB would be problematic in poor countries. In order to fully cure infectious diseases, such as TB, we need a plan to ensure equal access to health 77


care. Source: NTP Annual Report Performance Indicator Value: Year Actual Notes

2011 (baseline) 390 NTP Annual report

2012 1,536

2013 1,536

2014 (Target) 1,400

2014 748

2015 -

2016 (Target) 2,300

Known Data Limitation: The increasing incidence of multidrug resistant tuberculosis (MDR-TB) is a major concern for TB control programs worldwide. MDR-TB treatment requires prolonged use of multiple second-line anti-TB drugs, which are more expensive and toxic than first-line drugs, yet less efficacious. As a result of these problems, administration of MDR-TB treatment imposes substantial operational challenges in resource constrained settings. Further, the optimal composition and duration of MDR-TB treatment regimens is uncertain. Date of last Update: August 20, 2015

Name of OP: TB-LC Indicator No: 04 Directorate/Agency: DGHS Indicator: Sustaining Leprosy Elimination at the national level and reducing the new cases at least 10% per year Definition: Elimination of leprosy, as a public health problem, in 1991 WHO defined as a prevalence smaller than one per 10,000 populations. Underlying this elimination strategy was the hypothesis that because leprosy patients are assumed to be the sole source of infection, early detection and treatment with multidrug therapy (MDT) would reduce transmission of Mycobacterium leprae. It was expected that once the prevalence fell below this level, the chain of transmission would be broken, and leprosy would disappear naturally, thus leprosy elimination could be sustained at the national level. The elimination of leprosy as a public health problem was defined as a prevalence rate (PR) of less than one case per 10,000 populations. Numerator: New leprosy cases Denominator: Number of population Unit of Measurement: Rate (new cases per 10,000 population) Frequency: Yearly Justification/ Management Utility: The main objective of National Leprosy Elimination Program (NLEP) is to detect leprosy cases and ensure whole course of treatment. As a result, the leprosy patients will be cured and will get rid of development of physical deformity or disability and thus economic destitution. On the other hand, treatment of cases will cut the chain of transmission and will thus ensure healthy environment for other people. By end of 2010, only five districts had a leprosy prevalence of more than one case per 10,000 population. To achieve leprosy elimination by mid-2014 in all five districts, strategy has been taken during HPNSDP is to reduce leprosy prevalence at national level to less than 0.10 cases per 10,000 population. Source: Administrative record Performance Indicator Value: Year

Actual Notes

2011 (baseline)

0.20/10,000

2012

Reduce by>5%

2013 0.20/10,000 Reduced by 5%

2014 (Target)

5%, SS (2011)

2012 After 2006, BSS & Serosurveillance were not conducted among brothel based sex

2013

Sustained

2014 (Target) Feb), (JulJun->Aug)

NA

100% (FY 2011-12 annual performance 21 will be disseminated under APIR 2012), Planning Wing 2012

100%

100% (achieved by 2013)

Result 2.3: Improved human resources – planning, development and management 2.3.1

Proportion of service provider positions functionally vacant at district level and below,

DGHS/DGFP MIS, annual BHFS, every 2 yrs

Physicians: 45.7%; Nurses: 24.7%; FWV/SACMO/

Physicians 22: 46.1%, Nurses: 19.59%,

Physicians: 46.1%, Nurses: 19.59%,

Physicians: 29.9%, Nurses: 12.8%, FWV/SACMO/M

Physician s: 22.8%; Nurses: 15.0%;

14 In 2006, MOHFW decided to upgrade 1,495 UH&FWCs to provide basic EmOC [source: Mridha et al. (2009) Public Sector Maternal Health Programmes and Services for Rural Bangladesh, J Health Popul Nutr 27(2):124-138].] 15 % of UnH&FWC (upgraded) able to provide vacuum and forceps delivery only. 16 Considering three injections mentioned in the definition and being able to provide vacuum & forceps delivery (components of Basic EmOC). Previously in BHFS 2009 it was only considered for able to provide vacuum & forceps delivery. 17 Defined as able to provide 24/7 services for normal delivery. 18 ‘Disseminated’ is defined as distributed to, and discussed with relevant stakeholders. 19 Baseline set as ‘Not Applicable’ as the current practice by MISs is publication on time and distribution (no stakeholder discussion) 20 This is a new indicator. PMMU plans to help LDs to prepare six monthly programmatic and, financial reports. PMMU has developed a software for tracking monthly programmatic/ financial progress. PMMU is in the process of developing a six monthly data collection format for each of the 32 OPs. Combining these reporting mechanisms, six monthly reports will be prepared by LDs which can be shared with stakeholders. 21 As the program started in January 2012, the annual report was prepared for Annual Program Review-for the reminder of the program, such reports will be prepared both six-monthly and annually. 22 Physicians includes consultants and general physicians

160


Means of Verification & Timing

Performance Indicator

Sl #

by category # of additional providers trained in midwifery at Upazila health facilities Number of comprehensive EmOC facilities with functional 24/7 services covering all districts

2.3.2

2.3.3

Baseline & Source

Update 2012

Update 2013

Update 2014

Target 2016

MA: 16.9%, BHFS 2009

FWV/SACMO/ MA: 21.2%, BHFS 2011

FWV/SACMO/ MA: 21.2%, BHFS 2011

A: 11.7%, BHFS 2014

569, APIR 2013

1,102, MPIR 2014

FWV/SAC MO/MA: 8.5%

85 23, MNCAH LD, 2012

75, APIR2 013

101, MPIR 2014

204 24

NA (Proper data source is being identified)

NA 26

0.93%, MIS/DGHS 2014 27

6.2% 28

HRD/MOHF W, annual

NA

115, APIR 2012

MIS/EOC BHFS, every 2 yrs

132, MIS/DGHS 2009

DGHS MIS, annual

8%, 25 Health Bulletin 2009

BHFS, every 2 yrs

66.1%, 29 BHFS 2009

74%, BHFS 2011

74%, BHFS 2011

73.6% 30, BHFS 2014

75%

BHFS, every 2 yrs

58.1%, BHFS 2009

55.1%, BHFS 2011

55.1%, BHFS 2011

60.2%, BHFS 2014

70%

BHFS, every 2 yrs

51.0%, BHFS 2009

44.5%, BHFS 2009

44.5%, BHFS 2011

47.6%, BHFS 2014

75%

1982 Regulatory Act

Accreditation of public hospitals is under process, HSM OP 2012

Accreditation document finalized; MOU with 2 private hospitals signed,

3,000

Result 2.4: Strengthened quality assurance and supervision systems

Case fatality rate among admitted children with pneumonia in Upazila health complex

2.4.1

Result 2.5: Sustainable and responsive procurement and logistic system

% of health facilities, by type, without stockouts of essential medicines at a given point in time % of facilities without stock-outs of contraceptives at a given point in time

2.5.1 2.5.2

% of facilities (excluding CCs) having separate, improved toilets for female clients

2.6.1

Regulatory framework for accreditation of health facilities including hospitals (both in the public and private sectors)

2.7.1

Result 2.6: Improved infrastructure and maintenance

Result 2.7: Sector management and legal framework

MOHFW

Accreditation document developed, shared with stakeholders, and submitted

Reviewed (by 2012)

MNCAH suggested to revise the baseline to 78 upazilas for 2009. DGHS Voice of MIS Feb, 2009 25 Calculated from sex distribution of causes of death in each age cluster of children who attended outpatient and emergency departments of IMCI facilities. 26 Recently initiated online reporting tool for DGHS captures this and will be able to report update in the next year. 27 DHIS-2 Tabular Report (Online) Available at: http://103.247.238.82:8080/mishealth/dhis-web-caseentry/app/index.html 28 Calculated as a reduction of the CFR after the implementation of the WHO’s standard ARI case management guidelines found to be 23% [source: Theodoratou et al (2010)] 29 Defined as at least 75% of union level essential drug kit (10 drugs) available in the facilities at district level and below. 30 Defined as at least 75% of 8 union level essential drugs available in the facilities at district level and below (excluding CC) 23 24

161


Performance Indicator

Sl #

reviewed and updated 31

2.8.1

Means of Verification & Timing

Baseline & Source

Update 2012

Update 2013

Respective agencies, annual

to MOHFW, MPIR 2014

07 districts (including 14 pilot upazilas)

14 upz (PME OP) and 42 upz (PMR OP), APIR 2013

188 upz (PME OP) and 28 upz (PMR OP), MPIR 2014

Piloting complete d and reviewed for scaleup.

Irregular

1 out of 15 (only USAID), Planning Wing 2012

19% (3 out of 16 DPs), Planning Wing 2013

87.5% (14 out of 16 DPs), Planning Wing 2014

100%

79.4%, 32 FMAU 2009/2010

60% (FY 2011-12), APIR 2012 33

99%, APIR 2013 34

94%, MPIR 2014 35

100% (by 2013)

78.1%, APIR 2013

69%, MPIR 2014

100% (by 2013) 37

61%, World Bank 2013

34%, World Bank 2014

>80%

NA

Result 2.9: SWAp and improved DP coordination (deliver on the Paris Declaration)

2.9.1

# of non-pool DPs submitting quarterly expenditure reports

2.10.1

% of project aid fund (e.g. development budget) disbursed annually and quarterly

2.10.2

% of OPs with spending >80% of ADP allocation (annually)

2.10.3

% of serious audit objections settled within the last 12 months

Planning Wing FMAU

Result 2.10: Strengthened Financial Management Systems (funding and reporting) FMAU

FMAU/ Planning Wing

44.7%, 36 FMAU 20032011

FMAU

7%, FMAU 2007/2008 38

59.4% (with 80% or more); 50% (with >80%), Planning Wing 2012 39%, FMAU 2012

31 Reviewed and updated refers to as starting with a framework for facilitating accreditation of public hospitals and then extend to private hospitals 32 Baseline taken from the HPSDP Strategic Document, p.57 33 Estinated as the total fund allocated for the 32 OPs as the proportion of estimated budget in the PIP for FY 2011-12. 34 Estimated as the PA fund released against FY 2012-13 RADP allocation for PA 35 Estimated as the PA fund released against FY 2013-14 RADP allocation for PA 36 Baseline taken from HPSDP Strategic Document, p.71-72 37 Target set as 100% to ensure efficient fund utilization 38 Baseline from APIR 2009

162

Target 2016

APIR 2013

Result 2.8: Decentralization through LLP procedures

# of Districts/Upazilas having functional LLP procedures

Update 2014


ANNEX II: OP-LEVEL INDICATOR (REVISED) LIST Sl #

Unit of Measurement (Means of Verification)

Revised OP Indicators

Baseline (2011-12)

Target Mid-2014

Target 2016

78

132

204

OP#01: MATERNAL, NEONATAL, CHILD AND ADOLESCENT HEALTH (MNCAH) 1

Number of health facilities providing 24/7 C-EOC

3

Number of Upazilas having DSF program

2 4 5 6

Number of CSBA trained

Proportion of women age 15-49 yrs received TT-5 doses of TT during their last pregnancy Proportion of children aged 12-23 months vaccinated by all scheduled vaccines by 12 months of age Number of UHCs having an IMCI with Nutrition Corner

OP#02: ESSENTIAL SERVICED DELIVERY (ESD) 7 8 9

10 11

Number of Upazila under Upazila Health System (UHS) piloting Number of UHCs with personnel trained on MWM Number of Urban Dispensaries functional with HR and supplies Update of National Protocol for Mental Health Care Satellite clinics taking place in CHT as per workplan

Number of MCH, DH and UHCs (HIS/ Admin records) Number of persons (OGSB/ Admin record) Number of Upazila (DSF Monitoring Report)

7,089

9,000

13,500

Percent (Coverage Evaluation Survey - CES)

42.3%

45%

70%

80.2 %

85%

90%

Number (Admin record)

NA

3 Upazila

7 Upazila

Percent (Coverage Evaluation Survey - CES) Number of UHCs (Admin record/ IMCI MIS)

Number (Admin record) Number (Admin record)

Protocol updated and available Number of satellite clinics/ medical camps – 1 in each Upazila per month (Admin record)

OP#03: COMMUNITY-BASED HEALTH CARE (CBHC) 12

Patients per CCs per day

13

Number of CC referrals

14 15 16 17

Number of community clinic management committee meeting held Number training

of

CHCPs

provided

Basic

Number of a) Community Management groups (CG) and b) Community Support Groups trained Number of ANCs in CCs (including nutrition counseling)

OP#04: TB AND LEPROSY CONTROL (TB-LC) 18 19

TB case notification rate (all forms)

Treatment success rate among detected New Smear Positive (NSP) TB cases

163

Average number of patients in CC (Monthly monitoring report) Number of patients referred (Monthly monitoring report) Number of meetings per quarter (Monthly monitoring report) Number of person (Monthly monitoring report) Number of groups (Monthly monitoring report / Admin report) Number per month (HIS/CC Monitoring report)

Cases per 100,000 population/year (NTP Annual Report)

% (NTP Annual Report)

53

93

350

133

410

480

206 Upazila

306 Upazila

421 Upazila

NA

Draft finalized

Protocol Updated

NA

100 /year

200 /year

19/CC/ day (2010)

35/CC/ Day

40/CC/day

17

1.85% of total patients attended (2010) 5000

8,848 CG: 2,900

CSG: 6,141

33

2.50% of total patients attended 25,000

13,240 (Cumulative) CG: 13,000 CSG: 39000

2/month

6/month

99 /100,000

112 /100,000

92%

Sustain

33

3.00% of total patients attended 30,000

13,500 (Cumulative) CG: 16,000 (Cumulative) CSG: 48,000 (Cumulative) 10/month

120 /100,000 Sustain


Sl # 20 21

Revised OP Indicators Multi Drug Resistance (MDR) patients identified and managed Sustaining Leprosy Elimination at the national level and reducing the new cases at least 10% per year

OP#05: NATIONAL AIDS/STD PROGRAM (NASP) 22 23 24 25 26

Prevalence of HIV among Injecting Drug Users Prevalence of active syphilis among sex workers

Number of medical personnel trained in HIV % of service points having stock of ARV drugs Number of HIV testing centers providing regular service updates

Unit of Measurement (Means of Verification) Number (NTP Annual Report) Rate (new cases per 10,000 population) (Admin record) % (Sero-surveillance/ IBBS) % (Sero-surveillance/ IBBS)

Number (Admin record) % (Admin record)

% (Annual report)

OP#06: COMMUNICABLE DISEASE CONTROL (CDC) 27 28 29 30 31 32 33

Malaria mortality

Proportion of patients under coverage of EDPT for severe malaria Number of filariasis endemic districts stopped Mass Drug Administration(MDA) Number of school children of age 5-12 years administered with deworming drugs Kala-azar incidence

Proportion of dog bite victims managed with Post Exposure Prophylaxis (PEP)

Number of diseases under intensive surveillance

Rate - Deaths per 10,000 people Percent (NMCP MIS)

Number of districts (Transmission Assessment Survey TAS) Number of children (6 monthly report on MDA coverage) Rate – new cases per 10,000 people (CDC Annual Report) Percent (CDC Monthly Report)

Number of UHCs 39 providing a) hypertension and b) diabetes screening

35

Number of service providers trained on NCD screening and management

36

Number of Upazilas covered by awareness campaigns on injury (traffic and childhood injuries, including drowning)

37 38

Number of factories providing occupational health and safety training Number of arsenicosis patients treated

OP#08: NATIONAL EYE CARE (NEC)

39

Target 2016

390

1400

2300

0.20 /10,000