Results Framework Matrix

Program Development Objective: To improve quality of care, strengthen the management of NCDs and injuries and reduce inequities in reproductive and child health services in TN.
These results are at	Program Level
Program Development Objective Indicators
Indicator Name		DLI#	Unit of Measurement	Baseline	Cumulative Target Values
					YR1	YR2	YR3	YR4	YR5
1. Increased number of public facilities with quality certification (primary, secondary, and tertiary) Tertiary = medical colleges Secondary = District, Taluk, and non-Taluk hospitals Primary = PHCs and CHCs Priority districts: Ariyalur, Dharmapuri, Ramanathapuram, The Nilgris, Theni, Thoothukkudi, Tirunelveli, Tiruvannamalai, Virudhunagar		2	Number	Tertiary facilities with entry level NABH certification 0 Secondary facilities with NQAS certification 0 Primary facilities with NQAS certification 0	Tertiary facilities with entry level NABH certification 0 Secondary facilities with NQAS certification: 34 of which 9 are in the priority districts Primary facilities with NQAS certification: 11 of which 3 are in the priority districts	Tertiary facilities with entry level NABH certification 0 Secondary facilities with NQAS certification: 34 of which 9 are in the priority districts Primary facilities with NQAS certification: 71 of which 13 are in the priority districts	Tertiary facilities with entry level NABH certification 2 Secondary facilities with NQAS certification: 54 of which 13 are in the priority districts Primary facilities with NQAS certification: 141 of which 30 are in the priority districts	Tertiary facilities with entry level NABH certification 4 Secondary facilities with NQAS certification: 54 of which 13 are in the priority districts Primary facilities with NQAS certification: 221 of which 50 are in the priority districts	Tertiary facilities with entry level NABH certification 7 Secondary facilities with NQAS certification: 75 of which 15 are in the priority districts Primary facilities with NQAS certification: 300 of which 60 are in the priority districts
2. Improved scores in quality dashboard for primary, secondary, and tertiary level facilities			%	NA – to be established after quality dashboard is established	To be established	To be established	To be established	To be established	To be established
3. Increased screening in public sector facilities for cervical and breast cancers			%	Cervical Cancer: 15.8% Breast Cancer: 19.5%	Cervical Cancer: 18% Breast Cancer: 22%	Cervical Cancer: 21% Breast Cancer: 24%	Cervical Cancer: 24% Breast Cancer: 26%	Cervical Cancer: 27% Breast Cancer: 28%	Cervical Cancer: 30% Breast Cancer: 30%
4. Increased share of adults with hypertension or diabetes whose blood pressure or blood sugar are under control		3	%	NA – to be established after STEPS is implemented in 2019		---	NA – to be established after STEPS is implemented in 2019	---	Hypertension under control: 3 percentage point increase from baseline Diabetes under control: 6 percentage point increase from baseline
5. Improved provision of quality trauma care services		4	Number %	# of trauma centers using trauma registry: 0 % of surgical ED admissionsa: 6.7% % of IFT calls as a % of total 108 system calls: 41.1%	1 trauma center % of surgical ED admissions: 6.7% % of IFT calls: 41.1%	11 trauma centers % of surgical ED admissions: 8% % of IFT calls: 38%	24 trauma centers % of surgical ED admissions: 10% % of IFT calls: 35%	39 trauma centers % of surgical ED admissions: 12% % of IFT calls: 32%	54 trauma centers % of surgical ED admissions: 15% % of IFT calls: 30%
				a % of surgical emergency department (ED) admissions in Group A and B facilities who received surgery within 6 hours of admission in the same institution
6. Increased utilization of reproductive and child health services in priority districts		5	%	Full ANCa: 28.8% Fully immunizedb: 57.9% mCPRc: 38.5%	---	---	Full ANC: 36.3% Fully immunized: 65.4% mCPR: 41.5%	---	Full ANC: 41.3% Fully immunized: 70.4% mCPR: 43.5%
				a Full antenatal care (ANC): Pregnant women receiving at least four ANC visits, at least one TT injection, and taken IFA tablets or syrup for 100 or more days b Full immunization: Children 12-23 months receiving vaccinations against tuberculosis, diphtheria, pertussis, tetanus, polio, and measles c Modern contraceptive prevalence rate (mCPR). Modern methods include male and female sterilization, injectables, intrauterine devices (IUDs/PPIUDs), contraceptive pills, implants, female and male condoms, diaphragm, foam/jelly, the standard days method, the lactational amenorrhoea method, and emergency contraception.

Intermediate Indicators
Indicator Name	DLI #	Unit of Measurement	Baseline	YR1	YR2	YR3	YR4	YR5
1. Implementation of quality improvement interventions in primary, secondary, and tertiary care facilities	1	Number	Numberof primary, secondary, and tertiary level facilities implementing at least 1 endorsed quality improvement initiative from the list of evidence-based interventions specified in the QoC Strategy: 0 Number of primary, secondary, and tertiary facilities reporting on quality dashboard quarterly: 0	--	Number of facilities implementing at least 1 endorsed quality improvement initiative from the list of evidence-based interventions specified in the QoC Strategy: Primary: 142 Secondary and tertiary:62	Number of facilities implementing at least 1 endorsed quality improvement initiative from the list of evidence-based interventions specified in the QoC Strategy: Primary: 284 Secondary and tertiary:124 Number of facilities reporting on quality dashboard quarterly: Primary: 190 Secondary and tertiary: 83	Number of facilities implementing at least 1 endorsed quality improvement initiative from the list of evidence-based interventions specified in the QoC Strategy: Primary: 427 Secondary and tertiary:186 Number of facilities reporting on quality dashboard quarterly: Primary: 380 Secondary and tertiary: 166	Number of facilities implementing at least 1 endorsed quality improvement initiative from the list of evidence-based interventions specified in the QoC Strategy: Primary: 570 Secondary and tertiary:248 Number of facilities reporting on quality dashboard quarterly: Primary: 570 Secondary and tertiary: 248
2. Piloting of patient experience questionnaire for secondary & tertiary care facilities		%	0%	---	---	5%	7%	10%
3. Implementation of updated social and behavior change communication (SBCC) strategy		Text	N	N	Y	Y	Y	Y
4. Increased share of primary and secondary facilities with at least one staff trained on mental health		%	0%	---	5%	20%	30%	40%
5. Establishment of suicide hotline		Text	N	N	Y	---	---	---
6. Better equipped ambulance system to improve pre-hospital care - number of ATLS ambulances providing Level 1 care		Number	64	75	100	125	150	164
7. Improved capacity of trauma care providers - number of emergency department providers that received Level 3 (BTLS) and Level 4 training (ATLS)		Number	Level 3: Nurses – 165 Doctors – 100 Level 4: Nurses – 0 Doctors – 0	Level 3: Nurses – 1500 Doctors – 700 Level 4: Nurses – 150 Doctors – 70	Level 3: Nurses – 3000 Doctors – 2000 Level 4: Nurses – 300 Doctors – 200	Level 3: Nurses – 5000 Doctors – 3500 Level 4: Nurses – 500 Doctors – 350	Level 3: Nurses – 7000 Doctors – 5000 Level 4: Nurses – 700 Doctors – 500	Level 3: Nurses – 9000 Doctors – 6000 Level 4: Nurses – 900 Doctors – 600
8. Strengthenedcontent, quality, accessibility, and use of data for decision making	6	Text	*Conceptual Model and Operational Plan*for a strengthened and integrated Health Management Information System (HMIS): N	*Conceptual Model and Operational Plan* for a strengthened Health Management Information System (HMIS) covering all data sources, data users and data channels including integration with electronic medical records and patient tracking for NCDs: Y	Detailed data model and detailed design specifications completed: Y	Contract awarded for development of integrated HMIS, and key modules (electronic health record and reporting) piloted in at least 1 primary, 1 secondary, and 1 tertiary facility in a district: Y	Integrated system implemented in all the health facilities of at least one district: Y	Integrated system implemented in all the health facilities in 9 districts: Y
9. Strengthenedcoordination, integration, performance-based management, learning, and other cross-cutting functions for better results	7	Text	Policies/Strategies Adopted: N	Development and Adoption of TN Health Policy/ Strategy for Vision 2030: Y Development and adoption of an Environment Strategy for the Health Sector in Tamil Nadu: Y	Operational research program launched with 1 annual call for research proposals issued and selected proposal awarded: Y (ii) Deploying e-procurement system in TNMSC and 20% of value of total contracts of TNMSC under the Program done through e-procurement: Y	1 annual call for research proposals issued and selected proposalawarded: Y	(i) 1 annual call for research proposals issued and selected proposal awarded	(i) 1 annual call for research proposals issued and selected proposal awarded (ii)Development & adoption of performance-based incentive strategy for PHCs: Y
10. Increased transparency and accountability through citizen engagement (voice, agency and social accountability)	8	Text % Number	Districts conducting Health Assembly: 0% State Health Assembly: 0	Districts conducting Health Assembly: 0% State Health Assembly: 0	Districts conducting Health Assembly: 10% State Health Assembly: 1	Districts conducting Health Assembly: 20% State Health Assembly: 1	Districts conducting Health Assembly: 40% State Health Assembly: 1	Districts conducting Health Assembly: 60% State Health Assembly: 1