National Fact Sheet

2009
Government of India Ministry of Health & Family Welfare

Coverage Evaluation Survey

Introductory Note
The Coverage Evaluation Survey 2009 (CES-2009), a nationwide survey covering all States and Union Territories of India, was conducted during November 2009 to January 2010. The survey was commissioned by United Nations Childrens Fund (UNICEF) with the funding from IKEA Social Initiative. ORG Centre for Social Research was entrusted to carry out the survey. MOHFW, Government of India constituted a Technical Advisory Committee (TAC) to provide oversight and coordinate various activities related to CES-2009 including sampling, survey methodology, questionnaires, quality guidance, tabulation plan, data analysis and final tabulation data presentation. The data collection was monitored independently by National Institute of Health and Family Welfare, New Delhi in collaboration with Population Research Centers. Bilingual questionnaires in local language and in English were used. The data was collected from 45,058 households, 22,604 mothers of children of age 12-23 months and 22,984 women who delivered during the last 12 months. This fact sheet is an abridged version of the detailed report Coverage Evaluation Survey Report 2009.
Coverage Evaluation Survey 2009 - National Fact Sheet 1

CHILD IMMUNIZATION

@ 3 doses of Hepatitis B vaccine coverage among children 12-23 months in 16 States/UT where it is part of UIP Fully Immunized - Children (12-23 months age) receiving one dose BCG, 3 doses of DPT/OPV each and 1 measles vaccine

* Children 12-23 months age not receiving any vaccination # Example calculation of drop-out rate: BCG coverage minus measles coverage divided by BCG coverage

Indicator
Number of Children (12-23 months) (n)
Immunization Card (issued and seen) (%) Distance travelled to reach vaccination site (in km) (%) <1 1 to 3 3 to 5 5+ Mean distance (in km) Time taken to reach vaccination site (in Minutes) (%) <20 20-30 30+ Mean Time taken (in minutes)

Rural
12635
48.9 43.7 39.3 7.3 9.7 2.2 76.5 14.3 9.3 18.0

Urban
9969
58.0 42.3 43.7 6.7 7.3 2.1 78.4 15.7 5.9 17.6

Total
22604
51.5 56.2 30.1 5.3 8.4 2.2 80.0 12.0 8.0 18.2

CHILD HEALTH (0-2 YEARS)

Indicator
Number of children of 0-2 years of age (n)
Acute Respiratory Infection (ARI) in previous 2 weeks (%) Proportion seeking ARI treatment at (multiple response) (%) Govt. Health Facility/Provider Pvt. Health Facility/Provider Any health facility Proportion not seeking any healthcare for ARI Acute Diarrhea in previous 2 weeks (%) Proportion seeking Diarrhea treatment at (multiple response) (%) Govt. Health Facility/Provider Pvt. Health Facility/Provider Any health facility Others Proportion not seeking any healthcare for Acute Diarrhea 21.9 44.5 64.9 5.6 35.1 18.5 57.9 74.8 0.9 25.2 20.9 48.4 67.8 4.3 32.2 21.9 59.6 79.6 20.4 15.2 19 73.3 90.5 9.5 16.3 21.1 63.4 82.6 17.4 15.5

Rural
25228
18.9

Urban
19903
18.5

Total
45131
18.8

Coverage Evaluation Survey 2009 - National Fact Sheet 3

* Among children who were currently breastfed

MICRONUTRIENT

MATERNAL HEALTH

* Pregnant women who had at least 3 ANC checkups, 1 TT injection and 100 IFA tablets/syrup consumed.

Skilled birth attendance: Deliveries conducted by Doctor, ANM, Nurse, LHV

MATERNAL CARE (WOMEN DELIvERINg IN PREvIOUS 12 MONTHS)

Indicator
Women delivering in previous 12 months (n) Pregnancy registration Percent registered during last pregnancy Government doctor ANM Anganwadi worker ASHA Private doctor Others Stage of Pregnancy at the time of first ANC (%)
No antenatal check up First trimester Second trimester Third trimester Don't Remember 11.7 54.9 27.9 4.8 0.8 18.9 25.1 27.6 28.4 85.9 22.8 31.5 26.6 13.7 28.0 3.9 16.2 44.0 20.6 13.6 3.7 1.9 24.7 4.2 70.4 21.0 3.3 1.0 14.1 25.2 39.7 21.0 89.4 36.1 36.2 42.3 9.9 11.4 2.0 21.7 57.1 13.8 4.7 1.0 1.9 16.5 9.6 59.2 26.0 4.4 0.9 17.6 25.1 31.0 26.3 86.9 26.5 32.8 31.0 12.6 23.4 3.4 17.7 47.6 18.7 11.1 2.9 1.9 22.4

Rural
12849
91.1 35.6 17.8 18.9 2.5 15.6 0.7

Urban
10135
94.4 47.1 6.2 6.5 0.3 33.8 0.5

Total
22984
91.9 38.7 14.8 14.9 2.0 20.9 0.6

No. of days IFA tablets/syrup consumed during pregnancy (%)

< = 30 31-99 > = 100 None

TT Injection 2+ Full ANC* Distance travelled to get ANC services (in Kms) (%)
<1 1-2 3-4 5+

Mean distance (in Kms) Time taken to reach the place for getting ANC Services (in minutes)
<10 10-20 20-30 30-60 60+ Don't Remember

Mean time taken (in minutes)

* Pregnant women who had at least 3 ANC checkups, 1 TT injection and 100 IFA tablets/syrup consumed

DELIvERY CARE (WOMEN DELIvERINg IN PREvIOUS 12 MONTHS)

Indicator
Number of women delivering in previous 12 months (n) Institutional Delivery (%) Public Facility Private Facility Skilled Birth Attendance (institutional + home deliveries) For all Institutional Deliveries Distance of health facility (in Km)
<=1 2-5 6-10 11-20 20-30 30+ Dont Know/Cant say

Rural
12849 68.0
47.7 20.3 71.7

Urban
10135 85.6
45.1 40.5 87.9

Total
22984 72.9
47.0 25.9 76.2

11.4 27.8 19.6 16.3 6.9 5.7 12.2 11.2 64.2 24.8 3.6 7.4 39.2

30.0 37.7 9.9 5.6 2.1 1.3 13.4 4.9 85.2 11.1 1.1 2.6 24.3

17.5 31.0 16.5 12.8 5.3 4.3 12.6 8.1 71.0 20.3 2.8 5.9 31.8

Mean Distance from House (in Km) Time taken to reach the facility (in minutes)
< = 30 31-60 61-90 >90

Mean time taken (in minutes) to reach the facility

Coverage Evaluation Survey 2009 - National Fact Sheet 5

INSTITUTIONAL DELIvERY AND JSY SCHEME#

Indicator
Number of women who delivered in the previous 12 months (n)
Proportion aware of JSY scheme* (%) Proportion received any assistance under JSY during delivery* (%)

Low Performing States

8355
58.9 40.0

High Performing States

14629
61.1 25.5

Total
22984
60.0 32.5

Number of women who delivered in institution in previous 12 months (government + private) (n)
Proportion women reported that ASHA accompanied her to health facility for institutional delivery** (%) Proportion women reports ASHA stayed at health facility** (%)

5748
39.9 35.6

11957
8.4 6.1

17705
21.4 18.1

Number of women who delivered in government institution in previous 12 months (n)

Proportion of women who delivered in Government institution and received assistance under JSY*** (%) Proportion women reported that ASHA accompanied her to Government facility for institutional delivery*** (%) Proportion women reports ASHA stayed at health facility*** (%)

4076
81.1 54.3 49.1

7639
36.5 11.2 8.9

11715
59.3 30.4 26.7

Number of women who delivered in institution in previous 12 months (government + private) (n) Women who delivered in institution by Bed facility** (%)
Separate bed Shared bed No bed

5748
84.6 9.7 5.8

11957
86.5 11.0 2.5

17705
85.8 10.3 3.9

* Base = all women who delivered in the previous 12 months (all government & private institutional and home deliveries); ** Base = all women who delivered in institution (both Government and Private); *** Base = all women who delivered in Government institution; (Note: Segregation of states into low/high performing is as per JSY scheme) # Janani Suraksha Yojana Scheme

NEWBORN CARE
Indicators
Number of newborns in the previous 12 months (n) Proportion of newborns checked up <24 hours after birth Number of checkups done within 10 days after birth (%)
None 1 2 3+ 39.3 21.6 14.3 24.8 21.8 18.5 16.9 42.8 34.4 20.8 15.0 29.8

Rural
12673
60.7

Urban
9982
78.2

Total
22655
65.6

BREAST FEEDINg PRACTICES DURINg FIRST 6 MONTHS ACCORDINg TO AgE OF LIvINg CHILD
Age in months
<2 2-3 4-5 6-8 9-11 18-23 <4 <6 6-9

Number of living Children (n)

2038 4126 3829 5556 6978 10483 6164 9993 7691

Never Breast fed

0.2 0.1 0.7 0.5 0.5 5.2 0.1 0.3 0.6

Not Exclusive Breast Feeding Exclusive breast feeding till 6 Breast Feeding Breast Feeding Breast Feeding + Other months of age + Water + Other milk supplements
81.0 75.5 56.8 36.6 33.8 34.8 77.3 69.9 36.8 5.4 7.6 12.7 17.4 17.5 18.4 6.9 9.0 16.6 9.0 13.1 20.4 24.8 27.4 20.3 11.8 14.9 24.7 1.1 1.7 7.6 18.8 19.2 17.4 1.5 3.7 19.4

Breast Feeding + Other Food

3.4 1.9 1.9 2.0 1.6 4.1 2.4 2.2 1.9

(All figures in percentage)

SURvEY PROFILE
Sample Size
Respondents Number of children, total and by age
0-5 months 6-11 months 12-17 months 18-23 months 12-23 months

Rural 25228
5708 6885 6769 5866 12635

Urban 19903
4285 5649 5352 4617 9969

Total 45131
9993 12534 12121 10483 22604

Number of women who delivered in previous 12 months Number of Households

12849 25170

10135 19888

22984 45058

Characteristics of Sampled Population

Characteristics Sampled population by Caste (%)
Scheduled Caste Scheduled Tribe Other Backward Classes Others

Rural
24.2 9.2 40.9 25.7 82.8 12.2 1.5 2.4 1.1 90.6 25.2 15.9 58.9 30.8 41.4 27.8 49.2 42.5

Urban
18.7 4.1 42.3 34.9 73.3 21.0 1.5 2.2 1.9 96.9 68.1 19.0 12.9 9.4 34.3 56.3 62.1 24.7

Total
22.7 7.7 41.3 28.3 80.1 14.7 1.5 2.4 1.4 93.2 37.2 16.7 46.1 24.8 39.4 35.7 52.8 37.6

Sampled population by Religious groups (%)

Hinduism Islam Sikhism Christianity Other religious groups

Main source of drinking water

Improved source

Type of Toilet Facility

Flush or Pour Flush Toilet Pit Latrine No facility/Bush/Field

Type of house
Kachcha Semi-Pucca Pucca

Household with bank account Household with BPL* card

* BPL = Below Poverty Line

SAMPLINg DESIgN
The data for the CES 2009 was collected from mothers or care takers of child aged 12-23 months for child care services and from women who delivered during 12 months preceding the survey. Sample for each state was estimated to give results at 5% margin of error and 95% confidence interval. It was decided to have deep stratification that will make the samples more efficient and sampling biases get reduced considerably. Further, more sample was covered from bigger states. In each state, rural-urban sample was allocated in 60 to 40 ratios. Sampling in Rural Areas: For selecting the sample in rural areas in a state, a two stage sampling procedure was followed i.e., selection of villages at the first stage followed by the selection of households. Further, in first stage, districts were grouped into regions considering geographical contiguity as per procedure followed in NFHS-3. The state rural sample was allocated to regions in proportion to their respective rural population sizes. All the villages in each geographical region were further stratified into three strata viz., villages with <50 households, villages with 51-200 households and villages with more than 200 households. The number of PSUs in each region was allocated to each stratum in proportion to the total rural population in the region. In each region, the required number of villages was selected using PPS systematic random sampling procedure using % SC/ST population or % female literacy, both as per 2001 Census, as implicit variables. Sampling in Urban Areas: In each state all the towns were stratified in to five strata viz., metros, towns with more than 10 lakh population, towns with 5 lakh to 10 lakh population, towns with 1 lakh to 5 lakh population and towns with less than 1 lakh population. Total state urban sample was allocated to different strata in proportion to the urban population and in each stratum wards were selected using PPS systematic random sampling procedure. From each ward, one census enumeration block (CEB) was selected randomly. Selection of Households: In each selected village/CEB complete listing of the households was done to identify households with children 12-23 months, households with mothers who delivered during last 12 months. In each village/CEB, 10 households with child age 12-23 months and 10 mothers who delivered in the last 12 months were selected using systematic random sampling procedure and from selected households all eligible mothers/care givers were interviewed.
Coverage Evaluation Survey 2009 - National Fact Sheet 7

COvERAgE ALONg THE CONTINUUM OF CARE

SELECTED KEY INDICATORS BY STATE

ORT or Increased Fluids for Diarrhea (Among children <2 year of age who had diarrhea in preceding 2 weeks) 54.9 84.6 60.0 40.4 68.3 75.2 81.8 63.0 79.8 57.4 79.8 39.4 74.0 74.2 45.9 58.1 82.9 88.4 60.8 57.5 69.0 53.3 48.9 63.5 66.3 76.4 29.2 17.6 49.9 65.4 53.6
Care Seeking for ARI in any health Facility

Andhra Pradesh Arunachal Pradesh Assam Bihar Chhattisgarh Delhi goa gujarat Haryana Himachal Pradesh Jammu & Kashmir Jharkhand Karnataka Kerala Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Orissa Punjab Rajasthan Sikkim Tamil Nadu Tripura Uttar Pradesh Uttarakhand West Bengal UTs combined INDIA
(All figures in percentage)

99.5 69.8 89.6 84.3 98.7 95.9 99.2 94.8 89.4 91.3 93.8 87.6 97.5 97.4 92.3 97.3 93.7 95.1 91.9 53.7 98.0 95.3 86.8 91.9 98.5 90.9 71.6 74.6 99.0 90.2 89.6

97.0 50.4 66.4 33.8 71.4 83.4 97.7 83.2 68.6 67.4 87.0 57.5 91.3 90.8 60.0 82.6 85.0 71.0 79.0 29.4 77.0 73.4 55.2 87.3 92.6 83.1 38.2 54.8 83.2 82.8 68.7

46.2 16.3 21.3 4.5 19.9 41.6 53.4 45.7 42.9 39.2 43.5 10.9 40.2 77.9 11.1 27.0 28.4 28.1 21.7 3.5 37.5 29.4 14.6 27.7 44.1 21.5 12.4 17.0 17.4 41.0 26.5

94.3 69.9 64.4 48.3 44.9 83.6 99.8 78.1 63.3 50.3 80.9 40.1 86.4 99.9 81.0 81.9 80.0 63.7 83.0 30.4 75.5 60.3 70.4 68.9 98.4 82.6 62.1 53.5 69.5 88.1 72.9

95.6 71.9 65.5 53.2 56.4 84.6 99.8 85.2 69.3 53.7 82.9 47.3 88.4 99.9 82.9 85.5 82.7 65.2 85.1 43.8 79.1 66.7 75.8 69.9 98.6 83.1 64.2 58.7 72.6 90.7 76.2

89.9 45.0 67.5 59.3 66.5 79.5 92.4 68.0 75.0 93.4 77.0 68.7 88.2 88.7 50.6 85.8 62.7 69.3 77.8 45.9 70.5 91.4 60.1 85.3 78.6 70.6 58.1 78.1 72.8 82.0 71.5

90.4 48.2 80.1 58.2 73.1 83.3 91.5 78.0 79.9 96.2 77.2 67.5 89.9 86.2 61.9 91.2 60.3 74.1 81.1 52.2 71.9 87.3 65.6 87.8 88.4 68.8 52.8 75.8 77.2 83.3 74.1

68.0 24.8 59.1 49.0 57.3 71.5 87.9 56.6 71.7 75.8 66.6 59.7 78.0 81.5 42.9 78.6 51.9 60.8 73.7 27.8 59.5 83.6 53.8 85.3 77.3 66.0 40.9 71.5 64.9 71.3 61.0

58.3 35.9 27.7 26.0 37.4 56.1 89.1 43.7 27.9 73.2 42.0 22.4 68.4 62.4 29.8 60.6 39.9 16.4 67.1 13.6 15.9 53.8 25.1 63.7 78.9 50.7 17.0 37.1 46.7 72.3 41.4

84.4 40.0 69.3 49.0 62.1 65.2 87.8 66.9 55.9 87.8 59.0 63.3 85.5 66.8 45.1 82.6 47.9 58.1 74.4 28.2 69.7 73.1 59.9 90.1 52.6 68.0 48.9 60.8 73.4 67.8 64.0

27.2 55.6 46.1 16.5 44.4 28.5 66.3 50.0 51.0 38.8 20.4 15.6 38.2 66.0 31.2 51.3 75.1 67.7 56.5 49.4 63.7 16.4 27.7 55.7 39.1 7.1 15.6 24.9 29.2 42.9 33.5

88.2 64.5 79.2 82.9 85.0 90.7 97.0 84.4 92.2 92.6 83.7 70.9 90.7 94.2 75.8 93.1 77.8 94.3 87.6 50.6 79.4 94.7 89.9 91.2 88.8 95.5 72.3 83.2 77.8 95.8 82.6

For more information: UNICEF India Country Office 73 Lodi Estate, New Delhi 110003 Tel: +91-11-24690401/0409, 40798000 Fax: +91-11-24690410, 24627521 Web: www.unicef.org/india

(Among children <2 year of age who had ARI in preceding 2 weeks)

Full Immunization (Children (12-23 months) receiving 1 dose BCG, 3 doses of DPT/OPV each and 1 measles vaccine)

DPT Booster Dose (Children aged 18-23 months who received DPT booster dose)

Early Initiation of Breast Feeding (<1hr)

Full ANC (Women who received 3 ANC checkups, one TT injection and consumed 100 + IFA tablets)

Skilled Birth Attendance (Delivery by Doctor, ANM/Nurse/LHV)

Institutional Delivery

vitamin A 1st Dose

Measles vaccine

At least 1 ANC

DPT3 vaccine

States/UT

3 ANC