Varun Bhardwaj**,,

Motherhood is a divine feeling, a wonderful experience, but it brings with itself tremendous responsibilities which call for proper care for both mother and the child. For a healthy mother and child, it must be ensured that required medical care is provided to pregnant woman and full immunization course is administered to the child. It is with this spirit in the mind that the Ministry of Health and Family Welfare launched the Mother and Child Tracking System (MCTS) in December 2009. The focus in MCTS is on the Beneficiary Based Monitoring of the delivery of services to ensure that all pregnant women and all new born receive ‘full’ maternal and child health services. The MCTS utilizes Information Technology and seeks to capture details of every pregnancy in the country in a centralised data base. It is a generic system which aims to provide information of different health services received at the individual level, by monitoring all service deliveries that an individual benefits from.

MCTS Coverage

The MCTS database primarily comprises of

• All new Pregnancies detected/ registered from 1st December, 2009 at the first point of contact of the pregnant mother with the health facility/health provider.
• All Births occurring from 1st December, 2009.

Unique Identification Number

The record of each mother and child is tracked through a 16 digit unique identification number. The 16 digit unique number  contains  state code, district code, Block PHC/CHC Code, Health Sub-Centre Code, Pregnant Woman code, child code and the serial number given to each mother/child.

Advantages

The Ministry of Health and Family Welfare endeavoured to have a central data repository for quick reference of validated data for all pregnancies and births in India. Such a Central Database seeks to facilitate grassroots level health functionaries like ANM, ASHA, Anganwadi workers etc. in performance of their duties by enabling more effective transformation and utilization of information. It is envisaged to implement a Beneficiary Centred Approach so as to ensure delivery of maternal and child health services from conception till 42 days after delivery in the case of pregnant women and up to five years of age in the case of children so as to ensure that all pregnant women and all new born receive full maternal and immunization services.

Further, MCTS would enable roll-out of targeted health programs and schemes, for controlling of external cost and time spill-over and ensure tracking of full immunisation course for all children. It shall also lead to validation of information collected from each block/district/state at the central level, for figuring out authenticated situation at respective functional levels.

Furthermore, efficient need-based planning of allocation and management of health resources can be done at ground-level. For example a fair idea about drug stock and inventory can be made once  number  of pregnancies have been recorded at a particular level. Thus, it leads to improved supply chain management of vaccines and drugs .Also, MCTS can provide vital clues for making improvements in the system for better service delivery. The bottlenecks at the implementation level which hinder effective implementation of Government initiatives can be known and provide valuable inputs for public policy implementation. Not only this, MCTS is expected to facilitate qualitative improvement in the delivery of services to pregnant women and children of the country and thus facilitates an accelerated reduction in maternal, infant and child mortality.

Architecture of MCTS

The operationalization of the MCTS is achieved by clear cut role allocation at different levels viz. village level, Sub Centre level, PHC level, CHC level, District level, State Level and the National Level.

Village Level

Identification of pregnant women and new born is done at the Village level. The Accredited Social Health Activist (ASHA) of the National Rural Health Mission (NRHM) has been given the responsibility of informing the Auxiliary Nurse Midwife (ANM) about the details of the pregnant women and new born in the village every month.

Sub Centre Level

            The delivery of maternal and child health services according to the agreed service delivery protocol is done at the sub centre level. At the Sub Centre level the ANM is responsible for Contacting all pregnant women reported by ASHA and  preparation of the Pregnant Woman Card( One copy to be retained by the ANM and the other given to the pregnant woman).Services are delivered according to the agreed service delivery schedule and the ANM updates the Maternal Health Card.The ANM Contacts parents of all new born and prepares the Child Health Card.

The above data is entered into a Central Database at Primary Health Centre /Community Health Centre where internet facility is available. This registers pregnant women and the details of services due (example ANC or antenatal care) to the woman along with the dates are captured in the database. The name and contact details of associated ASHA worker/ANM are also entered into the database .In fact, two distinct fields in the data base viz. Services administered and Services overdue help in monitoring and tracking service delivery at field level.

Primary Health Centre (PHC)

The Medical Officer at PHC is responsible for organizing training of ASHAs in the identification of pregnant women and children below five years of age; organizing fortnightly/monthly meeting to review the records maintained by ANM with a view to improve the quality of the record; visiting all villages in the PHC at least once in a month to supervise the activities of ASHA and to provide her necessary support; on the spot verification of the data entered in MCTS using a standard sample design.

Finally, the Medical Officer also identifies gaps in the context of providing ‘full’ maternal and child health services to all pregnant women and all new born recorded in MCTS.

Community Health Centre( CHC)

The Block Program Manager at the CHC is responsible uploading the data on pregnant women and new born in the MCTS software and generating reports related to the implementation of MCTS at the PHC level within the CHC. He is also responsible for tabulation and analysis of the verification data available through the cross checking of the records entered in the MCTS system.

District Level

MCTS performance review  is done at the district level to fill up the gaps in the health care delivery institutions within the district in the context of delivering ‘full’ services to all pregnant women and all new born.

State Level

Monthly reports of the implementation of MCTS for all districts within the state are generated and state level monthly meetings are organized to review the implementation of MCTS at the district level and identify and address bottlenecks and constraints in implementing MCTS.

National Level

MCTS cell is responsible for monitoring and analysis of the progress of MCTS in terms of data entry status, identification of low reporting States/districts and identification of districts/facilities not reporting.

The Quality of data reporting is known through data of performance of state and district indicators and cross analysis of data and services provided. This helps in identification of abnormalities and and discrepancies in MCTS data.

Also National level meetings are organized to review the implementation of MCTS at the state/UT level and to identify and address the bottlenecks and constraints in implementing MCTS. Besides, the MCTS Cell also prepares Quarterly Research Note using the data available through MCTS.

Thus, the states can take action at their own end to ensure that services reach those for whom they are meant. This is possible since the contact details of all beneficiaries to whom services are overdue along with the associated ANM/ASHA are available at the click of a mouse. As on 1 May, 2012, a total of 2,07,55,732 women have been registered with the Mother and Child Tracking System.

The Central Government on its part regularly intimates Mission Directors of NRHM in states on the progress made and gaps which remain in provision of services to beneficiaries. In addition, a call centre has been established in the Ministry of H&FW to directly contact pregnant women and parents of the new born registered under the system to verify the services that they have received. A Toll-Free facility which provides information to beneficiaries registered with the MCTS server has also been started. At present the data of MCTS is available only through private login to the Ministry of Health and Family Welfare and various State Governments. Although, a  full fledged MCTS portal is expected to be launched so that the data is available in Public Domain. In a nut shell, MCTS  not only facilitates closer monitoring and regular check-ups of pregnant women and reduces avoidable complications but aids strategic decision-making and need based allocation of resources also.

*Disclaimer: The views expressed by the author in this feature are entirely his own and do not necessarily reflect the views of INVC