The document summarizes the District Level Household and Facility Survey (DLHS-4) conducted in India in 2012-2014. It provides information on the objectives, methodology, data collection process, types of data collected, and limitations of the survey. The survey collected household and facility level data on maternal and child health, family planning, nutrition, and non-communicable diseases from 18 states and 3 union territories in India. Data was collected through interviews with households and health facilities using paper questionnaires which were later converted to an electronic format.

1. Central University of Kerala
District Level Household and
Facility Survey (DLHS-4)
Presented by
Dr Rahna K
BDS,MPH

2. CONTENTS
• What Is The Data Set?
• Objectives
• Who Collects Data?
• Chief Characteristics
• Representation Of ?
• Methodology
• Type Of Data
• Methodology
• Obtaining The Data
• Limitations And Suggestions
• Research Question

3. What is the data set?
• Health and Family Welfare Statistics at District
level
• First population linked facility survey.
• Integrates Clinical, Anthropometric and
Biochemical (CAB) component
• setting the benchmarks examining the progress the
country has made after the implementation of family
welfare programmes(RCH)
• To assist in decentralized planning, monitoring and
evaluation

4. Objectives
• Coverage of ante-natal, natal and post natal care.
• Proportion of institutional/safe deliveries
• JSY Beneficiaries and economic burden of delivery.
• Child Immunization
• Prevalence rates & Unmet need for contraceptives-
spacing and limiting
• Awareness about RTI / STI and HIV / AIDS
• Health facilities(Accessibility, utilization, adequacy
and performance) &ASHA’s involvement
• Linkage between health facility and MCH indicators

5. Who collects data?
Provider: The Ministry of Health & Family Welfare
(MoHFW)
Nodal Agency for implementation: International
Institute for Population Sciences (IIPS)
• Design and development of survey tools and software.
• Training of Regional Agencies who undertakes the field work.
• Overall supervision and management of survey
• Obtaining data
Clinical, Anthropometric and Bio-chemical (CAB)
component :National Institute of Health and Family
Welfare (NIHFW)

6. IIPS
NOTE :
• Regional Institute for Training and Research in
Population Studies for the ESCAP region.
• Established in Mumbai in July 1956, under the joint
sponsorship of
– Sir Dorabji Tata Trust
– The Government of India and
– The United Nations.
• Demographic Training and Research Centre (DTRC) till
1970
• In 1985 it was declared as a 'Deemed University' under
UGC Act, by the MoHFW (Administrative control)

7. Chief characteristics
Geography : India (IND)
Coverage type: Country (done at district level)
Data collection: August 2012 to February 2014
Published: December 2015
Coverage: 21 states and union territories.
Facility survey All states/Union territories
Cross-sectional sample survey
• GPS coordinates (GIS)
• Sub nationally representative
• Urban-rural representative

8. Representation of
• India's 18 high-performing states& three high-
performing union territories
– Andhra Pradesh, Arunachal Pradesh, Goa,
– Haryana, Himachal Pradesh, Karnataka,
– Kerala, Maharashtra, Manipur,
– Meghalaya, Mizoram, Nagaland,
– Punjab, Sikkim, Tamil Nadu,
– Telangana, West Bengal, Tripura
– Andaman and Nicobar Islands,
– Chandigarh Pondicherry.

9. Survey Year House-
holds
district
s
How they differ?
RCH-I 1998-99 529,817 504 •Maternal And Child Health Status
•Healthcare Utilization
RCH-II 2002-
2004
620,107 593 •Maternal And Child Health Status
•Healthcare Utilization
•Nutritional status-weight of children less than 6yrs
•Haemoglobin Level Of
Below 5 Years,
Girls In 10-19 Years
Currently Pregnant Women In 15-44 Yrs
DLHS-3 2007-08 720,32
34 states
and Union
teritories
601 Maternal And Child Health Status
Healthcare Utilization
Family Life Education(Unmarried Women-15-24 Yrs)
DLHS 4
(pen and
paper to
CAPI)
2012-
2014
350,000 321 •Maternal And Child Health Status(76,847 pregnant
women )
•Healthcare Utilization
•Health And Members ( Height, Weight, Haemoglobin
Levels Blood Pressure& Blood Sugar )
•Morbidity( Life Style Diseases)

10. Annual Health Survey (AHS)
• All the other 284 districts of 8 EAG States and
Assam.
• (Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh,
Odisha , Rajasthan, Uttar Pradesh, Uttarakhand)
• Conducted by: Office of the Registrar General of India
• Funding : The Ministry of Health and Family Welfare
• Comprehensive, representative dataset on core vital
indicators IMR, MMR and TFR along with their co-
variates process and outcome indicators
Web link -
http://censusindia.gov.in/2011common/AHSurvey.html

11. METHODOLOGY
• DLHS-4 sampling design is multi-stage stratified
Probability Proportional to Size sampling
• Multistage sampling -selection of representative
villages/urban primary sampling units (PSU) systematic
PPS sampling(higher chance of selection to larger PSUs).
• Within each district urban and rural areas formed no
overlapping strata
– Rural strata(Census 2011 )-less than 50/ 51-300 /300+ households
and allocation is proportional to size of each substrata
– Urban (NSSO UFS )-Sub-strata within urban strata-million class
towns and other towns/cities proportional to population

12. What types of data available in it
• Type of data Table and graph
• extracted using STATA
• Converted to SPSS Format(.spv)
Topic percent Total 339
Maternal and child health 54.9 186
Reproductive health issues other than
infections
30.4 103
Reproductive tract infection 10.9 37
NCDs 2.9 10
Reproductive tract infection 0.6 2
Injury 0.3 1

13. Data collection technique
In-person interviews
Facility interviews
Anthropometric measurements and samples
Computer Assisted Personal Interview (CAPI).
Ever-married women ages 15-49 years,
Households
Canvassed by using paper & pen in
Villages,
Health Facilities

14. Data collection tool
ever-married women’s questionnaire contained women’s characteristics
– Maternal care and average out of pocket expenditure for deliveries.
– Immunization(5-6yrs), breastfeeding practices and childcare
– Contraception and fertility preferences,
– Reproductive health including HIV/AIDS literacy.
– Tobacco and alcohol use
– Common childhood morbidity symptoms (cough, fever and diarrhoea).
village questionnaire-
– Health Literacy
– Education,
– Village Assets
– Access To Health Facilities.

15. Data collection tool
• Health facility questionnaire : data on staffing, availability of
services and organizational structure in view of the completion
of 6 years of National Rural Health Mission (2005-12)
• http://rchiips.org/Questonaire.html
– DH (District Hospital),
– SDH (Sub-Divisional Hospital),
– CHC (Community Health Centre),
– PHC (Primary Health Centre) and
– SHC (Sub- Health Centre),
• House hold questionnaire: investigated socio-economic characteristics and
household members
– Morbidity and mortality since Jan 2008
– assets
– living conditions and

18. Clinical, Anthropometric and Biochemical
(CAB) component
Nutritional status and prevalence of certain lifestyle
disorders among all the members of households.
components Target population
Length/ Height : 1 month and above
Weight : 1 month and above
Blood Test for measurement of Anaemia 6 months and above
Blood Test for Glucose 18 years and above
Blood Pressure Measurement 18 years and above
Household salt testing for Iodine level: All Households

19. Criteria and
For inclusion
• Beneficiaries of Janani Suraksha Yojana (JSY) similar
schemes, and non-beneficiaries of any scheme.
• All Sub-Health Centres and Primary Health Centres
which were expected to serve the population of the
selected PSUs were also covered.
For exclusion
• 8 EAG States and Assam.
• Men were not included in the survey
• excludes beneficiaries of other schemes.

20. • Go to site: http://ghdx.healthdata.org/record/india-district-level-
household-survey-2012-2014
• The files were in stata(DTA) format which was later conerted to SPSS
fromat in SPSS software.
• Converting:SPSS->OPEN->DATA->FOLDER->CHANGE FILES OF TYPE TO ‘’STATA(*.dta)”-
>choose the STATA file->wait till conversion->save in SPSS
1.Obtaining the data

21. 2.By Data Request
2-Data request option in home page official website of IIPS
http://www.iipsindia.ac.in/content/data-request
3-Approach Information Communication and Technology (ICT)
unit in IIPS if the u face any difficulty in obtaining the data

22. Underutilised gems in the survey
• Compared to NFHS(337) publications using data only 48 ON
DLHS and AHS (3) (Based on the title review and abstract)
• Publications resulting from the NFHS(600 ),DLHS(95) & AHS
(73)
• Facility data at rural and community levels for strengthening
government health setups
• making certain communities more attractive to medical career.
• questions on tobacco and alcohol use didn’t meet the criteria
surveillance recommended by WHO for monitoring over time.
WHY?
• Format is not user friendly
• 21 months delay in publishing data (to synchronize with the AHS
data)
https://www.who.int/bulletin/online_first/BLT.15.158493.pdf

23. Recommendations
• Single major national health survey at 5 year intervals
– disease burden and their risk factors, automated verbal
autopsy methods and crucial indicators to capture the
heterogeneity
• Standardize key variables for easy comparison over time.
• More partnerships with the academic community
• Detailed methods should be published.
• Data should be made publicly available as soon as possible
• Linking HH survey data with health service use and
administrative data using geospatial coding
• Continuous design for its national health survey, with
advantages for survey management and timely provision of
findings

24. Sample Research questions
Which are the outlier districts of each state with
respect to the awareness on Infectious
diseases and HIV?
Application:
Data help in channelling money for better
awareness programs in those specific districts
and states who actually lacks it.