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Ms.Hannah Ranjani.A Msc (nsg)Iyr student bstetrics and gynecological Nursing department .

(the author duely recognizes the various sources of information from internet and journals. This is not an original document)

MONITORING OF INFORMATION AND EVALUATION SYSTEM (MIES) INTRODUCTION Existing system National Rural Health Mission Raising fund allocations. Streamlining of interventions. Reports and reviews. Monitoring & Evaluation under RCH-II/NRHM The elements of MIES (a) Quality Assessment Mechanism (QA) (b) Programme Management Evaluation (c) Community Monitoring Decentralization Validation of data through Triangulation Methodology Evaluation Surveys Population Research Centre (PRCs) Regional Evaluation Teams (RETs) Area Specific studies and concurrent evaluation Significance of MIES WEAKNESSESS IN THE PRESENT M&E SETUP- A report of the Task Force on HMIS in March, 2006 (i) Legislative. (ii) Administrative and Organizational (iii) Upward flow of information (iv) advances in Information Technology (v a nodal Health Information Officer (vi) the data reporting system by integration Essentials of PROPOSED HMIS STRATEGY (A)Identifying Nodal Information Officer at all levels (B)Structuring the Information flows (C)Infrastructural strengthening- IT, Networking, Manpower

(D)Information flows from the private sector (E)Earmarking upto 3% of the States Budget in Information Technology interventions INFORMATION EDUCATION & COMMUNICATION Introduction Red triangle Landmark strategy Knowledge of contraceptive methods New initiatives Decentralized strategy Three tier approach IEC at state level IEC at district level \Non governmental efforts Population education Project on School education. Project on post-literacy & continuing Education Project on Higher Education Project on Vocational Training ( Project for involvement of Elected Representatives Project for involving journalists REFERENCES http://www.mohfw.nic.in/dofw%20website/family%20welfare%20programme/iec.htm . http://nrhm-mis.nic.in/Training_HMIS_Portal/MEActivities.aspx

MONITORING OF INFORMATION AND EVALUATION SYSTEM A. INTRODUCTION 1.The Statistics (Monitoring & Evaluation) Division in the Ministry of Health & Family Welfare is responsible for monitoring and evaluation of the National Family Welfare Programmes in the country. The information flows from the primary levels and is consolidated at the State level on a monthly basis before the information is sent to the centre for the national level consolidation. The system for capturing information on Family Welfare programmes has evolved over the years based on the changing needs of the Ministry. Similarly, for the National Health programmes like TB, Malaria, Leprosy etc, the respective Divisions in the Ministry have evolved their data reporting system. The Department of AYUSH and National AIDS Control Organisation also have their own reporting system. 2.The Government of India launched the National Rural Health Mission (NRHM) in April, 2005 with an aim to achieving the targets set by the Millennium Development Goals (MDGs) 4, 5 and 6 and making the health delivery system more responsive to the health care needs of the people of India. The Reproductive and Child Health Phase-II (RCH-II) is a critical programme under the National Rural Health Mission (NRHM). The NRHM has a pro-poor focus and aims at establishing bottom up planning and monitoring processes and systems so as to enable increased peoples participation, decentralization of health services and accountability of health delivery and care personnel. 3. The Government of India is committed to raising public expenditure on health from the current 0.9% of GDP to 2-3% of GDP and substantial inputs are being infused into Public Health System so that adequate capacities are created in the health sector. The NRHM aims to undertake architectural correction of the health system to enable it to effectively handle increased expenditure allocations and promote policies that strengthen public health management and service delivery in the country. It has, as its key components, provision of a female health activist in each village (ASHA); a village health plan prepared through a local team headed by the Health and Sanitation Committee of the Panchayat; results and outcome based management and performance based funding; feedback through regular monitoring and evaluation; strengthening of the rural hospital for effective curative care and accountable to the community and integration of the National Health and Family Welfare Programmes and funds for their optimal utilisation in the delivery of primary healthcare. 4.With the launch of the NRHM, there has been a concerted effort towards streamlining and convergence of the various interventions for Health, Family Welfare, AYUSH and NACO. In this context, the Statistics Division has integrated the key indicators for these interventions in a common MIES format that would facilitate efficient monitoring of these programmes. The State Governments also need to revise the primary registers for capturing of the required information at the disaggregate level. 5. In the meanwhile, we are continuing to receive the information on the National Family Welfare Programmes in the pre-revised format. The reports/information is received monthly, quarterly and annually as per requirement for monitoring the schemes/programmes. A monthly performance Review is prepared on the basis of the reports for monitoring the monthly progress of the programme. Besides, annual returns on socio-economic and demographic particulars of Vasectomy, Tubectomy and IUD acceptors viz. (i) number of living children (ii) age of wife of acceptors etc, are also collected and published in the annual publication Year Book. In addition, the M& E Division also organises the conduct of various surveys like National Health Family Survey (NFHS), District Level Household Survey (DLHS) etc. This Division is also responsible

for conducting the activities of the Population Research Centres (PRCs), Regional Evaluation Teams (RETs), NIHFW and IIPS, all of which are associated with the research activities to support the statistical and demographic activities of the health sector. B. Monitoring & Evaluation under RCH-II/NRHM 6. The Monitoring & Evaluation Strategy of Ministry of Health and Family Welfare (MOHFW) for the National Rural Health Mission (NRHM) and Reproductive and Child Health Programme II (RCH-II) programme increasingly focuses on achieving output/outcome results and has clearly articulated the set up of monitoring and evaluation system. The technical strategies in NRHM/RCH II are designed to increase access and improve service quality for specific evidence based interventions. In line with principles of RCH-II/NRHM, most of the states have prepared their Programme Implementation Plans (PIPs) and have also worked out in detail the logical framework wherein output/outcome indicators have been spelt out. Like wise under NRHM, the district plans are to be evolved with the district specific objectives/goals. Since the financial disbursement from GOI to the State and from State to districts are all linked to the performance and achievement of the proposed objective/goal, M & E Division is in the process of evolving an effective MIES to track the progress of the various initiatives under RCH-II/NRHM. 7. Besides, the MIES strategy under NRHM the emphasis is not only on monitoring the physical performance but also to evaluate the quality of services and to conduct the management evaluation assessment of institutional arrangements for delivering the services. The elements of MIES are classified into three distinct components of programme inputs, monitoring and tracking and quality assessment review and evaluation. (a) Quality Assessment Mechanism (QA) 8.Assessing and continuous improvement in the quality of RCH services is one of the thrust priorities of NRHM/RCH II programme. The MOHFW intends to undertake a process of evolving a methodological framework for accessing maternal health, child health and family planning services being provided by the public health system in RCH II programme. Since, quality assessment and improvement is in nascent stage, it was decided to adopt a simplistic approach and confine to a few selected indicators of reproductive and child health programme so that the health system is able to absorb and internalise QA activities as part of the routine activities. Being a new concept, it has been decided to pilot QA in some selected districts before up scaling at the national level. On the basis of the pilot, the details of assessing and evaluating quality of services will be worked out and appropriate parameters will be devised. However, as this activity is going to be initially through external facilitation, the methodology of conducting the study, details of number of health institutions to be covered, frequency of visiting the institutions and undertaking the activity will be finalized after the pre-testing exercise. b) Programme Management Evaluation 9. One of the initiatives in RCH-II includes creating new management support structures at centre, state and district levels. Under programme management, evaluative studies will be piloted to assess the management capacity of the public health system. Subsequently, appropriate tools will be designed for enhancement of management skills of public health personnel. IIM, Ahemdabad was identified as the nodal institute for preparing the tools for assessing the institutional arrangement for service delivery in the states. The Institute conducted a pilot study in Gujarat and Rajasthan and submitted report/instruments to the Ministry which were circulated to the States. (c) Community Monitoring

10. The National Rural Health Mission (NRHM) and the Reproductive and Child Health Programme (RCH-II) have articulated the need for decentralization of health programmes and strongly advocated community management of the health programmes. Keeping this in view, M & E Division is in the process of developing a framework and tools for implementing Triangulation of Data involving Community Monitoring, which is to be piloted initially before up scaling at the national level. As this is a new concept in the public domain, appropriate tools, methodology and frame work are to be prepared and tested. The Development partners are providing technical assistance for this aspect. (d) Validation of data through Triangulation Methodology 11. MIES under RCH-II/NRHM also envisages the need for validation of data by triangulation to minimize the potential of misreporting. To be effective for policy development and programme management; triangulation data generated will allow for comparisons over time and lateral comparisons between target groups simultaneously. At the same time, it will enable increased participation by all stakeholders in managing and developing accountable and responsive services and supports, participatory decision making based on data reflecting enabling factors and implementation bottlenecks. Given these advantages of the approach, there is a consensus within the M&E division of GOI to experiment this method but an appropriate methodology of triangulation of data in reproductive health is yet to be formalized. As a matter of fact two sources of information- one from MIS and the other through surveys are often available. However, the third component of community reporting in a formalized manner is a new concept that has to be evolved. A methodology for community monitoring mechanism and later triangulation process are going to be piloted. On the basis of the experience gained in the pilot study, a practically feasible methodology for triangulation will be evolved and introduced as part of the MIES. (e) Evaluation Surveys 12.Besides having regular Monitoring and Evaluation mechanism in house as well as through Population Research Centres (PRCs) and Regional Evaluation Teams (RETs) in respect of ongoing interventions, M&E Division also organizes large scale surveys namely National Family Health Survey (NFHS) on the lines of Demographic and Health Surveys conducted in the other countries, Districts Level Household Surveys (DLHS) Facility Survey to assess and evaluate the outcome/impact of the programmes /interventions from time to time. The surveys through data at district/state level covering the areas viz Family Planning, Immunization, Maternal Health &care, Infrastructure facilities available at various health facilities levels including trained /skilled manpower (medical and paramedical) in the country. The Survey data also gives information by social groups viz SC, ST, OBC, Others. In pursuance to the decisions of the National Commission on Population, the Ministry is now actively considering to conduct an Annual Health Survey so that the District Health Profile of each district could be prepared and used as an input for policy initiatives. In the meanwhile, the DLHS would aim to provide the baseline, midline and endline surveys for assessing the impact of the health interventions on the community. (f) Population Research Centre (PRCs) 13.The Ministry of Health and Family Welfare established a network of 18 Population Research Centres (PRCs) scattered in 17 major States. These PRCs are located in various Universities (12) and other Institutions (6) of national repute and are under the administrative control of M&E Division. The Centres are responsible for carrying out research on various topics of population stabilization, demographic, socio-demographic surveys and communication aspects of population and family welfare programme. The PRCs have been operated as a Plan Scheme which has been

continuing and it is being proposed to extend the same in the subsequent Plans. (g) Regional Evaluation Teams (RETs) 14.RETs are responsible for monitoring and evaluating the programme implementation of Health and Family Welfare services provided to the community in the country and to check the reliability of information on Family Welfare Programmes. The seven RETs are located in the Regional Offices of the Ministry of Health & Family Welfare. Each Evaluation team is supposed to undertake tour of 20 days every month and cover 2 districts having 6 centres (2 rural family welfare centers and urban F.W. Centres in each districts) selected randomly covering on an average of 700 acceptors of family planning including RCH beneficiaries for field verification. Sample verification is done by the team members contacting personally the selected acceptors of Family Welfare Services who are selected from the registers maintained in the Health Centres. The RETs are functioning under the guidance and supervision of M & E Division but their administrative control rests with their concerned Regional Offices for Health and Family Welfare. (h) Area Specific studies and concurrent evaluation 15.The M&E Division provides technical inputs in formulating studies to conduct concurrent evaluation of various Programmes implemented by the Ministry under NRHM as well as coordinates the same with the field organization involved in fieldwork etc. Most of the studies are allocated to the 18 Population Research Centres, International Institute for Population Sciences, Mumbai, National Institute for Health & Family Welfare. In addition the M&E Division is underatking a scheme for concurrent evaluation of the NRHM by independent agencies that would be entrusted with the task of evaluating the impact of the Mission in its various dimensions across various States. C. Significance of MIES 16.It may be appreciated that monitoring and evaluation is a key component of the NRHM as it aims to provide critical indicators that would assist in identifying and developing mid course corrections so that the goals of the NRHM and the Millennium Development Goals are achieved. In particular the MIES framework under the NRHM would have the following advantages once it is in position and fully operational:

Addresses community needs and expectations Helps in preparation of Annual Action plan based on the community needs. Facilitates amalgamation of districts plans with state PIPs Addresses unmet need for services and provides insight on the extent of met services Creates a system approach for monitoring and evaluation of RCH-II programme. Evolves a system of community monitoring Flexible in approach and allows decentralized planning Helps incorporation of state-specific indicators Allows for finalizing list of indicators upfront Adaptable to incorporate the next level of health revision-NRHM. Provides all requisite information to all stakeholders i.e. community, district, State, Centre, donor partners and all other agencies. Increases accountability of programme managers in monitoring and strengthens feedback mechanism Provides mechanisms for institutionalization managers

Strengthens the hands of programme D. WEAKNESSESS IN THE PRESENT M&E SETUP 17.The weaknesses in the data reporting system in the States has repercussions in the consolidation of health related information at the National level. The Ministry appointed a Task Force on HMIS in March, 2006 and this has gone in depth into the weaknesses in the system and made several remedial suggestions. Briefly, the weaknesses are listed below: (i) Legislative Health being in the State List, leads to coordination problems in implementing the health interventions in the states as also for monitoring of information. (ii) Administrative and Organisational this emanates from having different Departments for Health and Family Welfare in the States and also multiple reporting on various issues from the primary health institutions. (iii) Upward flow of information There is an inherent bias in the upward reporting of information which needs to be corrected by providing critical feedback down the system to the primary interface. This would not only improve the accountability of the information but also its ownership. PIPs (iv) There is an urgent need to leverage the advances in Information Technology so that data can flow more quickly and be easily validated. A GIS based application would be useful in mapping the resource availability with the needs. (v) There is also a need to designate a nodal Health Information Officer at all levels who would be mandated to ensure the flow of information in both directions. (vi) Strengthening and streamlining the data reporting system by integration of the parallel efforts by different agencies. 18.One of the new initiatives under the NRHM is to have a well established M &E System at all the levels in the health system starting from block level onwards. This was also recommended by the HIMS Task Force. For a better M&E System, the following broad areas are essential:(A)Identifying Nodal Information Officer at all levels (B)Structuring the Information flows (C)Infrastructural strengthening- IT, Networking, Manpower (D)Information flows from the private sector (E)Earmarking upto 3% of the States Budget in Information Technology interventions PROPSED HMIS STRATEGY (A) Identifying Nodal M&E Information Officer at all levels 19.1At the Central level, it is proposed to integrate the data collection machinery in the various Programme Divisions by establishing a National Bureau/Centre for Health Statistics (NBHS). The proposed NBHS would essentially be a Resource Centre for the collection and dissemination of all statistics related to Health & Family Welfare and also coordinates the statistical activities for the Ministry. The NBHS may be headed by the Statistical Adviser of the MOHFW in terms of the recommendations of the National Statistical Commission. Thus the proposed NBHS would be responsible for integration of all information that is being presently collected by the M&E Division, CBHI, NICD (including IDSP), NACO, and AYUSH etc. It is also proposed to augment the manpower and upgrade the infrastructure at the national level to meet the data requirement of various stakeholders. 19.2At the State level, this task could be performed by the State MIS Officer in the State Programme Management Unit (PMU) where ever they exist. In States that are yet to establish the

PMU, they need to create such a position and the qualifications; eligibility and emoluments would be the same as that of the State MIS Officer. 19.3Some States have already appointed a District Data Assistant at the District PMU level. These could be re-designated as the District M&E Officer. For States that do not have a PMU in position, they need to create such a position and the qualification, eligibility and emoluments of the District M&E Officer would be the same as that of the existing District Data Assistant. 19.4Thus at the PHC and CHC levels, an M&E Officer is to be identified or appointed to handle the flow of information through the specified reporting forms for the various NRHM programmes. (B) Structuring the Information flows 19.5The success of the proposal is integrally dependent on the key stakeholders providing and making available the NRHM related information with the Nodal M&E Officer (at any level). Thus it will be necessary to ensure that the respective Programme Officers (RCH, RNTCP, NVBDCP, NLEP, IDSP etc) simultaneously endorse a copy of the compiled data to the Nodal M&E Officer at that level (State, District or Sub-District). The Nodal M&E Officer will ensure that the analysis of this data is sent to the State/District Mission Director and also fed back to the lower and parallel formations so that they are aware of their status and how they are performing vis--vis their peers. The Nodal M&E Officers will be encouraged to leverage the advances in Information Technology in establishing an intelligent and responsive database. (C) Infrastructural strengthening - IT, Networking, Manpower etc at all levels 19.6Adequate support for reinforcing the hardware and software support and manpower is to be given/established at the District and State level statistical units/divisions in the Health & Family Welfare Department. This will also require integration and merger of health and family welfare statistical units in the States. (D) Information from the private sector 19.7Presently, Health Statistics are compiled in the Government Health Sector only as an offshoot of the administrative data collection. In the last few years, the private sector has been providing health facilities in a big way, not only in the urban areas but also in the rural areas. The NRHM envisages involvement of the private sector in improving the health care delivery systems through various interventions like NGO involvement, PPP initiatives, community mobilisation etc. In the process, several private health care facilities are also being accredited for providing services on a payment basis. It is contributing significantly towards meeting the basic health care needs and in providing other specialised medication and diagnostic services. However, there is no systematic collection of information regarding these private health establishments, as these are not required to be registered. The guidelines for accreditation by GOI/State Govts in standardizing the quality and scope of services are being finalized. In the process of accreditation, the following issues need to be considered while framing the Guidelines for accreditation: (1) The M&E Division had evolved a format for capturing data on the NRHM/RCH-II interventions in consultation with the various Programme Divisions and it includes information to be captured from the private sector also. Presently there is no formal mechanism to capture information from the private sector. To begin with, information from the accredited institutions could be captured through statutory/mandatory returns. (2) Thus while accrediting the institutions, it may be ensured, as a part of the accreditation exercise, that these institutes report data on the key parameters (indicated in the format) to the

NRHM Mission Director in the State/District as a mandatory exercise. (3) (3) In addition, the incentives being proposed for these institutions by the various Programme Divisions should be invariably linked and be dependent on the institutions providing the data on these key parameters. (4) Appropriate forms for data reporting by these Institutions could be especially designed to capture both physical and financial performance. 19.8As brought out above, most States have not evolved a holistic Monitoring and Evaluation strategy for the health programmes. Some States have confined their M&E strategy to hiring Consultants and procuring computers. Although Monitoring and Evaluation is IT intensive and requires capital investment in a planned manner, only a few States have paid adequate attention to this activity and have bundled it as an integral component in the implementation of the health programmes. Moreover, at the time of approving the budget, it is usually the M&E component that gets marginalised and so also does the data and information flows. It is thus proposed that while approving the budget outlay for the State, if they have undertaken a holistic approach towards M&E, keeping in view points (A) to (D) above, the outlay for M&E may be preserved as per their PIP proposals upto 3% of the total outlay, which will be in line with the IT Action Plan of the GOI towards IT investments. This will ensure that the monitoring and evaluation systems in the States are continuously kept in view as an integral part of the PIPs. 20.The Empowered Programme Committee of the NRHM, in January, 2008, approved the above strategy for improving and strengthening the Monitoring and Evaluation framework under NRHM. INFORMATION EDUCATION & COMMUNICATION Introduction The communications media have played an important role in promoting the family welfare programme. Following the pattern of the successful agricultural extension services, during the third Five Year Plan, a strategy shift from clinic approach to extension approach was adopted and family planning workers were required to visit people in their homes to inform and educate them about various aspects of the Family Planning programmes. Family Planning communication received a new impetus with the creation of the Mass Education Media(MEM) division within the Department of Family Welfare during the Inter Plan period of 1966-69. Simultaneously, the media units of Information and Broadcasting Ministry were strengthened for Family Planning communication. The objective was to evolve a differential communication strategy. Simple messages with simple pictures were selected for wider dissemination and through media which were easily visible and audible. Red Triangle It was during the Fourth Five year Plan that communication efforts began to be much more meaningful. The famous Red Triangle symbol for family planning was conceived during this

period and a national campaign was launched for advocating " two or three children- enough". The campaign for male contraception-the Condom under the brand name Nirodh as the first social marketing effort which carried professional communication orientation was also initiated about this time. Films were seen as a major vehicle of communication and the district units of the MEM division were equipped with audio-visual vans for exhibiting a series of motivational films. The Satellite Instructional Television Experiments (SITE) programme helped assess the impact of TV programmes about family planning on the beliefs and practices of the rural communities. Knowledge of Contraceptive Methods in States/Uts States/Uts Delhi Haryana Himachal Jammu Region Punjab Rajasthan Madhya Pradesh Uttar Pradesh Bihar Orissa West Bengal Assam Gujarat Maharashtra Andhra Pradesh Karnataka Kerala Any Method 99.7 99.9 100.0 98.8 100.0 98.8 97.8 98.4 99.2 98.6 99.6 98.4 98.5 99.4 98.9 99.4 99.7 Any Modern Method 99.7 99.8 100.0 98.8 100.0 98.7 97.8 98.3 99.2 98.3 99.4 98.3 98.3 99.4 98.9 99.3 99.7

Tamil Nadu India

99.9 99.0

99.9 98.9

Source: National Family Health Survey, India 1998-99, Landmark strategy During the Fifth Five year Plan, the Government of INDIA executed an agreement with the Advertising Agency Association of India to design a communication strategy for the states of Uttar Pradesh, Andhra Pradesh and West Bengal and this agreement is still considered a landmark in evolving communication strategies in Family Planning programme. The objectives of the strategy were to provide appropriate knowledge about methods of contraception, allay fears among the people, provide accurate information as to where one can have family planning services, and finally stimulate inter-personal contacts. Finally the strategy was required to motivate people for increasing the practice of Family Planning. The gains of such strategies were fairly obvious as during this time multi-media approach was put into practice, different messages were evolved for different audience and in almost all cases, local languages received due importance. Around 400 prototype materials were prepared and sent to Uttar Pradesh, Andhra Pradesh and West Bengal for use. The strategy also envisaged covering all media of mass communication such as radio, press, song and drama, exhibition, group discussion through extension educators and field workers. Eminent lyricists like Prem Dhawan and singers like Lata Mangeshkar and Asha Bhonsle were utilised. The involvement of voluntary organisations was much wider and special campaigns were organised to ensure greater acceptance of Family Planning by minorities. Considerable efforts to involve scholars, writers, journalists, doctors, opinion leaders for promoting Family Planning programme were also initiated. New Initiatives As part of the new IEC strategy in tune with the Reproductive & Child Health Programme, it has been decided by the Centre to utilise private professional agencies for creating audio-visual and Advertising campaigns for the mass media. For effective communication and optimal impact, it has been decided to utilise the services of eminent filmmakers for producing full length feature films with sensitive depiction of messages on Reproductive Health and Population issues. In the new strategy, the Centre has chosen a few specific channels of communication viz. Television, Radio, the Song and Drama Division, Directorate of Field Publicity and the Print media for promoting the Reproductive Health and Population issues. Television: Beside utilising the services of eminent filmmakers for production of films, the Department utilises the services of creative producers in the making of Video spots, arranging interactive panel discussions with opinion leaders of district and region and audiences and panel discussions on important RCH issuses with subject specialists.

Radio:Apart from revamping of old programmes, a new folk song programme has been launched on AIRS Vivid Bharti channel from August 1999.Audio spots are produced and broadcast by the All India Radio and inserted in the popular sponsored programmes. To maximise the audience only the channels like Vividh Bharati and National channel are used. Song and Drama shows: Song and Drama division of the Ministrey of Information & Broadcasting(MIB), whose troups perform live shows in the villages have been asked to intensify coverage by assigning one troupe the responsibility of covering 2-3 districts in a phased manner with their live shows on Reproductive Health and Population issues. Field Publicity: The Directorate of Field Publicity, another media unit of the MIB, which have been organising a variety of programmes such as film shows, song and drama shows, special plays, photo exhibitions, seminars, symposia, debates, baby shows and other contests through its field units at the district level, have been asked to involve women, students and youth in a big way. Print media: Advertisement campaigns on Reproductive Health issues are being designed from time to time and released to all major news papers in 13 languages viz. English, Hindi, Assamese, Oriya, Bengali, Marathi, Gujarati, Urdu, Punjabi, Kannada, Malayalam, Telugu and Tamil. Recently,the RCH Newsletter has been started in Assamese,Oriya,Hindi and English.The copies of this newsletter being sent to Health functionaries in the district on a regular basis. At the State level, similar activities are being undertaken by the States Governments. Funds for maintenance of Mahila Swasthya Sangh-womens groups are being provided by the Centre. States are being encouraged to open separate IEC Bureaus for better planning and evolve local specific media strategies. Decentralised strategy An important initiative of the new IEC strategy is to decentralised IEC efforts to the level of district, so that every district is able to plan and implement local specific IEC keeping in view the cultural, ethnic, linguistic requirements. IEC through Zila Shksharta Samitis (part of the National National Literacy Mission) are new thrust areas aimed at for integrating education with Family Welfare by utilising the already existing network. Under the ZSS scheme, the concerned districts are to plan and implement their IEC plans, with a thrust on the folk media, design and display of posters, wall writing and paintings and specific cultural medium in their respective areas. Decentralisation of IEC campaign is giving the District much more flexibility to work with freedom and creativity. When compared with the top-down approach from either the Centre or the State Govt.,the decentralised efforts have the potential of opening up unlimited, region specific possibilities in the sphere of inter-personal and group communication as well. Three-tier approach While the IEC division of the Ministry of Health and Family Welfare, Department of family Welfare, Government of India has the overall responsibility for planning major IEC activities and national compaigns, the implementation is being largely carried out by the States and Union

territories, various media units of Ministry of Information and Broadcasting (MIB) and professional agencies. District becomes focal point for local IEC compaigns as well as a subcentre of activities in the surrounding rural areas. IEC at State level Each State/UT has State Directorate of Information and Publicity, which plays the same role as the MIB at the Central level. The responsibility of planning and conducting IEC activities rests with the State IEC division headed by the State Media officer. IEC at District Level At the district level, there is a District Extension & Media Officer. There is a block extension education officer, and at the sub centre level IEC is combined with clinical service delivery and is carried out by multipurpose workers. Community workers/health functionaries used for IEC and advocacy activities in most States include Auxilliary Nurse cum Midwives (ANMs), Multipurpose workers, Male Health Workers and Mahila Swasthya Sanghs.. Rajasthan and a few other states have developed special networks such as the Jan Mangal and Swasthya Karmi. Unfortunately, the understaffed IEC structure in the field has often been found overworked and used for other activities and projects. It is assumed with the introduction of independent District IEC efforts, these personnel will not be used for other activities any more. Non Government IEC efforts In addition to the Government initiatives, a large number of NGOs at the national, state and district levels carry out IEC activities independently. Prominent NGOs who have contributed significantly to the IEC campaigns include the Family Planning Association of India, Bombay, Voluntary Health Association of India, New Delhi, Society for Services to Voluntary Agencies, Pune and Gandhigram Institute of Rural Health and Family Welfare Trust who cover vast areas independently. Population education Population education programmes are implemented through cells in the Centre and the States at the primary, secondary, post-literacy, Higher education and vocational training programme levels . Presently, four national projects on Population and Development with the assistance of UNFPA are in progreess. Project on School education is being implemented with the help of the National Council of EducationResearch and Training (NCERT) in 30 out of a total of 32 States/ U.T. In this project, over 2.2 million teachers and educational functionaries have been oriented in Population education. Over 540 titles on various themes have been published in 17 Indian languages. . Introduction of Adolscence Education in school curricula, which already includes Population related messages, have been introduced.

Project on post-literacy & continuing Education is being implemented by Dte. Of Adult Education ( National Literacy Mission)through State/Regional Resource Centres in 430 districts of 26 States/Uts. Major activities under this project includes training of Project functionaries, preparation, production and distribution of training and education material including integrated primers,supplementary readers,follow-up materials and reading materials for continuing education ,outreach activities like exhibitions and fairs, street plays, awareness camps for mothers-in law and research and evaluation. Motivational material for electronic media was also produced. Project on Higher Education is being implemented since 1986 through 17 Population Education Research Centres (PERCs), set up in various University campuses all over India, to disseminate information regarding Reproductive Health and Population issues to the University and College students. Thirty-five Universities have introduced special paper on Population Education. Over 1400 Population Education clubs have been set up under the project to organise various education activities with the cooperation of the community and the NGOs. Project on Vocational Training is being implemented through Directorate General of Employment and Training (DGET), M/o Labour in 600 Industrial Technical Institutes (ITI) all over the country in its second phase. The first phase covered about 1000 ITIs. The component of Population Education have been integrated in the social studies curiculum in all the ITIs which runs a number of vocational courses for the adolescents and youth. Project for involvement of Elected Representatives The Project titled "Involvement of elected representatives for advocacy on population, RCH, HIV/AIDS, Reproductive rights and women's involvement' is being implemented by Indian Association of Parliamentarians on Population and Development, New Delhi. Launched in November 1999, it is initially sanctioned for a period of two years. The project will cover the entire states of Madhya Pradesh and Rajasthan and 20 more districts of Maharashtra, Gujarat, Orissa and Kerala where UNFPA funded integrated population and development projects are under implementation. The goal of the project is to sensitize, mobilise and involve elected representatives (including Panchayat Raj representatives) in effective population stabilisation, reproductive health porgrammes including awareness of HIV/AIDS.

Project for involving journalists A project for sensitising media persons on Reproductive Health issues has been operationalised in May 2000 for a period of two years, with the help of Press Institute of India (PII), New Delhi. PII is involving journalists for advocacy efforts by sensitising them on Reproductive Health issues.

REFERENCES http://nrhm-mis.nic.in/Training_HMIS_Portal/MEActivities.aspx http://www.mohfw.nic.in/dofw%20website/family%20welfare%20programme/iec.htm