Research Projects/Studies Completed Year-2003-2004
Empowering Panchayati Raj Institutions for Promoting Primary, Reproductive and Child Health Care Programme
Agency:CIDA, New Delhi
Project Team:R.S.Goyal, Prasanta Patra, Adesh Chaturvedi and Chandna Saha
It was a two-year operations research project. The project was implemented in collaboration with a local NGO at Sawai Madhopur district of Rajasthan. The project was based on the premise that to build ownership of PRIs for developmental activities it was desirable that technical and managerial support be provided for a reasonable period of time along with training. The main objectives of this operations research study were:
- To build technical and managerial capabilities of the members of panchayati raj institutions (PRIs) and to promote reproductive and child health care programmes in collaboration with public sector health care institutions
- To provide technical and managerial support to PRIs for planning and carrying out innovative activities to promote RCH care of all people in collaboration with public sector health care institutions
The project has succeeded in developing a framework for involvement of PRIs in the Reproductive and Child Health Programme. Over 2000 members of panchayats were provided orientation training on their role and responsibilities in promoting reproductive and child health care in collaboration with public sector health care institutions. Ten selected panchayats were provided specific management and technical inputs to undertake innovative activities to promote the Reproductive and Child Health Care Programme. An assessment of the impact of interventions indicates that ongoing regular support has enabled panchayats to assume responsibilities for supervising developmental activities and undertaking innovative programmes on their own. It has significantly contributed to the improvement in the health scenario at the village level.
Concurrent Evaluation of FHAC
Project Team:L.P.Singh and Anju Bala
Family Health Awareness Campaign (FHAC) is a strategy through which target population (15-49 years) would be sensitised towards RTIs, the risks they pose and their modes of transmission, and all efforts would be made to encourage early detection and prompt treatment of RTI/STD by fully involving the community. Rajasthan State Aids Control Society (RSACS) with the support of India Canada Collaborative HIV/AIDS Project (ICHAP) conducted a concurrent evaluation of FHAC by NGOs to have a fair idea of the effectiveness of FHAC. The Institute was been entrusted by ICHAP with the task of undertaking the assignment of evaluating FHAC in Udaipur district
Operational Research Study on Meeting Reproductive and Sexual Health Needs of School-going and Out-of-school Adolescents
Agency:Ministry of Health and family Welfare, Government of India
Project Team: R.S.Goyal, Anoop Khanna and Shantanu Chakraborty
The study was undertaken with a view to examining the perceptions and assessing the reproductive and sexual health needs of school-going and out-of-school adolescents. The study was also aimed to undertake an intervention programme to meet these needs.
The project was carried out in Ajmer district of Rajasthan. During the first phase of the project, a situational analysis was conducted to understand the background and needs of the adolescents regarding reproductive and sexual health. On the basis of the findings of the situational analysis, a strategic plan was developed and interventions were identified to meet the information needs. The project envisaged active involvement and participation of parents, peers, teachers, health providers and other stakeholders at each stage of the intervention programme. The project involved the development of communication material based on the needs of the adolescents; formation of groups of adolescent boys and girls in the local wards; counselling; community meetings; interaction with local influencers, teachers and parents; involvement of health care providers; and a referral system for addressing health and information needs.
The project provided an important lesson to learn- that there was an appalling gap in the information about sexuality and reproductive health related issues among adolescents. They had access to such information from other means, largely from pornographic magazines, which provide half-truths and exaggerated and false information. The project showed that creating an enabling environment, communicating through small community peer groups of adolescents and youths with the help of parents, teachers, counsellors and peers makes a significant change in the perspective and knowledge about sexuality-related issues and reproductive health among the adolescent population. The groups of adolescent boys and girls, constituted under the project and facilitated by the counsellors and teachers, proved to be an excellent medium to reach the adolescents and educate them in this sphere of life.
Study of Infrastructure and Implementation Mechanism of RNTCP
Agency: Ministry of Health and Family Welfare, Government of India.
Project Team:Ch. Satish Kumar, S.D. Gupta, Vikas Dwivedi, Devesh Sahu, N.D. Sharma, Shreena Ramanathan, Basant K. Singh and S. Nirmala
The main aim of the study was to assess the infrastructure and implementation mechanism of the Revised National Tuberculosis Control Programme. The study was taken up with the following additional objectives:
- To study the performance of the programme in terms of the achievements of the various quantitative indicators in the states with full contractual staff in comparison with the states with redeployed staff
- To study the work-time analysis (work allocation and workload) of grassroots workers i.e. ANMs, Anganwadi workers, and laboratory technicians engaged in other public health programmes, e.g. Malaria Control Programme, Leprosy Eradication Programme etc, which would permit their optimal utilisation in RNTCP and minimal hiring of contractual staff, if necessary.
The study covered six states, namely Gujarat, Maharashtra, Delhi, Andhra Pradesh, Tamil Nadu and Karnataka. The study involved the state and district level organisational structure, work profile and performance. The findings of the study would underline the issues and areas that would need to be strengthened in RNTCP to make the implementation of the programme more effective.
Study on Accessibility and Utilisation of RNTCP Services by Scheduled Castes and Scheduled Tribes in India
Agency:Ministry of Health and Family Welfare, Government of India
Project Team:Dhirendra Kumar, Barun Kanjilal, L.P. Singh, J.P. Singh, Neetu Purohit, J.B. Singh, Ritu Garg, Anju Bala, Surjit Chakraborty and Vaibhav Saroha, Swati S. Roy.
One of the objectives of the Revised National Tuberculosis Control Programme (RNTCP) was to improve access and utilisation of services by SC/ST population. The programme did not have any baseline information regarding accessibility and utilisation of RNTCP services by these groups. The Central TB Division, Ministry of Health and Family Welfare has entrusted the Institute with the task of conducting a baseline survey in six states, namely Rajasthan, Gujarat, Madhya Pradesh, Andhra Pradesh, Orissa and Manipur. The survey provides information on indicators, such as case detection rate, success and cure rate, percentage of SC/ST patients using RNTCP services, percentage of SC/ST patients defaulted and retrieved by DOTS providers, patient satisfaction and other service utilisation statistics. The information on some of the indicators will serve as a benchmark to monitor the programme.
Rapid Impact Assessment of IEC Programmes on TB Case Detection, Treatment, Compliance and Cure
Agency:Government of Rajasthan
Project Team: Sudhir Kumar, Shweta Tewari and Parul Tandon
The main objectives of the study were to review various IEC activities being carried out under RNTCP in Rajasthan and also to assess the efficacy of IEC activities and identify factors associated with default and MDR. The study suggested ways and means to enhance the efficacy of IEC to increase case detection, treatment, compliance, cure, and to minimize dropout cases under RNTCP ' DOTS.
Study on Health Financing in Rajasthan
Agency:Government of Rajasthan, European Commission, Rajasthan
Project Team:Barun Kanjilal, Shamly Austin, Soma Mitra, Surjit Chakraborty and Anju Bala
A set of studies on Health Financing was carried out by the Institute as a part of the European Commission supported Health and Family Welfare Sector Investment Programme, which is currently being implemented in Rajasthan with a focus on the state level policy and district level operational reforms. The purpose of the study was to help the government in taking an informed decision regarding an alternative mechanism of financing health care in the State.
The study attempted to explore three areas:
Study 1: To conduct a study on people's ability and their willingness to pay for health services Study 2: To determine the cost of major surgeries and some other services to be offered to clients as a package of services Study 3: To estimate the cost of providing free services to all public sector clients
Study 1 was carried out in three districts of the State, representing the desert, tribal and the plains, viz, Barmer, Banswara and Jaipur. A total of 400 households were covered in each of these districts. The findings that emerged were: Utilisation of health care facilities was heavily biased towards private sources and health care delivery services were not adequately poverty-focused; drugs and medicines absorbed a major share of out-of-pocket expenses; dominance of informal providers in birth delivery services in rural areas; lack of protection against catastrophic health expenses; and lack of an alternative financing mechanism. In Study 2 estimation of the cost of surgical services was carried out in the District Hospital, Shrimati Rukhmani Devi Jaipuria, Hospital, Jaipur, Community Health Centre, Y.N. Government Hospital, Kishangarh, Ajmer, and Soni Hospital, Jaipur, a private hospital. Study-3 was based on the information generated from the first two studies and the current evidences from the literature.
Strengthening District Health Systems in Hoshangabad Districts of Madhya Pradesh
Agency: Royal Danish Embassy, New Delhi
Project Team:S.D. Gupta, Barun Kanjilal, P.C. Dash, R.S.Goyal, Vinod K. Arora, Rohini Jinsiwale and Hemant Kumar Mishra
Strengthening management of the district health system is the key to improve performance and enhance access and availability of health care. The Institute implemented an operations research project to test selected management interventions to improve the efficiency and performance of district health care delivery system. The key approach was management through problem solving. The project was implemented in Hoshangabad district of Madhya Pradesh in collaboration with the State Health and Family Welfare Department and DANIDA support unit, Madhya Pradesh. The total duration of the project was three and a half years.
The project identified six major areas of interventions: Decentralised District Health Planning and Implementation, Logistics and Supply System, Human Resource Development, Management Information System and Disease Surveillance, Community Participation and Involvement of PRIs, Community Financing and Quality Assurance. During the first phase of the project, diagnostic studies were conducted in the above key management functions. The diagnostic studies aimed at identifying the key managerial problems and constraints in the district health system. These key constraints and issues were used to develop appropriate management interventions.
The Institute facilitated the preparation of a District Health Plan through the bottom up approach and the participation of the health functionaries at the sector, block and district levels. Guidelines for preparing the District Health Plan were developed at all levels. The process involved annual performance review at the levels of primary health centres and the district in the context of the health programmes and various services, formal and structured discussions in the block level workshops to identify issues and constraints in the effective implementation of the programmes, setting the objectives and expected levels of achievements of goals, identifying critical solutions, and developing interventions and plan implementation. Training programmes at the sector, block and district levels were organised for developing skills in decentralised planning.
The project aimed at improving logistics and supply of medicines, vaccines, and other supplies. The weakest component in the chain was the stores at the PHC and the district level. The project interventions focused on improving the drug stores and procurement and distribution systems. A training programme was conducted for drug store management. Guidelines were developed for procurement, supply, and storage of drugs and medicines, especially essential medicines. The intervention succeeded in streamlining the supply and availability of medicines and equipment. One of the major achievements was the changed face of the stores in terms of improvement in the physical facilities and the system of arrangement and distribution, information about the availability of medicines to the prescribing doctors and the competence of the staff in managing the stores.
The project streamlined the existing information system by facilitating the preparation of various reports, accuracy and completeness of data, and timely flow of information at various levels in the systems. A comprehensive MIS software was developed and tested in one block of Hoshangabad district. The software provides information for all services components at the village, sector and block levels. Reports could be generated for various health services and programmes at the sub-centre, PHC and district levels. The MIS software managed to generate data even at the household level. The software can be customised to the needs of the health systems and could be used for district specific reports at the state level.
Interventions for enhancing community participation in health and family welfare services were designed and implemented. The interventions mainly focussed on the Panchayati Raj Institutions (PRIs) and non- government organisations (NGOs). The major learning from the project was that there was a perceptible enthusiasm and willingness among the PRI members to work with the community to create awareness of family welfare and RCH services, promote and encourage utilisation of these services and provide support to the health functionaries in organising campaigns and outreach camps in the villages. The PRIs were also willing to share resources and the funds available with them in enhancing the availability and utilisation of medicines and nutrients.
Community financing of health care was a major success. The people and the PRIs contributed funds for the renovation of the sub-centres in the entire district. In each block, five sub-centres, owned by the government, were identified in consultation with the district health authorities, PRIs and the local people. In all, 35 such centres were identified for renovation to make them functional. One of the lessons learned from this intervention was that the community and the PRIs were keen to ensure improved access and availability of the health and welfare services, even if they were asked to contribute financially. The other lesson was that there was no dearth of funds at the level of the community for such activities if proper utilisation was ensured with transparency and accountability.
Quality Assurance was yet another challenging intervention in the project. At various stages of the project it was revealed that the processes of health care were weak. Hence the project focused on improving the process of antenatal care, delivery of the child, postnatal care, family planning (contraceptives ' IUD and oral pills), immunisation, and ARI and diarrhoea management among children. The interventions were implemented in one block only. A whole-site training in Quality Assurance was conducted for all categories of staff to enable them to work as a team for achieving the goals. Process checklists were developed and the staff was trained in their use for various services. The use of checklists by the auxiliary nurse midwives not only improved the performance but also enhanced their skills and job satisfaction. The use of checklists also helped to improve the satisfaction of the users of the services. The lesson learned in the project was that the performance and motivation of the staff could be improved by developing their skills in performing their responsibilities and tasks. Continuous and supportive supervision made a significant influence on the motivation levels of the health care providers.
Disease and Nutrition Surveillance Project
Agency: European Commission Humanitarian Office (ECHO), World Health Organisation
Project Team:S. D. Gupta, Sudhir Kumar, Anoop Khanna, N.K. Sharma, N.D. Sharma, Neeraj Mishra, Vaibhav Siroha, Kshitij Sharma and Surjeet Chakrovorty
Disease Surveillance is a key public health tool used in monitoring disease trends, estimating magnitude of the diseases, identifying high risk populations and geographic areas and early warning and forecasting of outbreaks of epidemics. The National Health Policy 2002 directs the Government of India and the State governments to design and establish a disease surveillance system all over the country.
The Institute designed and implemented a disease and nutrition surveillance system in four districts of Rajasthan. It covered 25 blocks, 195 PHCs and 1138 sub-centres. The surveillance system included 16 diseases, acute malnutrition, anaemia and vitamin A deficiency. Formats for villages, sub-centres, PHCs and districts were developed. Each health unit was required to report the selected diseases on a fortnightly basis. A computer software was developed to enter data and make projections for disease trends and measure morbidity and mortality.
The project was implemented in close collaboration with the state and district health systems to ensure sustainability and also to build capacity of the health system. A series of training programmes for the district level health officials, medical officers and supervisors were conducted to impart skills in conducting surveillance, analysing data and interpretation results.
In addition to institutional reporting mechanism, a periodic rapid household survey was conducted in 375 villages covering over 26000 households mainly to detect malnutrition among children and women.
The project was a major learning experience in several ways. Firstly, it showed that it was feasible to set up disease surveillance on a large scale. Secondly, it revealed that the existing health system could undertake this activity effectively with the available health manpower. Thirdly, the model developed at IIHMR was very effective and could be adopted by the health system in accordance with the national health policy directives.
World Bank Assisted Rajasthan Health Systems Development Project ' Project Implementation Plan (PIP)
Agency: Medical and Health Department, Government of Rajasthan
Project Team:P.R. Sodani, S.D. Gupta and S.K. Puri
Rajasthan Government, with assistance from the World Bank, proposed to strengthen the delivery of health care services in the state. The Institute prepared a five-year Rajasthan Health Systems Development Project (RHSDP) for financial assistance from the World Bank. It was proposed to upgrade 27 facilities in the first year of the proposed project. The Government of Rajasthan approached the Institute to plan, design and prepare detailed working drawings and bid documents for the up-gradation, and renovation/ extension/new construction of hospitals to fill the gaps in the existing facilities.
The main objectives of the assignments were: a) to design, plan and suggest reallocation of rooms, internal and external spaces to improve circulation, adjacency and functioning of the hospitals, b) to prepare detailed working drawings for all internal and external development works required to upgrade the facilities, c) to prepare detailed Bill of Quantities and detailed cost estimates; d) to prepare specifications, and e) to prepare and compile bid documents as per World Bank guidelines.The IIHMR carried out the following tasks to complete the assignment:
Visited the hospitals to be upgraded and to make assessment of the quantum of renovation/ extension / new construction works to be carried out in each room/ corridor/ waiting/ entry hall in consultation with the doctors and the engineers in charge of maintenance to prepare the drawings and estimates accordingly.
Prepared conceptual plans showing renovation and extension of the existing buildings/ construction of new buildings and site development works keeping in view the functional needs of the facilities. Such renovation/extension/new construction was based on relevant yardsticks as formulated in the State norms, ISI codes for hospital buildings and as per the need of the facility and the type of expansion proposed, equipment and staffing
- Prepared site plans showing the existing and proposed service lines underground and over-ground keeping in view new buildings, extensions, shifting of service lines and new internal/existing roads
- Obtained a conceptual plan approved from the Project Management Unit, RHSDP
- Prepared designs and detailed working drawings for renovation, alteration, extension, new construction of the buildings and for all external development works and services. Detailed working drawings (architectural, structural) and plans of sanitary and water supply, electrical, site development etc. were prepared by the IIHMR not only in connection with the preparation of the bid documents but also for successful execution of the contract by the successful bidder
- Prepared and compiled bid documents along with a bill of quantities (BOQ), detailed estimates, specifications and special terms and conditions as per the World Bank guidelines
- Issued a structural safety certificate for all the works.
- Included the waste management requirements in the drawings and specifications
- Prepared all drawings on AUTOCAD as per the World Bank guidelines
Impact Evaluation Study of West Bengal Health System Development Project
Agency:Department of Health & Family Welfare, Government of West Bengal
Project Team: Barun Kanjilal, Ch. Satish Kumar, Santanu Chakroborty, Soma Mitra and Hemant Mishra
The purpose of the study was to assess the impact of some of the key activities carried out by the State Health System Development Project ' II (SHSDP-II) in West Bengal during 1996-2004. The impact in the present context was assessed on the basis of four dimensions: (1) Hospital dimension, which reflects hospitals' performance (process, output and outcome indicators), (2) Community's dimension, which reflects community's perception regarding change in accessibility, utilisation, quality, and equity of health care services, (3) Other stakeholders' dimension, which represents the perceptions of other key stakeholders, such as project managers, health officials, etc. who did not directly provide services but were closely associated with the project implementation process, with respect to achievement, bottlenecks and future needs of the project, and (4) Policy dimension, which involves an analysis of impact of policy directions proposed in the Staff Appraisal Report (SAR) of the project.
Primary data from hospitals and community were collected from four regions of the state. Except the Sunderbans, one district hospital (DH), two to three sub-divisional / state general hospitals (SDH / SGH), and four rural hospitals (RH) were selected from each region. For Sunderbans, two Block Primary Health Centres (BPHC) and four Primary Health Centres (PHC) were selected. In total, 29 health facilities (23 hospitals, 2 BPHCs, and 4 PHCs) made the sample. Taken together, these hospitals spread over 11 districts of the State.
The study reflected positive trends in all hospital output indicators. Strengths and weaknesses in the management processes at the hospital level were identified and a set of recommendations for future directions was outlined.
Estimation of Manpower and Operating Expenses for 300-Bedded G.K Hospital, Bhuj, Gujarat
Agency:Department of Health and Family Welfare, Government of Gujarat
Project Team: Barun Kanjilal and Shamly Austin
The Institute carried out this study during April 2003 at the behest of the Department of Health and Family Welfare, Government of Gujarat to estimate the required manpower and annual operating cost of the hospital to make it functional according to its design.
The earthquake that struck Gujarat on January 26, 2001 left in its wake a trail of death and destruction. G.K. General Hospital, Bhuj, a district hospital of Kutch, had totally collapsed killing 182 patients and their attendants and 11 staff members (7 Nurses and 4 Class IV Employees). The Prime Minister Shri A.B. Vajpayee visited the site. He declared that the hospital be reconstructed and sanctioned 100 crore rupees to build an earthquake proof super specialty hospital with a medical college. After the completion of the project, the Government of Gujarat invited the Institute to conduct a study on the required manpower for the functioning of the new hospital and to calculate operating expenses taking into account the new infrastructure and equipment installed and the required manpower.
In the course of the assessment, every care was taken to make the assessment compatible with the industry standards. The estimated manpower for the new hospital is 736 while the existing PREFAB hospital has staff strength of 232. This means additional staff strength of 504 is required to run the newly constructed facility. The staff to bed ratio is 2.37, which is comparable to the benchmark of 2.5 to 3 staff per bed. A suggestion was given for outsourcing support services like security (including lifts, fire fighting and mortuary), laundry, housekeeping and kitchen.
The estimated annual operating expenses are approximately Rs.11 crore (monthly expenses of Rs. 91,92,734), of which the expenses on salary constitute about 60 percent followed by medicines and consumables, electricity and AMC on equipment.
Development of Clinical Protocols for Primary Health Care in Rajasthan
Agency: Government of Rajasthan, European Commission
Project Team: J.S. Bapna, S.D. Gupta and Rameshwar Sharma
The Government of Rajasthan identified IIHMR for developing Clinical Protocols (CPs) for common health problems at the level of primary health care as a part of the European Commission supported Health and Family Welfare Sector Investment Programme.
A review of the process adopted by various states in India and other countries for developing their CPs was carried out. Emphasis was given to a participatory approach of prescribers at different levels of healthcare delivery in its development so that they might own these and use in their practice. These CPs were developed for prescribers at Primary Health Centres (PHCs) and Community Health Centres (CHCs). The format of write-ups in CPs was based on the existing CPs as well as the WHO guidelines given in 'Managing Drug Supply'. The health problems included general symptoms and specific diseases. In the monographs some conditions that were similar in nature were put together though some of the signs and symptoms might have minor variations to keep the size small. It is hoped that the prescribers will find these CPs a handy reference and use them during their clinical practice. Ten thousand copies have been printed and will be distributed to all the doctors working at PHCs and CHCs.
GRAMSAT ' Development Communication Project
Agency: DECU-Indian Space Research Organisation, MPLAD-DRDA
Project Team: L.P.Singh, S.D.Gupta and Shuchi Kaushick
It was a pilot intervention project to test the development communication model developed by the Indian Space Research Organisation (ISRO)-DECU known as GRAMSAT in collaboration with the Institute. UNICEF Rajasthan was also a partner in the project. The pilot project was implemented in Jhalawar and Baran districts, and subsequently extended to Dholpur district. The project provided a platform to all user departments to communicate with their development functionaries and people more effectively and uniformly. The project could be used as a good opportunity for conducting training in a cost-effective manner with high quality. The departments involved in conducting the training activities were: Medical and Health, Women and Child Development, Elementary Education, Technical Education, Agriculture, Panchayati Raj, Watershed Development and Soil Conservation.
The satellite-based interactive communication system (one-way video and two-way audio) had three major elements, i.e. the teaching end (classroom), the satellite transponder and the receiving end. The teaching end of the classroom required an advanced studio. DECU, ISRO had a teaching end at Ahmedabad. The trainees in the classroom had 'talk back' capacity using STD telephone. They could ask questions to the resource persons' receiving ends (classrooms) in all the blocks of Jhalawar, Baran and the district headquarters of both the districts. In the last year, over 20,000 beneficiaries were reached under the project.
Subsequently, the project would be scaled up for the whole state depending on the response of the Government of Rajasthan and the success of the pilot initiative. The pilot study was successfully completed in March this year. The project was successful in initiating e-learning in the State Government. It also provided an excellent platform for interaction between the state and the functionaries at the village level. Moreover, it helped immensely to improve the skills of the functionaries in a very short period of time.
Operations Research Study on Assessment of Efficacy of Pre-school Activity in Anganwari Centres and its Relevance in View of DPEP at Rajiv Gandhi Swarna Jayanti Pathashala
Agency:Department of Women and Child Development, Government of Rajasthan.
Project Team:Anoop Khanna and Surjeet Chakrovorty
Strengthening pre-school education has been considered an important support to elementary education because it motivates students for schooling and develops school readiness. The Integrated Child Development Service (ICDS) is the largest inter-sectoral programme, which seeks to directly reach out to children from vulnerable and remote areas and give them a head start by providing an integrated programme of health, nutrition and early childhood education. The main objective of the study was to assess the quality and impact of pre-school education component of the ICDS programme in terms of enrolment, retention and mainstreaming in Class-I of formal primary school for boys, girls and scheduled caste children separately. It also evaluated the delivery of pre-school education in the Anganwari centres in terms of teaching-learning process, use of materials and pedagogy. The study emphasised identifying the strengths and weaknesses of the existing system and suggested measures to enhance the convergence between the ICDS, DPEP, and Rajiv Gandhi Pathshala.
Operational Study on Assessment of Local Child Bearing and Child Practices and their Impact on Child Development' under ICDS III Project
Agency: Department of Women and Child Development, GoR
Project Team:Nutan Jain and Swati S. Roy
In Rajasthan, a large number of children suffer from malnutrition, which is reflected in various morbidity patterns. It is therefore, essential to strengthen the local practices and also to augment local resources for the nutritional and health care of the children. Families do apply their traditional system while caring for their children. These practices were studied scientifically to assess their efficacy and look for corrective action to strengthen them to achieve the desired goals. The study aimed to suggest an effective communication strategy, including messages and channels to promote behavioural changes at the household level. The study was carried out in a pre-allocated sample of eight blocks of seven districts of the State and, keeping in view the clients' perspective and preferred mode of communication, it was suggested that strengthening inter-personal contacts with the family was essential for behavioural change. Direct, face-to-face interchanges are still the most frequently used forms of communication. Talking with each other, meetings, training in person, child-to-child, parent-to-child, parent-to-parent and caregiver-to-parent/ child interactions for learning are to be shared and built upon.
Promoting EmOC at Periphery Level: An Evaluation Study in BDCS of Rajasthan and Maharashtra
Agency:UNICEF, India Country Office
Project Team:N. Ravichandran, Y. Sathyapriya, Anju Bala, Parul Tandon, Swati S. Roy, Pradip Jyoti Sharma, James, R. Shrinath and Venkata Ramana
This evaluation study was undertaken with a specific aim to assess the impact of the Women's Right to Life and Health (WRLH) project on the access to, and the availability, quality and utilisation of emergency obstetric care services through the UN process indicators. The present study used an evaluation synthesis design with a hundred percent coverage of all maternal health institutions, irrespective of their size and locality, or whether they were private or public. The institutions were selected from each of the WRLH project sites. The outcomes were discussed in terms of access to the availability, and utilization of services, met needs and case fatality rate.
The evaluation findings supported the results of the WRLH project experiences and extended our learning on how small focussed maternal health promotion programmes can increase health facility activity and build the capacity of key stakeholders involved in these efforts. The evaluation team also learned that the WRLH initiatives faced many challenges in (a) designing and implementing realistic yet effective programmes, (b) working within environments that were resource poor, and (c) building the necessary infrastructure and community support to enhance programme sustainability. Unlike many large-scale initiatives that focused on single health issues or used common approaches for their interventions, the WRLH project is noteworthy in the sense that small-scale maternal health promotional activities implemented a wide variety of interventions targeting various stakeholders in a given setting. This made the evaluation quite challenging in terms of our ability to derive general observation from what on the surface appeared to be 'black and white'.
Promoting EmOC at Periphery Level: An Evaluation Study in BDCS of Rajasthan and MaharashtraReaching Out, Scaling Up Safe-Motherhood Initiatives in BDCS in Uttar Pradesh and Madhya Pradesh
Agency: UNICEF, India Country Office
Project Team: N. Ravichandran, Y. Sathyapriya, Anju Bala, Swati S. Roy, Venkata Ramana, Anju Viswakarma, Pradip Jyoti Sharma
The baseline study drew together experiences and evidence from women, health care providers, and the community on all aspects of maternity care to create a flexible quality needs assessment framework. However, a central challenge in developing reproductive health strategies was giving real meaning to the rights of the couples and individuals (particularly women) to determine safe motherhood freely and responsibly. Reproductive health strategies were built around a core concept of women as thinking and feeling personalities shaped by the particular social, economic and cultural conditions that are central to their own reproduction. But the existence of maternal health services did not guarantee their use by women. Neither did the use of maternal health services guarantee optimal outcomes for women. An important aspect of care was highlighted to explain why women did not have access to the services at all or had access to them when it was too late or why they suffered an avoidable adverse outcome despite timely presentation, related to the intangible nature of the quality of care. Part of the reason for the intangible nature of quality is that it is too difficult to measure. There was substantial evidence from the study that there was a relationship between the quality of care that a facility provides and patterns of utilisation.
Exploring the Linkages between Alcohol Use and Domestic Violence ' A Pilot Study In Rajasthan
Agency: Alcohol Research Group, Public Health Institute, Berkeley, CA
Project Team:Ch. Satish Kumar, Basant Kumar Singh, Shreena Ramanathan
This pilot study was initiated to study the patterns of alcohol use in groups of men who resorted to violence both with and without associated injury to their wives and to study the associations between alcohol use patterns, domestic violence and injuries due to men's violence towards their wives. The findings of the study were expected to be used for developing an elaborate project about the epidemiology of alcohol use and associated negative health outcomes in India.
RCH Facility Survey in Punjab, Haryana, and Jammu & Kashmir (Region 10)
Agency: Ministry of Health and Family Welfare, Government of India
Project Team: P.R. Sodani, Laxman Sharma, Anju Vishwakarma, Sunish Kumar V.P. and Mohiddin Pasha
The Ministry of Health and Family Welfare, Government of India, implemented a Reproductive and Child Health (RCH) programme in the country. Under this programme a range of reproductive and child health services is provided through a network of government health facilities. The programme also aimed to strengthen health infrastructure in terms of trained staff, equipment and supplies to enable the facilities to provide good quality RCH services. The Government of India had decided to undertake a facility survey at the district level to assess the availability of trained staff, equipment and supplies and their utilisation at different health facility levels. This time the facility survey also included the survey of ISM (Indian System of Medicine) hospitals and ISM dispensaries under the government, which had not been included in the earlier RCH facility survey.
The facility survey was conducted a) to assess the facilities having critical inputs as per the norms stipulated under the project; b) to assess the availability of critical items against the consignee lists supplied by the districts; c) utilisation of facilities for providing RCH services; d) utilisation of CHCs and FRUs as referral units; and e) service quality assessment using appropriate outcome indicators at each level
The IIHMR was assigned the task of conducting the facility survey in Region 10 consisting of three states; Punjab, Haryana and Jammu & Kashmir. In all, 31 districts were covered. The district level reports were prepared for each district. A state level report for each of the three states was also prepared.
Baseline Survey ' Anchal Se Angan Tak Project
Project Team: Ch. Satish Kumar, Shreena Ramanathan, Basant K. Singh, Devesh Sahu, Vikas Dwivedi, R. Swarna Sai Menon, Arvind Singhal, Bobby Thomas, Mejo Jose, S. Bala Murugan and A.P. Bijoy
The Department of Women and Child Development, Government of Rajasthan, with technical and financial help of UNICEF, had initiated 'Anchal se Angan Tak' Project in seven districts of Rajasthan. The project aimed to increase the survival of children by preventing low birth weight and better caring of pregnant women and newly born children using the life-cycle approach to promote physical and psychological growth through better monitoring, care and stimulation, and to ensure proper development of the child through nutritional, health, psycho- social care, early child learning and participation.
- To provide baseline indicators for the effective implementation of 'Anchal Se Angan Tak' Project, the Institute was assigned the responsibility to conduct a baseline survey in the project districts of Rajasthan. The main objectives of the survey were -
- To assess the status of early childhood care (psycho-social care, physical growth, nutrition and health care) of children below 3 years of age
- To assess the nutritional status and knowledge of reproductive health issues of adolescent girls
- To assess the knowledge and utilisation of antenatal services by pregnant women
- To assess the knowledge and behaviour of lactating mothers regarding breast-feeding practices
- To assess fathers' involvement in child care
- To assess the infrastructure facilities and knowledge, attitudes and skills of Aanganwari workers to provide early childhood care
- In the baseline survey, information on the achievement of development milestones by children up to three years of age and their psychosocial development was also collected. The survey, revealed a low level of knowledge regarding early childcare among women and adolescents and a low nutritional status of children.
Feasibility Study for Popularising Corneal Transplants in Rajasthan
Agency:ORBIS International, Bhoruka Charitable Trust and Government of Rajasthan
Project Team: L P Singh, Neetu Purohit and Y. Sathyapriya
This study was undertaken to help eye banking and to make corneal transplant services a part of the available ophthalmic services in Rajasthan. Based on the findings, the study came up with the following recommendations:
- High-level policy decisions are to be made on the extent of sustainable government role in eye banking / corneal transplantation / post-op follow-up services.
- Basic decisions on acceptable standards and infrastructure for eye banking / corneal transplantation/post-op have to be made.
- Decisions have to be made to start visible fund flows from the existing government schemes.
- If private funds are needed to supplement efforts, there has to be high-level acceptance of the sharing of responsibility. For example, if financial aid for equipment / training is solicited, the sharing of responsibility for ensuring equipment maintenance and establishing accepted levels of training at selected institutions should be accepted and granted.
- Concept of sharing of collected corneal tissues should be accepted.
- Policies for long-term retention of trained personnel at eye banks / transplant centres are required to be in place.
- More sessions on corneal transplant should be organised in medical colleges and on counselling regarding eye donation in nursing colleges. Schools of social work should also be involved.
- Grief counselling should be continued and made part of the curriculum for medical schools.
- Public awareness strategies (electronic, print and interpersonal communication strategies) should be incorporated on a priority basis in the overall agenda for combating corneal blindness in the State.
- High-level approval of selected private and NGO partners should be notified to get support from all government institutions.
Enhancement of Capacity of Faculties of PSM Dept ' Part -I
Agency:Government of Rajasthan ' SIHFW, European Commission, Rajasthan.
Project Team: S.D. Gupta
The Government of Rajasthan with support of the European Commission had decided to strengthen the department of Preventive and Social Medicine in the medical colleges of Rajasthan. It involved capacity development of the faculty in public health and strengthening physical infrastructure. The Institute was assigned to undertake the capacity building of the faculty. A need assessment study was carried out in collaboration with the State Institute of Health & Family Welfare to identify the key competency areas of the faculty the strengthening of which would improve teaching, training and research capacity. The assignment also involved identifying critical physical needs of equipment and support material to facilitate effective functioning of the departments.
Rapid Assessment Survey of Blindness ' 2003 in South District of Sikkim State
Agency:Directorate General of Health Services, Government of India
Project Team:P.R. Sodani and Laxman Sharma
The Directorate General of Health Services, Government of India, entrusted the Institute with the task of conducting a Rapid Assessment Survey of Blindness ' 2003 under the National Programme for Control of Blindness. The objectives of the study were: a) to estimate the prevalence of blindness due to cataract among the population aged 50 years and above; b) to estimate the cataract surgical coverage rate; and c) to assess the outcomes of cataract surgeries in operated cases. The survey was conducted in randomly selected 20 clusters in the district covering 1000 persons aged 50 years and above.
Facility and Training Needs Assessment Survey of All Health Institutions in Dehradoon and Hardwar Districts of Uttaranchal
Agency:The Futures Group International, New Delhi
Project Team:Anoop Khanna, P.R.Sodani, Swati S. Roy and Soma Mitra
Uttaranchal being a newly formed state, there was a dearth of adequate data on health facilities to design and initiate effective health intervention programmes. The Institute with the support of the POLICY Project, the Futures Group International, New Delhi conducted a facility and training needs assessment survey of all the public health institutions in Dehradoon and Hardwar districts. Each health facility in the state was covered to assess the need for civil works, equipment, training and services. The findings of the survey will be utilised for the up-gradation of health facilities and for conducting training programmes with an aim to improve the skills of health service providers.
Mid-term Evaluation of Mother NGOs under the World Bank Assisted RCH Programme
Agency:Ministry of Health and family Welfare, Government of India
Project Team:Anoop Khanna, Nutan P. Jain, P.R.Sodani, L.P.Singh, Ch. Satish Kumar and Ajit Jain
The Institute has been nominated as a National NGO for appraisal, evaluation and for providing technical support to mother NGOs under the World Bank Assisted RCH Programme. The Institute has conducted appraisals and evaluations of various Mother NGOs in Madhya Pradesh, Uttar Pradesh, Haryana, Tamil Nadu and New Delhi. Evaluations of the following Mother NGOs were carried out with the aim of assessing their performance with regard to their activities, technical support to field NGOs, monitoring and management of funds:
Voluntary Health Association of India, New Delhi Tarun Sanskar, Jabalpur Society for Women and Children's Health (SWACH), Panchkula, Haryana PRAYAS, New Delhi Tamil Nadu Health Association, Chennai Voluntary Association of Punjab, Chandigarh Indcare Charitable Trust, New Delhi World Welfare Research Institute, Gonda, Uttar Pradesh