District Level Household Survey- 3

1. District Level Household &
Facility Survey III
Dr. Suraj Chawla
Department of Community Medicine,
PGIMS, Rohtak

2. CONTENTS
Introduction
Objectives of DLHS-3
Agencies involved & funding
Survey design
Sample instruments
Field work & sample coverage
Data processing & tabulation
Sample implementation
Fact sheet: India & Haryana
Salient points about DLHS- 4

3. INTRODUCTION
The Reproductive and Child Health (RCH) programme
that has been launched by the Government of India
(GoI) is expected to provide quality services and achieve
multiple objectives.
It ushered a positive paradigm shift from the method-
oriented, target-based approach to providing client-
centered and demand-driven quality services. Also,
efforts are being made to reorient provider’s attitude
and to strengthen the services at outreach levels.
The new approach requires decentralization of planning,
monitoring and evaluation of the services.

4. CONT…
The district being the basic nucleus of planning and
implementation of the RCH programme, Government of
India (GoI) has been interested in generating district level
data on utilization of the services provided by
government health facilities.
It is also of interest to assess people’s perceptions on
quality of services. Therefore, it was decided to
undertake the District Level Household Survey (DLHS)
under the RCH programme in the country.
The recent District Level Household and Facility Survey
(DLHS-3) 2007-08 is third in the series preceded by
DLHS-1 in 1998-99 and DLHS-2 in 2002-04.

5. CONT…
DLHS-3 is one of the largest ever demographic and
health surveys carried out in India, with a sample size of
about seven lakh households covering all districts of the
country.
DLHS-3, like other two earlier rounds, is designed to
provide estimates on maternal and child health, family
planning and other reproductive health indicators. In
addition, DLHS-3 provides information related to the
programmes under the National Rural Health Mission
(NRHM).
Unlike other two rounds in which currently married
women aged 15-44 years were interviewed, DLHS-3
interviewed ever-married women (aged 15-49).

6. CONT…
In DLHS-3, along with ever-married women, unmarried
women (aged 15-24) are also included as respondents.
In DLHS-3, facility survey is integrated with the
household survey with a view to link the RCH care
outcomes to health facility accessibility, availability of
medical and paramedical manpower and other village
infrastructure.

7. OBJECTIVES
The main objective of DLHS-3 is to provide RCH indicators
at the district level covering the following aspects:
Coverage of antenatal care and immunization services
Proportion of institutional/safe deliveries
JSY beneficiaries
Contraceptive prevalence rates
ASHA’s involvement
Unmet need for family planning
Awareness about RTI/STI and HIV/AIDS
Family life education among unmarried adolescent girls
Linkage between health facility and RCH indicators.

8. AGENCIES INVOLVED & FUNDING
The Ministry of Health and Family Welfare (MoHFW),
GoI designated the International Institute for Population
Sciences (IIPS), Mumbai, as the Nodal Agency responsible
for the development of survey design, instruments, data
entry and tabulation software, training, supervision of
field work, analysis and report writing.
The sources of funds for DLHS-3 are the MoHFW, GoI
and United Nations Population Fund (UNFPA) and
United Nations Children’s Fund (UNICEF).
A Technical Advisory Committee (TAC) constituted by
the MoHFW, GoI guided the designing, implementation,
progress, tabulation, basis of selection of RCH indicators
and consistency issues.

9. SURVEY DESIGN
A multi-stage stratified systematic sampling design was
adopted for DLHS-3.
In each district, 50 Primary Sampling Units (PSUs) which
were census villages for rural areas and wards for urban
areas were selected in the first stage by systematic
Probability Proportional to Size (PPS) sampling.
The Census of India 2001 was the sampling frame . All
villages and urban wards in a district were stratified in to
different strata based on household size ( < 50, 51-300
and 300+ ); percentage of ST/SC population (below or
above 20%), female literacy ( in 7+ age), etc.

10. CONT…
The sample size among the districts in the country varies
according to their performance in terms of ante-natal
care (ANC), institutional delivery, immunization, etc. and
it was fixed based on information related to such
indicators from DLHS-2.
For low performing districts, 1500 Households (HHs), for
medium performing districts, 1200 HHs and for good
performing districts, 1000 HHs were fixed as sample size.
In addition 10 percent over-sampling of households was
made to cushion for non-response.

11. CONT…
The PSUs are allocated to rural and urban areas of each
district proportionally to the actual rural-urban
population ratio.
Within the rural-urban domains, the PSUs are further
distributed proportionately to the different sub-strata of
combinations of household size, percentage of SC/ST
population and levels of female literacy.
In rural areas in the second stage of sampling households
were drawn from the selected villages (PSUs) after house
listing.

12. CONT…
For larger villages (more than 300 HHs) segmentation
was carried out. In case of 300 to 600 HHs, two
segments of equal size were made and one was selected
using PPS.
For PSUs having more than 600 HHs, segments of 150
HHs were created depending on the size and then two
segments were selected using PPS.
No segmentation was necessitated for sampled villages
with less than 300 households. Small villages with less
than 50 households were linked with other nearby
villages to form a PSU appropriate for mapping and
listing.

13. CONT…
In case of urban areas, number of wards were selected
using PPS at first stage. In a selected ward, one census
enumeration block (CEB) from 2001 census was selected
again using PPS.
No CEB was segmented as the CEBs had less than 300
households. Mapping and listing of selected CEBs in
urban areas were carried out under systematic
monitoring and supervision.
The numbers of households selected from the sampled
PSUs of districts represented by 1,000, 1,200 and 1,500
households were 22, 27 and 33 respectively.
Circular systematic sampling was adopted for the
selection of households.

14. SURVEY INSTRUMENTS
The uniform bilingual questionnaires, both in English and
in local language, were used in DLHS-3 viz., Household,
Ever Married Women (age 15-49), Unmarried Women
(age 15-24), Village and Health facility questionnaires.
In the household questionnaire, information on all
members of the household and the socio-economic
characteristics of the household, assets possessed, number
of marriages and deaths in the household since January
2004 etc. was collected.
In case of female deaths, attempts were made to assess
maternal death.

15. CONT…
The household questionnaire also collected information
on respondent’s knowledge (seen/read/heard) about
messages related to various government health
programmes being spread through media and other
sources.
The ever married women's questionnaire consisted of
sections on women's characteristics, maternal care,
immunization and child care, contraception and fertility
preferences, reproductive health including knowledge
about HIV/AIDS.

16. CONT…
The unmarried women's questionnaire contained
information on her characteristics, family life education
and age at marriage, reproductive health-knowledge
and awareness about contraception, HIV / AIDS, etc.
The village questionnaire contained information on
availability of health, education and other facilities in
the village and whether the health facilities are
accessible throughout the year.
The respondent for the village questionnaire is either
‘Sarpanch’ or ‘Pradhan’, or any other knowledgeable
person in the village including ‘teacher’.

17. CONT…
For the first time, population-linked facility survey has
been conducted in DLHS-3. In a district, all Community
Health Centres (CHCs) and District Hospital (DH) were
covered.
Further, all Sub-centres (SC) and Primary Health Centres
(PHC) which were expected to serve the population of
the selected PSU were also covered.
There were separate questionnaires for SC, PHC, CHC
and DH. They broadly include questions on
infrastructure, human resources, supply of drugs &
instruments, and performance.

18. Team Composition of Field Staff
Mapping & Listing Team No. Educational Qualification
Mapper 1 Graduate in any discipline
(Preferably Social Sciences)
Lister 1 Graduate in any discipline
(Preferably Social Sciences)
Facility Survey Team
Health Investigator (Facility Survey) 2 The minimum qualification for health investigator should
be Diploma or degree in Para medical courses
Household Survey Team
Supervisor 1 Graduate in any Social Science (Prefer knowledge of
Biology) having experience of large scale survey
Investigator 4 Graduate in any discipline
(3 Females and 1 Male) (Preferably Social Sciences)

19. State Level Staffs with Regional Agencies
Sl. No. Name of Position No. Educational Qualification Experience
State Level Staff
1 Project 1 Ph D./Masters Degree in 1. Experience in large scale surveys
Coordinator Mathematics/ • At least 5 years experience of
(Full time) Statistics/Social Science / handling large scale
One x per State x Demography demographic/health surveys as a
per RA team leader
2 I.T. Consultant 1 Post Graduate 5 years of experience in handling
(Full time) degree/Diploma in any 1. Large Scale Demographic Survey
One x per State x Computer Science data
per RA Application
3 Health Coordinator 1 MBBS/BAMS or any other At least two years experience in Bio-
(Full time) medical degree marker in Health surveys
One x per State x
per RA
4 Statistician/ 1 Ph D./M.Phil/ Masters 3 years of experience for Ph.D./M.
Demographer Degree in the relevant field Phil holders
(Consultant) 5 years of experience for Master
Degree holder in handling Large Scale
Demographic Survey data

20. FIELD WORK AND SAMPLE COVERAGE
The field work of DLHS-3 was carried out during
December 2007-December 2008 in 34 states and union
territories covering 601 districts in the country. The
present report excludes the state of Nagaland.
DLHS-3 questionnaires were canvassed from 7,20,320
households, 6,43,944 ever married women aged 15-49
years and 1,66,260 unmarried women aged 15-24 years.
However, for the purpose of comparison with DLHS-2
indicators based on currently married women aged 15-44
years in the selected tables.
The Facility Survey covered 18,068 Sub-Centres, 8,619
Primary Health Centres, 4,162 Community Health
Centres and 596 District Hospitals.

21. DATA PROCESSING AND TABULATION
CSPro (Census and Survey Processing System) based
data entry software was developed in-house and IT-in-
Charge personnel of all Regional Agencies (RAs) were
given one weeks’ training on the use of the software.
DLHS-3 data for all types of questionnaires were entered
by the collaborating Regional Agencies and validated
centrally at IIPS.
CSPro software has a module for generation of district
socio-demographic and RCH indicators and RAs used this
module to run district level indicators and brought out
district fact sheets. For state and national tabulation
STATA and SPSS syntaxes were written and executed.

22. SAMPLE IMPLEMENTATION
The overall household response rate − the number of
households interviewed per targeted 100 households −
was 94 percent.
For the ever-married women, the overall response rate
at the national level was 89 percent.
However, the overall response rate for unmarried
women was only 85 percent.
Regional Agency for Haryana : ORG Centre of Social
Research, New Delhi
Monitoring Agency for Haryana : NIHFW, New Delhi

23. Antenatal care
India- Total India- Rural India- Urban
(Haryana) (Haryana) (Haryana)
Indicators (%) DLHS DLHS DLHS DLHS DLHS DLHS
III II III II III II
Mothers who received any 75.2 73.6 70.6 67.5 87.1 89.3
antenatal check-up (87.3) (86.4) (85.2) (85.6) (93.8) (93.1)
Mothers who had antenatal 45.0 40.4 38.5 33.3 61.8 58.7
check-up in first trimester (55.1) (13.7) (52.0) (14.4) (64.4) (6.9)
Mothers who had three or 49.8 50.4 44.1 41.9 69.1 72.1
more ANC (51.9) (43.1) (47.2) (40.8) (66.1) (63.9)
Mothers who had at least 73.4 80.2 68.7 76.6 85.6 89.6
one TT injection (86.1) (83.5) (84.1) (82.7) (92.1) (90.9)
45.7 57.7 38.0 50.2 65.8 77.1
Mothers whose BP taken (42.8) (38.0) (36.9) (34.9) (60.6) (65.7)
Mothers who consumed 100 46.6 20.5 47.3 16.9 45.0 29.6
IFA Tablet (29.0) (16.5) (28.1) (15.9) (31.7) (21.6)
18.8 16.5 14.7 12.8 29.4 25.9
Mothers who had full ANC (13.3) (10.3) (10.2) (9.5) (22.6) (17.9)

24. DLHS-3 India & State factsheet
Percentage of women who received full ANC

26. Delivery care
India- Total India- Rural India- Urban
(Haryana) (Haryana) (Haryana)
Indicators (%) DLHS DLHS DLHS DLHS DLHS DLHS
III II III II III II
47.0 40.9 37.9 29.8 70.5 69.4
Institutional delivery (46.9) (35.7) (42.2) (27.3) (61.4) (56.4)
52.3 58.6 61.3 69.8 29.0 29.8
Delivery at home (52.6) (64.3) (57.4) (72.7) (38.0) (43.6)
Delivery at home 5.7 13.5 5.7 10.5 5.4 21.3
conducted by SBA (6.5) (14.0) (5.8) (10.0) (8.2) (23.7)
52.7 48.0 43.6 37.2 75.9 75.8
Safe Delivery (53.4) (43.9) (48.0) (34.6) (69.6) (66.7)
Mothers who received
49.7 41.7 69.7
PNC within 2 Weeks of (49.5)
NA (46.5)
NA
(58.7)
NA
delivery
Mothers who received FA 13.3
NA
13.6
NA
12.5
NA
for delivery under JSY (4.7) (4.5) (5.7)

27. Indicators at District level % (Haryana)

28. Rohtak: DLHS-3
Institutional Deliveries by Residence
60
52.9
41.9 41.9
40
Percent
31.6
20
0
Total Rural
DLHS - 2 DLHS - 3

29. Children Immunization (12-23 months)
India- Total India- Rural India- Urban
(Haryana) (Haryana) (Haryana)
Indicators (%) DLHS DLHS DLHS DLHS DLHS DLHS
III II III II III II
54.0 45.9 50.4 40.0 63.1 61.1
Fully immunized (59.6) 59.1) (55.9) (56.7) (70.8) (66.3)
Not received any 4.5 19.8 5.2 23.6 2.9 10.0
vaccination (1.9) (11.8) (1.9) (12.4) (1.9) (10.3)
86.7 75.0 85.2 70.3 90.4 87.2
Received BCG vaccine (86.5) (83.5) (85.0) (82.5) (91.0) (86.1)
63.5 58.3 60.1 52.3 72.2 73.6
Received 3 doses of DPT (69.1) (73.6) (66.3) (71.6) (77.6) (78.6)
66.0 57.3 63.1 51.4 73.7 72.4
Received 3 doses of Polio (67.9) (72.9) (65.1) (70.8) (76.2) (77.9)
Children who have 69.5 56.1 66.5 50.2 77.5 71.2
Received Measles (69.0) (65.4) (66.4) (63.5) (77.2) (70.0)
Received at least one dose 54.5 31.1 52.0 28.2 61.1 38.7
of vitamin-A supplement (46.3) (42.2) (43.8) (39.3) (53.9) (49.2)

30. Indicators at District level % (Haryana)

31. Current use of family planning methods
India- Total India- Rural India- Urban
(Haryana) (Haryana) (Haryana)
Indicators(%) DLHS DLHS DLHS DLHS DLHS DLHS
III II III II III II
54.0 52.5 51.1 48.8 60.2 61.9
Any method (%) (62.0) (60.3) (61.8) (58.8) (62.9) (64.0)
Any Modern 47.1 45.2 44.4 42.0 53.0 53.4
Method (%) (54.5) (54.3) (55.0) (54.0) (53.1) (55.2)
Female 34.0 34.3 34.1 34.1 34.6 34.7
Sterilization (%) (36.3) (35.6) (39.8) (40.0) (25.6) (24.7)
Male 1.0 0.9 1.0 0.9 0.7 0.9
Sterilization (%) (1.0) (1.0) (1.1) (0.9) (0.7) (1.1)
4.2 3.5 4.1 3.0 4.4 4.7
Pill (%) (2.8) (3.1) (2.6) (2.5) (3.6) (4.5)
1.9 1.8 1.4 1.1 2.9 3.7
IUD (%) (3.8) (4.5) (3.3) (3.6) (5.2) (6.7)
5.9 4.6 3.8 2.8 10.6 9.3
Condom (%)
(10.4) (10.0) (8.0) (6.9) (17.8) (17.7)

32. Unmet need for family planning
India- Total India- Rural India- Urban
(Haryana) (Haryana) (Haryana)
Indicators
DLHS DLHS DLHS DLHS DLHS DLHS
(%) III II III II III II
Total unmet 21.3 21.4 22.8 23.2 18.2 16.8
need (%) (16.0) (14.7) (16.2) (15.0) (14.9) (13.8)
7.9 8.6 8.7 9.7 6.1 5.8
For spacing (%)
(5.7) (5.5) (6.1) (5.8) (4.4) (4.7)
13.4 12.8 14.1 13.5 12.1 10.9
For limiting (%)
(10.3) (9.2) (10.1) (9.2) (10.5) (9.3)

33. Rohtak: DLHS-3
Contraceptive Use (Any Method)
80
66.8 66.1
63.2 61.3
60
Percent
40
20
0
Total Rural
DLHS - 2 DLHS - 3

34. Child feeding practices (based on last-born children)
India- Total India- Rural India- Urban
(Haryana) (Haryana) (Haryana)
Indicators (%) DLHS DLHS DLHS DLHS DLHS DLHS
III II III II III II
Children under 3 years
40.5 27.8 39.8 25.1 42.5 34.7
breastfed within one hour
(17.4) (17.4) (16.8) (16.0) (18.7) (20.8)
of birth
Children age 0-5 months 46.8 48.1 43.2
NA NA NA
exclusively breastfed (9.4) (9.3) (9.7)
Children age 6-35 months
25.5 22.7 26.2 23.7
exclusively breastfed for NA NA
(5.7) (33.0) (5.4) (6.5)
at least 6 months
Children age 6-9 months
57.1 56.5 58.8
receiving solid/semi-solid NA NA NA
(74.1) (72.7) (78.9)
food and breast milk

35. DLHS-3 Facility Facts
INDIA HARYANA

36. DLHS - 4
The data from previous three rounds of DLHS have been
useful in setting the benchmarks and examining the
progress of the country after the implementation of
RCH programme.
These surveys were useful for the central and state
governments in evaluation, monitoring and planning
strategies.
In view of the completion of six years of National Rural
Health Mission (2005-12), there is a felt need to focus on
the achievements and improvements so far.
It is, therefore, proposed to conduct DLHS-4 during 2011-
2012.

37. Objectives of DLHS-4
The overall objective is to assess the performance of various
programmes under NRHM at district level. The specific
objectives are same as DLHS – 3 but additional objectives
are:
To Know the level of anaemia, blood sugar, BP and
anthropometric parameters through the
Clinical, Anthropometric and Bio-Chemical (CAB) test
and measurements.
To know the contribution of public-private sectors to
RCH services

38. Proposed Activities
In DLHS-4, it is proposed to complete the field survey in
all the districts within a period of 6 months.
In EAG states including Assam (9 states), IIPS will
undertake only the facility survey. In all other states, IIPS
will carry out both household and facility survey
together.
The NIHFW will be the nodal agency for the CAB
component of DLHS-4, under the overall coordination of
IIPS.

39. Proposed Activities
In DLHS-3, the district-wise sample size vary (1000, 1200,
1500 households) across districts. In DLHS-4, it varies from
1000 to 1750 households
The number of households per PSU is 25, however this
shall vary for North-Eastern states and hilly districts.
Number PSU per district:
- 40X25 = 1000 for 1100 HH district
- 50X25 = 1250 for 1370 HH district
- 60X25 = 1500 for 1650 HH district
- 70X25 = 1750 for 1925 HH district

40. Proposed Activities
One of the main factors that influence the quality of
data is the length of training period and monitoring of
field work. In DLHS-4, the length of training of trainers
(TOT) will be of at-least 14 days including 2 days of field
practice.
Later, the field agencies would be asked to provide the
training to their investigators for a minimum of three
weeks which includes the field practice

41. Proposed Activities
Another factor that influences the quality of data is the
monitoring mechanism at the nodal agency. It is
proposed to strengthen the monitoring by involving
more coordinators and project personnel at IIPS.
In addition to this, the Principal Investigator/Project
Coordinators will be regularly visiting and supervising
each state during the field work. Along with the IIPS
officials, MoHFW officials would also be involved in the
monitoring of the survey.

42. SAMPLING DESIGN
Sample Survey- Collection of information from
representative sample of villages, HH, individuals and
facilities
DLHS-4 coverage- 20 states and 6 union territories
Facility survey will be conducted in all states/UTs.
Independent sampling for each district in the 26 states
/union territories. Within each district urban and rural
areas shall form non-overlapping strata

43. SAMPLING DESIGN
DLHS-4 sampling design is multi-stage stratified PPS
systematic sampling. Each selected rural/urban PSU is
represented by 25 HH.
Multistage sampling- selection of representative
villages/urban primary sampling units (PSU) by PPS
sampling first followed by selection of representative
households
Rural PSUs are villages and sampling frame in the
Census 2001. Urban PSUs are NSSO UFS(Urban frame
survey block).

44. SAMPLING DESIGN
Sub-strata within urban strata-million class towns and
other towns/cities and allocation is proportional to
population of sub-strata
Sub-strata with rural strata-less than 50, 51-300 and
300+ households and allocation is proportional to size of
each sub-strata
The selected village (PSU) will be under the jurisdiction
of one Sub Centre and that Sub Centre will be covered
for the survey. The PHC to which this Sub Centre is
attached, will also be covered in the survey.
All CHCs, Sub Divisional Hospitals and District Hospitals
will be covered in facility survey.

45. DATA COLLECTION
Household Survey
In DLHS-4, it is proposed to use Computer Assisted
Personal Interview (CAPI) for data collection.
Therefore, each investigator will be provided a mini
laptop that will have bilingual questionnaire.
This will save a lot of time usually taken for transferring
the filled- in questionnaires from field to office, data
editing, data entry, etc.
Facility Survey
It would be conducted using the paper-pencil format as
the information has to be collected from different
officials/departments in each facility and more than one
visit is required to gather all the required information.

46. DATA COLLECTION
CAB Component
Field Agencies will record the test results for the CAB
tests as well as other relevant information on CAPI.
Field Agency would also need to take the consent on the
‘consent form’, from the eligible individuals/ households
(as required) before conducting the tests in each
household.

47. Team Composition of Field Staff
Mapping & Listing Team No. Educational Qualification
Mapper 1 Graduate in any discipline
(Preferably Social Sciences)
Lister 1 Graduate in any discipline
(Preferably Social Sciences)
Facility Survey Team
Health Investigator (Facility Survey) 2 The minimum qualification for health investigator should
be Diploma or degree in Para medical courses
Household Survey Team
Supervisor 1 Graduate in any Social Science (Prefer knowledge of
Biology) having experience of large scale survey
Investigator 4 Graduate in any discipline
(3 Females and 1 Male) (Preferably Social Sciences)
Health Investigator (CAB) 2 The minimum qualification for health investigator in CAB
should be Diploma in Nursing/ANM/B.Sc. Nursing/Diploma
in Medical lab technology/ Bachelor in Medical lab
technology/ B.Sc. Nutrition/DDPHN/ Diploma in

48. REFERENCES
www.rchiips.org/state-fact-sheet-rch3.htm
www.iipsindia.org/.../DLHS-4%20PRE
www.nihfw.org/Activities/MONITORINGOFDLHS3.html
mohfw.nic.in/NRHM/Presentations/Trends_in_DLHS3.pps
nrhm-mis.nic.in/Publications.aspx
www.demographie.net/demographicdata/
www.researchandpractice.com/articles/5-1/sharma_rani-
1.pdf
www.rchiips.org/PRCH-3.html