Background and objectives of the survey
The Reproductive and Child Health (DLHS) programme that has been launched by Government of India (GoI) in 1996-97 is expected to provide quality services and achieve multiple objectives. It ushered a positive paradigm shift from method-oriented, target-based activity to providing client-centred, demand-driven quality services. Also, efforts are being made to reorient provider’s attitude at grassroots level and to strengthen the services at outreach levels.
The new approach requires decentralization of planning, monitoring and evaluation of the services. The district being the basic nucleus of planning and implementation of the RCH programme, Government of India has been interested in generating district level data on utilization of the services provided by government health facilities, other then that based on service statistics. It is also of interest to assess people’s perceptions on quality of services. Therefore, it was decided to undertake District Level Household Survey (DLHS) under the RCH programme in the country.
The Round I of RCH survey was conducted during the year 1998–99 in two phases (each phase covered half of the districts from all states/union territories) in 504 districts for which International Institute for Population Sciences (IIPS), Mumbai was designated as the nodal agency.
In Round II, survey was completed during 2002-04 in 593 districts as per the 2001 Census. In DLHS-DLHS, information about RCH has been collected using a slightly modified questionnaire. In Round II, some new dimensions, such as test of cooking salt to assess the consumption of salt fortified with iodine, collection of blood of children, adolescents and pregnant women to assess the level of anaemia, and measurement of weight of children to assess the nutritional status, were incorporated.
The main focus of the DLHS-DLHS has been on the following aspects:
- Coverage of ANC & immunization services
- Proportion of safe deliveries
- Contraceptive prevalence rates
- Unmet need for family planning
- Awareness about RTI/ STI and HIV/AIDS
- Utilization of government health services and users’ satisfaction.
For the purpose of conducting DLHS-DLHS, all the states and the union territories were grouped into 16 regions. A total of twelve research organizations including Population Research Centres (PRCs) were involved in conducting the survey in 16 regions with IIPS as the nodal agency.
In Round II, a systematic, multi-stage stratified sampling design was adopted. In each district, 40 Primary Sampling Units (PSUs – Villages/Urban Frame Size) were selected with probability proportional to size (PPS) using the 1991 Census data. All the villages were stratified according to population size, and female literacy was used for implicit arrangement within each strata. The number of PSUs in rural and urban areas was decided on the basis of percent of urban population in the district. However, a minimum of 12 urban PSUs were selected in each district in case the percent urban was low. The target sample size in each district was set at 1,000 complete residential households from 40 selected PSUs. In the second stage, within each PSU, 28 residential households were selected with Circular Systematic Random Sampling (CSRS) procedure after house listing. In order to take care of non-response due to various reasons, sample was inflated by 10 percent (i.e. 1,100 households).
For selecting the urban sample, the National Sample Survey Organization (NSSO) provided the list of selected urban frame size (UFS) blocks in the district. The UFS blocks were made available separately for each district for urban areas. The maps of selected blocks were obtained from the NSSO field office located in each state/union-territory.
But in each state, in two districts, the PSUs that were surveyed in Round I of DLHS-RCH (also known as DLHS-DLHS) were also selected for survey in Round II. This was done in order to measure the changes more accurately. Two districts, one with the highest proportion of safe delivery and another with the lowest proportion of safe delivery among those surveyed during Round I of the survey were selected for this purpose. In all other districts, fresh sample of PSUs were selected.
House listing and sample selection
The household listing operation was carried out in each of the selected PSU segment prior to the data collection that provided the necessary frame for selecting the households. The household listing operation also involved preparation of location map and layout sketch map of the structures and recording the details of the households in these structures in each selected PSU. This exercise was carried out by independent teams each comprising one lister, one mapper and one supervisor under the overall guidance and monitoring of the survey coordinator of households of the selected regional agencies.
A complete listing of households was carried out in villages with households up to 300. In case of villages with more than 300 households but less than or equal to 600 households, two segments of more or less same size were formed and one segment was selected at random and household listing was carried out. In case of villages with more than 600 households, segments each of about 150 households were formed and two segments were selected for listing using the systematic random sampling method.
Small villages with less than 50 households were linked with a nearest village. After combining it with the nearest village, the same sampling procedure was adopted as mentioned above.
For the urban PSUs, the selected UFS blocks needed no segmentation as they were of almost equal size and contained less than 300 households.
No replacement was made if selected household was absent during data collection. However, if a PSU was inaccessible, a replacement PSU with similar characteristics was selected by the IIPS and provided to the regional agency for survey.
DLHS-RCH collected information on various indicators that would assist policy makers and programme managers to formulate and implement the goals set for the DLHS programme. There were five modules of schedules: Households Questionnaire, Woman’s Questionnaire, Husband’s Questionnaire, Village Questionnaire and Health Questionnaire. They were finalized after in consultation with Ministry of Health and Family Welfare, World Bank, and a Technical Advisory Committee.
The house–listing teams and the interviewers and the supervisors for the main survey were given rigorous training based on the manuals developed for the purpose by the IIPS.
All the questionnaires were bilingual, with questions in both regional and English language.
Fieldwork and sample coverage
The fieldwork for DLHS Round II was done in two phases. During Phase I, 295 districts were covered from March 2002 to December 2002, except in some districts of Bihar and Jharkhand where the fieldwork got extended to 2003, and 298 districts were covered during Phase II from January 2004 to October 2004, except in some districts of Bihar and Jharkhand where the fieldwork continued also in 2005.
During Round II, a total of 620 thousand households were covered. From these surveyed households, 507 thousand currently married women (aged 15-44 years) and 330 thousand husbands of eligible women were interviewed.
All the five types of completed questionnaires were brought to the headquarter of regional agencies and data were processed using microcomputers. The process consisted of office editing of questionnaires, data entry, data cleaning and tabulation. Data cleaning included validation, range and consistency checks. For both data entry and tabulation of the data, IIPS developed the software package. The district and state level reports were prepared by regional agency whereas national report is prepared by the nodal agency.
Facility survey - 2003
After the completion of the First Phase of Facility Survey (1998-99) in 221 districts in India, the Ministry of Health and Family Welfare, Government of India has undertaken the Second Phase of Facility Survey in the remaining 370 districts in 2003 to assess the availability of health care facilities and their utilisation in the Sub Centres, Primary Health Centres, Community Health Centres, First Referral Units, District Hospitals, Indian System of Medicine & Homeopathy (ISM&H) Hospitals and Dispensaries under the Reproductive and Child Health Programme. The present report is based on the data collected during the Second Phase of the Facility Survey in 2003 covering 370 District Hospitals, 1,882 First Referral Units, 1,625 Community Health Centres, 9,688 Primary Health Centres, 18,385 Sub Centres, 2,151 ISM&H Hospitals and 7,064 ISM&H Dispensaries in 26 states of India.