Research Projects/Studies Completed Year-2005-2006
Aapni Yojna: Integrated Water Supply; Sanitation and Health Education Programme
Agency: KfW (Government of Germany) and Public Health Engineering Department, Government of Rajasthan
Project Team:Goutam Sadhu, Santosh Kumar Sharma, Jitendra Pareek, Govind Narayan Sharma, Alka Srivastava, Dheeraj Saxena, Ram Chandra Singh and field teams
Aapni Yojna is a path breaking project in the area of provision of safe drinking water to the water starved villages and rural communities in the desert areas of Rajasthan where shortage of water is always a serious problem. It is a unique example of partnership between Government (Public Health Engineering Department), Non Government Organisations and the community. While the PMC has successfully brought water to the villages through setting up a distribution system and hardware, the Community Participation Unit, a consortium of five NGOs led by the Indian Institute of Health Management Research, ensured community participation in water resource management at the local level. The unique features of the project were that the safe drinking water is available round the clock in the villages through PSP water supply and the families pay regularly for the water consumed in the households. The water charges are collected by the community in advance and deposited with the PHED.
The success of the project can be attributed to the latest technology and the community participation model used. But implementation of the project has been possible only because of the faith and cooperation among the Government and Non Government partners. Besides, the active involvement of the all NGO members of the consortium (with different core competencies) has ensured the success of the community participation programme.
The project had two main components: Hardware and technical components and complementary measures and soft support activities. The hardware and technical components were dealt with by PHED which included laying down the pipelines, construction of rapid filters, reservoirs, pump stations and power grids. The PHED did a commendable task of laying down pipelines as long as 1800 Kilometers. The project covered 355 villages in which safe drinking water provided and tap water supply was installed. The total cost of the project was Rs. 4260 million.
Community Participation Unit undertook the complementary measures and tasks. The role of CPU included:
- Water resource management by the community
- Sanitation and health education
- Womens Health and their participation
- Other measures such as a rehabilitation of traditional sources of water in the villages
The unique feature of the project was community participation and ownership of the project. The community supervised local resource management of water distribution and deciding and collecting user charges. In addition, the main highlight was that the households paid the user charges. By the end of the project they had deposited more than Rs. 5 crores to the PHED. As a part of complementary measures over 23,000, twin-sets of sanitary latrines and bathrooms were constructed in the individual households. Beneficiaries' contribution was more than 40% of the total cost. The low-cost, household-level sanitation units were built by local masons with the support of the CPU and have set a new standard of quality. School sanitation programmes and user groups training are a regular feature in the villages. The Water Health Community (WHC) was constituted in each village that was responsible for water resource management and sanitation. To ensure sustainability, Pani Panchayats were established and a federation of Pani Panchayat was created at the later stages of the project. The project has set a new model of water resource distribution and management for safe drinking water in the rural areas with the participation of community in partnership with government and NGOs. It has become a role model now for all other water projects in the rural areas in the country. Further, the project also enabled the Government of Rajasthan to create additional employment generating over 3 lacs of man-days. Towards the end of the project an end-line project evaluation was conducted by an external agency, that clearly showed enhanced access of drinking water, improved sanitation and highlighted more importantly, changed behaviour of the community towards their responsibility and ownership. Besides the major benefits of the project, the women who spent most of the time to fetch water had spare time for income generation and participation in the development process. In addition to the end-line evaluation, a series of studies and process documentation have been conducted to analyse the impact of the project and demonstrate future potential use of knowledge and learning.
Independent Survey to Monitor Performance at the Close of Second National Leprosy Elimination Project
Agency: Central Leprosy Division, MoHFW, GoI
Project Team:Barun Kanjilal, S D Gupta, J S Bapna, Anoop Khanna, Dhirendra Kumar, Ch. Satish Kumar, Manisha Chawla, J P Singh, N D Sharma, Sunita Nigam, S. Nirmala, Satya Priya, Subronil Ganguly, Partha Sarathi Dutta, Soma Mitra, Swati Roy, Hemant Mishra, Kshitij Sharma and Shiv Shankar
The purpose of the survey was to carry out an independent survey to monitor the performance of the Second National Leprosy Elimination Project (NLEP-II) at the close of the project. The study attempted to assess the quantitative and qualitative achievements made under different components of NLEP-II and gained a complete understanding of the immediate impacts.
The objectives of the independent evaluation were as follows:
- To assess the qualitative and quantitative achievements made under different components of the Second NLEP
- To assess leprosy activities on specified indicators on elimination, integration, quality of MDT services, adequacy of drug supply and monitoring
- To assess the impact of IEC on awareness of leprosy
- To assess the role-played by NGOs/CBOs in leprosy programme implementation
The study covered 13 states in the country. The project emphasised on five major components: decentralisation and institutional development; strengthening and integration of service delivery; disability care and prevention; training; and information, education and communication. The study revealed that the total number of registered cases reduced from 0.389 million in March 2001 to 0.217 million at the end of the project period implying a reduction of 43 percent. The Prevalence Rate (PR) had reduced from 3.74 in 2001 to 1.99 in 2004 ' a reduction of about 47 percent. Since the trend in reduction in PR is almost linear, the country is expected to reach the elimination status by the last quarter of 2005. The findings of the study were used by the Government of India while making decision to declare leprosy elimination in the country.
Study on Institutional Assessment for Revised National TB Control Program
Agency:Central TB Division, MoHFW, GoI.
Project Team:Ch Satish Kumar and Neetu Purohit
The Government of India had requested the World Bank to support implementing Phase- II of RNTCP project. The overall aim of the project was to assist the Government of India in achieving its overall goal of improving health outcomes, in line with the millennium development goals in health.
As a prerequisite to understand the institutional and implementation gaps, the study was undertaken to prepare the PIP for Phase-II.
While the broad objectives were to assess the institutional capacity of central and state government and; state and district TB societies and formulate a strategy in consolidation of TB control programme, the specific objectives were:
- To conduct the institutional assessment at central and state levels
- To study the organisational mechanism (structure) and its linkages with the health department and medical colleges
- To study the participation and linkages of other sectors, non-governmental and private sectors with RNTCP
- To develop a strategic framework for the RNTCP II PIP
End of Project (s) Evaluation of NGO Implemented Project
Project Team:Nutan P. Jain and Neeraj Mishra
In the State of Uttar Pradesh, USAID supported Innovations in Family Planning Services Project (IFPS) was initiated under the executive management of the State Innovations in Family Planning Services Project Agency (SIFPSA). Under the project, the agency funded various non-government organisations to undertake innovative projects to create demand and improve services in terms of accessibility, quality and utilisation of reproductive health services. SIFPSA had institutional arrangements with the IHMR to evaluate the performance. The Institute evaluated the following projects for SIFPSA.
- RCH Services at the Doorsteps in Shergarh Block of Bareilly District implemented by Shri Ram Murti Smarak Trust, Bareilly
- RCH Services at the Doorsteps in Richha (Damkhoda) Block of Bareilly District implemented by Indian Medical Association, Bareilly
Continuous Social Assessment Study in Villupuram, Salem, Madurai, Thanjavur and Thirunelveli Districts of Tamil Nadu
Agency:Department of Women and Child Development, Tamil Nadu
Project Team: Ch. Satish Kumar, Neetu Purohit, E. Thirumurugan, M. Arulappa, S. Balamurugan and S.M. Pasha
The Department of Women and Child Development proposed a social assessment study to make the ICDS programme more community friendly by incorporating the perceptions, needs and expectations of the poor and disadvantaged community and also to include providers' perception on some of the barriers hindering the behavioural change operating at the family and community level.
The overall objective of the study was to assess the perception of the community and providers with respect to ICDS activities. The study also focussed on the role of enabling environment and convergence of Anganwadi Centres (AWCs) with other sectors. The specific objectives were:
- To assess community perception regarding ICDS project activities
- To monitor growth of all children (0-36 and 37-60 months), adolescent girls, antenatal mothers and pre-school activities at AWCs
- To arrange emergency transport to antenatal mothers and role of anganwadi workers (AWWs) in educating the community about the consequences of childhood marriage and female infanticide, using contraception for a minimum period of 3 years and keeping the household surroundings in a hygienic manner
- To initiate involvement of the community in planning and monitoring ICDS services, i.e. going beyond the role of passive beneficiaries
- To understand the perspective of providers (AWWs and helpers) in terms of ICDS activities
- To instigate availability, quality and maintenance of infrastructure and regularity of supply, especially of supplementary nutrition, medicine kit and play kit
- To set off community level involvement in planning and monitoring, i.e. the extent to which community acts as an 'active partner'
- To study the role of AWWs in identifying, improving and addressing the resistance for desired family based practices and also in investigating the infant and maternal deaths occurred in the village
- To study partnership between the community, service providers of the government and NGOs, and convergence and networking of services, and make suggestions for enhancing the same
Assessment of the Impact of Management, IEC, Clinical and EMOC Training in Uttaranchal
Agency:Uttranchal Health System Development Corporation (UAHSDP)
Project Team:R.S.Goyal, S.K.Puri, Anoop Khanna, N.K. Sharma and Anand Bairagi
Uttranchal Health System Development Corporation (UAHSDP) sponsored medical officers of different categories, nurses, and other staff to various short duration MDPs, and to clinical, EMOC and IEC training programmes organised by leading institutions in the country. The Institute was entrusted with the task of carrying out a study to assess the impact of these programmes. The assessment included the quality and impact of the training, skills acquired by the participants, usefulness of training in improving the quality of services, identifying gaps, and making recommendations for future training programmes. The assessment was based on primary and secondary data.
The study revealed certain important information regarding the strengths, weaknesses and gaps in the trainings provided so far. It also called for development of a training policy. Based on the findings of the study, the State decided to develop a policy for in-service training of staff of the Department of Medical and Health. This task involves micro and macro level assessment of present and future training needs in the context of health and population policy of the state, human resource management system, evaluation of capacity building facilities and other related issues. The Institute has been entrusted to undertake the task of developing the training policy of the Department of Medical and Health, Uttaranchal.
Study of Reproductive and Sexual Health Education of Adolescents
Agency: ICMR, New Delhi.
Project Team: R.S. Goyal, Kanupriya Saxena, Anand Bairagi, Rashmi Chartuvedi and Venkat Polumuri
The main aim of this operations research study was to develop a feasible model for providing reproductive and sexual health education to school-going adolescents in different parts of India. It was a multi-centric study carried out by six different institutions each in Jaipur, Delhi, Lucknow, Pune, Trivandrum and Kolkotta.
The study had three components: a base line study, a school-based education programme and an end of project evaluation of interventions. The project was designed for school-going adolescent boys and girls studying in 9th and 11th standards. The main objectives were:
- To undertake a situation analysis to assess the adolescents', parents' and teachers' perception of and attitude towards reproductive and sexual health issues and education and to set benchmarks for intervention study
- To develop a reproductive and sexual health education module for school-going adolescents
- To provide reproductive and sexual health education to adolescents in selected urban and rural schools in different parts of India
- To evaluate the impact of educational interventions on adolescents awareness, knowledge gains, attitudinal changes and sexual behaviour
In the first phase of the study a base line study was carried out to understand the perception, attitude and behaviour of adolescents towards reproductive and sexual health issues. Information was collected from adolescents, parents and teachers. A total of 1451 adolescent boys and girls, 439 parents and 171 teachers participated. In the second phase, specific training material (in Hindi) was developed (base material was provided by ICMR). Six training modules were developed on specific themes, namely growing-up concerns of adolescents; reproductive and sexual health; body image; interpersonal and gender relationships; understanding RTI/STI and HIV/AIDS; and life skill development.
Mapping All Private Health Facilities in Ranchi Town of Jharkhand
Agency:Futures Group, New Delhi
Project Team:Coordinator: Santosh Kumar and Swati S. Roy
The major objective of the study was to identify private practitioners in all wards of Ranchi town and to understand the type of services they provided. The specific objectives were:
- To collect list of private healthcare facilities ward wise in Ranchi town covering all systems of medicine and all types of practitioners, such as registered and unregistered providers
- To collect information about the inpatient and outpatient services provided by these private practitioners from all the wards of Ranchi town
Methodology:A descriptive study was conducted using the following methods:
- Record reviews
- Facility observations
- Key informants' interviews at the facility
Appropriate tools provided by Futures Group were used for collecting information. The key informants will include private practitioners/ staff. The research team covered all private healthcare providers situated in the 37 wards of Ranchi town. Findings: A total of 378 private health facilities were traced in Ranchi. Out of these 308 health care providers provided OPD facilities only whereas a total of 70 institutions were provided inpatient services. Among all, 255 clinics and hospitals provided allopathic treatment whereas homeopathy treatment was provided by 115 health facilities followed by Ayurvedic treatment (39). Nearly 35 private healthcare providers practiced with multi-drug therapy. Almost all private health providers said that they provided affordable and accessible services to the urban poor (Table for Q38) by charging low fees for consultations, subsidised services and, if required, by giving free treatment.
It was evident from the study that the private healthcare providers of Ranchi town were interested in participating under a public-private partnership scheme. Based on the specialty and available resources, the private health care providers were interested in public private partnership. The services in which most of the providers have shown their interests are:
- 1.General OPD
- 2.Organising camps (for ANC, anaemia, TB and orthopaedic)
- 3.Inpatient services etc.
Some of the private healthcare providers were willing to provide specialty services only, (such as paediatric treatment, OBG, dental care, ENT and ophthalmology care. A few private practitioners said that they were ready to work as volunteers if the government required their participation in the areas of their expertise. Some of them even offered their hospital premises for public programme.
Review of Safe Motherhood and Child Survival Program of CRS
Agency:Catholic Relief Services
Project Team:Neetu Purohit, Kshitij Sharma and Swati S. Roy
Safe Motherhood and Child Survival Program being implemented by Catholic Relief Services (CRS) was reviewed in three districts of Rajasthan in terms of:
- a.Capacity building and health seeking behaviour of the community members where program is being implemented and
- b.Sustainability of the practices among the community members from where the agency has phased out
The specific objectives of the study were:
- To find out about the ANC and PNC seeking behaviour of the mothers of children up to 2 years
- To know about the status of immunisation and vitamin A supplementation for children up to 2 years
- To ascertain the approach practiced by the providers in carrying out need-specific interventions for growth monitoring of each child
- To find out about the continuity or owning of the practices/program from where the agency has phased out
- To know about the practices of the TBAs for ensuring safe motherhood and child survival
- To find out about the retention of the knowledge imparted to VHW for ensuring safe motherhood and child survival and its transmission among the community members
- To validate the information recorded in the monitoring registers of the OPs or village health workers of CRS
Both quantitative and qualitative methodologies were used. It was encouraging to note that health status of the phase-in villages was found to be better on many indicators. Observance of five cleans was found high in phase-in villages. Building local capacity in terms of training TBAs and VHWs seemed to have bearing positive results. However, most of the healthy practices initiated during the phase-in period did not sustain to the expected level after the program phase-out.
Quality Network for Rational Drug Management in Primary Health Care in Asia and Europe (Qu4RaD) ' Multi-country IT Project on Rational Drug Management
Agency:European Commission and Asia IT & C
Project Team: J.S. Bapna, S.D. Gupta, Atal Khandelwal, IIHMR, Jaipur, India; Reinhard Huss, University of Heidelberg, Germany; Debarati Guha-Sapir, Universit' Catholique de Louvain, Belgium and Dennis B. Batangan, Ateneo De Manila University, Philippines
The project aimed to establish a quality network for rational drug management (Qu4RaD) at the Primary Health Care (PHC) level within 24 months starting on April 1, 2003. The soft launching of the Qu4RaD website was held at IIHMR during the Promoting Rational Drug Use in the Community (PRUDC) Course on Feb 28, 2004. Steps towards the popularisation of the website were underway through linkages with other websites, articles on Rational Drug Management, and availability of clinical protocols for primary health care that have been developed by this Institute. The network was based on advanced information technology (IT) and had been set up through a multidisciplinary approach by four organisations in Belgium, Germany, India and Philippines. The target groups were providers and purchasers of PHC in these four countries involved in quality improvement activities in rational drug management (RDM).
The final objectives were to improve decision making of the target groups through electronic access to international knowledge and skills about RDM and electronic exchange about their experience in improving RDM. The main activities were to set up a self-sustainable infrastructure and website for the network including training and supervision in the use of advanced IT.