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Research Projects/Studies Completed Year-2006-2007

End line Survey for ICDS III Project in Rajasthan

Agency: Government of Rajasthan

Project Team:Ch. Satish Kumar, Neetu Purohit, N.D. Sharma, Mittu Muthu Varghese, Jai Singh Shekhawat, Pasha M, Bejoy A.P. and Balamurugan

Under the Monitoring & Evaluation Component of the ICDS-III project, periodic external evaluations during different phases of the project including baseline, end-line surveys, continuous social assessment and operations research were envisaged to be undertaken by independent organizations to assess the changes brought about by the project during the intervening period. Initially the Government of Rajasthan conducted a Baseline survey in the project area to establish the benchmark indicators for the project planning. After successful implementation of the project for two years, DWCD took up concurrent social assessment to monitor the project progress and community understanding to reconfirm or redefine their operational plan to understand the impact of their implementation strategies. The project was to conduct end-line surveys to assess the progress and achievement of the project as compared with the baseline status

The specific objectives were:

  • To study the utilisation level of the ICDS services by lactating and expectant women and the impact of the ICDS program in improving the childbearing core practices like breast-feeding and colostrums intake
  • To assess the extent of antenatal care of pregnant women, breastfeeding and weaning practices
  • To assess growth monitoring, nutritional status and participation of the children below 72 months in pre-school activities at Anganwadi centres
  • To assess the knowledge of adolescent girls about family life education
  • To assess participation of the community in ICDS programs like household care and feeding practices
  • To compare the results of the end-line survey with the base line results on critical indicators to appraise the progress and achievement of the ICDS project

interventions using the baseline results in Rajasthan project areas. It was a cross sectional descriptive study with the multistage sampling technique with the basic unit as household. The survey covered about 257 project areas WB old, new and general including the rural, tribal and urban areas. The total households covered by the survey were 17427.

The Endline survey observed a reduction in the percentage of underweight and severely malnourished children in the age group of 0-36 months from that in the Baseline survey. The weight at birth of the children showed an increase from the Baseline survey (16.7 percent) to Endline (29.1 percent). The practice of initiating breast-feeding within 2 hours of birth increased rapidly from 9 percent to 38.5 percent in the Endline. Colostrum feeding has increased from 20.7 percent to 45.1 percent in the Endline. The percentage of children who are exclusively breast-fed also increased from 4.7 in Baseline to 5.9 in Endline. About 78 percent of lactating mothers got registered after confirmation of the pregnancy. Doses of two T.T were received by around 90 percent of the lactating mothers.

The percentage of adolescent girls participating in the women's activities conducted by AWW was 0.9 percent in the Baseline survey against 5.5 percent in the Endline survey. The adolescent girls who got registered in the AWC were 3.5 percent in the Baseline survey and 10.2 percent in the Endline survey. The regular growth monitoring of children less than 3 years of age was 81.3 percent in the World Bank assisted projects.

Rapid District Baseline Survey for Pilot Projects for Population Stabilisation in Tonk and Jhalawar

Agency: Government of Rajasthan

Project Team:Ch. Satish Kumar, Mittu Muthu Varghese, Jai Singh Shekhawat and M. Arulappa

Rapid growth in population of Rajasthan has an enormous pressure on its natural resources, which has invariably hampered all the attempts made by the GoR to improve the quality of life of the people and also in the attainment of a sustainable development. To develop people-friendly interventions and strategies, a declaration by State Population Policy commended to energise the systems to reach replacement level of fertility by 2016 via mobilizing all possible resources in all the sectors. The GoR had planned a pilot project in two districts of Rajasthan for population stabilization. Before initiating the interventions, it was inevitable to have the baseline status of the districts on indicators relating to maternal and child health and family planning to assess effectiveness of interventions.

The total population covered in the survey was 51832 in Tonk district and 45018 in Jhalawar district. Total 1255 women were interviewed from Tonk and 1152 women from Jhalawar district. The percentage of boys married at age less than 21 years was 59 per cent in Tonk and 67.1 per cent in Jhalawar. Girls married at age less than 18 years old were 44.8 percent in Tonk and 55.3 percent in Jhalawar.

The fertility characteristics showed the mean number of children born to a mother was 3 in both Tonk and Jhalawar. The 3rd birth order was found between 55-60 per cent in either of Tonk and Jhalawar. The percentage of women using terminal method was higher than those using spacing method. The percentage of terminal method users was 38.7 in Tonk and 39.0 in Jhalawar, while that of spacing method users was 21.6 in Tonk and 14.6 in Jhalawar. The unmet need for limiting was 3 per cent in Tonk and 17.7 per cent in Jhalawar. The unmet need for spacing method was high in Tonk, while for limiting method was high in Jhalawar.

The 'maternal health care' was taken care of by 50 per cent of the respondents. About 80 per cent of the women had undergone at least one antenatal check-up, about 60 per cent had consumed two doses of T.T. injection, and about 20 per cent consumed adequate doses of IFA tablets. The institutional deliveries were comparatively less than the home deliveries in both Tonk and Jhalawar.

Only 10 per cent of women practiced exclusive breastfeeding for 4 months in both Tonk and Jhalawar. Besides this, only half of the mothers fed their children with colostrums. The complete immunization of children accounted to 36.2 per cent in Tonk and 26.8 per cent in Jhalawar. Only one fourth of the mothers visited health facilities during the last 12 months of the survey. The overall satisfaction received with the health services was 87 percent in Tonk and Jhalawar.

End-line Evaluation of Youth Education on Sexuality (YES) Project in Agra District of UP

Agency: FPA India, Mumbai

Project Team:P.R. Sodani, Laxman Sharma

A project on Youth Education on Sexuality (YES) was implemented by the Family Planning Association of India (FPA India), funded by the Community Fund, National Lottery Charities Board (NLCB) through International Planned Parent Federation ' South Asia Regional Office (IPPF-SARO). The project was implemented in 316 villages and five towns of two sub-divisions, Kiroli and Kheragarh of Agra district in Uttar Pradesh, from January 2001 to December 2005. The five-year project offered a unique opportunity to young people to lead a happy, healthy and satisfying sexual life free of exploitation, fear, guilt, misconceptions and diseases. The primary beneficiaries of the project were young people (10-24 years), whereas secondary beneficiaries included parents, teachers and community leaders.

The objectives of the YES were:

  • To enlist support from the community to enable the youth to make voluntary and responsible reproductive health choices
  • To increase the accessibility of services and correct information to the youth to improve their sexual and reproductive health status and protect them from avoidable reproductive health risks.
  • To enable the youth to lead a sexual life free from exploitation, fear, shame, guilt and misconceptions/ false beliefs about sexuality.
  • To effect a reduction in adolescent pregnancy by 10 percentage points and an increase in the girl's age at marriage by 3.2 years by the end of 2005.

The awareness of sexual and reproductive rights as well as of seeking services as and when required was reasonably found among 8200 adolescents including females in the annual reports. The end-line evaluation report reflected that males (72%) and females (66%) were sensitive towards their sexual health needs. About 4400 expecting mothers received ANC services and approximately 2500 mothers received PNC services during project implementation. More than 12500 youths received information through project efforts on implications of early marriage and early child bearing. Mean age at marriage was found to be 20 years for the boys and 18 years for the girls in the intervention area, against 19 for the boys and 17 for the girls in the control area.

Increase in contraceptive practices among 7300 couples reflected the advocacy in women regarding unwanted pregnancies and untimely pregnancies, and improvement in the quality of their lives. A majority of youth (71%) was aware of female sterilization regarding permanent methods. Similarly, within the intervention area a majority of 15-24 years youths (85%) had awareness of oral pills and condoms as a spacing method compared to the youths of 10-14 years (60% - 69%).

The project was successfully implemented with the three key strategies for achieving the overall goal, which was to enable young population to develop improved sexual and reproductive health (SRH) status and to exercise their reproductive rights and responsibilities. These strategies may be replicated in other areas for up-scaling the SRH programme for better results with a wider coverage.

To collate health information on identified areas, data entry and upload the Documents on WHO India Office

Agency:WHO India

Project Team: P.R. Sodani, Lata Suresh

The WR India office approached the institute for collating health information on the following four identified areas: health expenditure, user charges, cost analysis, decentralization and quality of care. The information on the identified areas was collected from published and non-published material obtained from various sources. Under this assignment, we collected information from about 250 articles. The material search included empirical research studies, research studies based on primary and secondary data, papers published in national and international journals, policy papers, working papers, occasional papers from national and international institutions. Apart from these, the search also included workshop and conference reports, and technical reports. The sources of information collection included library search, journal searches, web searches, institutions/organizations and contacting them. The information was uploaded on the WHO India office application

Financial Resource Flow for Population and AIDS Activities (Phase I ' 56 Countries)

Agency:NIDI, Netherlands

Project Team: Anoop Khanna, Kshitij Sharma

The Resource Flows (RF) was a joint collaboration between UNFPA, UNAIDS, Netherlands Interdisciplinary Demographic Institute (NIDI) and IIHMR. The aim of the RF project was to develop and refine a system for the collection, monitoring, analysis and dissemination of data on financial flows for population and AIDS activities at a worldwide level. The project was established to monitor expenditures related to population and AIDS and to advocate that adequate funds be mobilized to ensure that ICPD and UNGASS promises were realized. The principal method of data collection consisted of annual mail surveys to donors and developing countries. The project had created a resource flow database of both donor and domestic resources that is updated regularly.

Developing Training Modules on Legal Norms in Reproductive Health

Agency: IFES

Project Team:N Ravichandran, S.G. Kabra, S.C. Gupta, Ajit Kumar Jain, Manisha Chawla, Sunita Nigam

Training needs assessment had undertaken through the questionnaire method and focus group discussions with health care and media personnel to assess their existing knowledge on reproductive health, related laws and their perceived role. Apart from this, inputs were taken from visits to the premier institutions in the state and meetings with policy makers and programme managers.

A workshop was conducted to design appropriate curriculum and pedagogy for training, which were pre-requisites for addressing the competency needs of health care providers. A needs assessment as perceived and expressed by the health care providers was undertaken vis-'-vis programme goals and objectives and interventions thereof. Further, evaluation of the developed module by experts, pre-testing of the module and participants' feedback was used to improve the programme design.

The module on 'Laws protecting women's rights relating to reproductive health' aimed at empowering health care providers, media professionals and others working in the area of reproductive health and gender with critical knowledge of reproductive rights, essential medico-legal background and related laws impacting on the reproductive health of women.

Objectives of the module:

  • To understand women's health status affected by complex biological, social and cultural factors
  • To appreciate rights-based approach to reproductive health as a crucial aspect of human rights To understand medial background of the laws related to reproductive health
  • To enumerate various women's rights related to reproductive health
  • To enumerate the various laws and other legal provisions related to reproductive health
  • To understand the obstacles in proper implementation and monitoring of the laws relating to reproductive health
  • To internalise their individual and collective roles in implementation and monitoring of these laws and provisions
  • To develop skills to effectively counsel women and others about women's rights

Baseline Survey for Behaviour Change Communication Campaigns in Uttar Pradesh

Agency:Futures Group, New Delhi

Project Team: Neetu Purohit, Ch. Satish Kumar, Sanjay Rode, Mathew George, Ganesh Rajput, Hemant Mishra, Swati S Roy, T. Sudhir Raj, Sanjay Tripathi, Pitambar P, Arnab Mandal, Jayati Srivastava, Shweta Chooramani, Laxman Sharma, Swadhin Mandal

The survey was aimed initially at providing baseline indicators for initiating the Behaviour Change Communication (BCC) campaign in Uttar Pradesh. Later on, these indicators were used for evaluating the impact of Behaviour Change Interventions on the target community. The main objectives of the survey was a) to provide information regarding knowledge, attitude and practices with regard to reproductive health issues like family planning, ante-natal, natal and post natal care and child care from women in the reproductive age group and their spouses; b) to assess the role of mothers-in-law in decision making for contraception use by sons and daughters-in-law, her influence on child preference and her own history of contraceptive use and knowledge on ante-natal care; c) to assess the knowledge, training status and attitude towards clients among community level health providers like ANM, AWW and TBA.

This large-scale survey has covered 370 villages spread across 66 districts of Uttar Pradesh. As a whole, 7,400 households had been selected for interviewing the target respondents like women in the reproductive age group of 15-49 years, their spouses, mothers-in-law of the currently married women present in the household. Among the Community level health providers, a total of 600 ANMs, 600 AWWs and 600 TBAs were being interviewed from the corresponding PHC catchments area of the selected rural PSU.

In order to provide client based and time specific communication interventions, the survey collected information on the types of media exposure, timing of exposure and suggestions for suitable timing for the campaign.

National Health Workforce Plan 2001-2010, Ministry of Health, Maldives

Agency: WHO, Maldives

Project Team:S.D.Gupta and Nutan Jain

The Ministry of Health, Maldives approached the WHO Maldives to provide technical support to undertake review the NHWP 2001-2010, and appropriately revise the same. As a result WHO Maldives entered in an APW with the Institute with the following objectives:

  • Review and revise the existing NHWP 2001-2010
  • Revise the criteria for prioritising training requirements of the health sector
  • Identify possible institutional mechanism to implement the activities in the NHWP and include list of possible training institutions and course details

The existing plan was reviewed by interviewing and holding the workshop with key stakeholders at Male. Consequently, a revised workforce plan was developed considering the norms for each level of Maldives health system ' Island to the Regional level; and managerial positions at each of the department and the IGM hospital. The plan had worked out replacement of expatriates with the nationals. It is recommended that a national level training institute need to be established to address the training needs of the in-service health workforce. Establishment of a medical college is also recommended to produce medical professionals as a strategy to replace the expatriates. To ensure the effectiveness of these divisions, it is necessary that each of them develop a clear description of roles and responsibilities, hierarchy and reporting relationship and span of control. For this each division prepare a task and skills matrix, and type of health personnel needed to undertake the identified tasks.

National Family Health Survey- 3 (NFHS-3) for State of Rajasthan and Madhya Pradesh

Agency:IIPS, Mumbai

Project Team:Dhirendra Kumar, Santosh Kumar, N D Sharma, J.P. Singh, Hemant Mishra, Santosh Kumar Sharma, Neeraj Mishra, Soma Mitra, Anil Jha, Rajesh Pareek

Ministry of Health and Family Welfare (MoHFW), Government of India (GoI) had decided to conduct the third round of National Family Health Survey (NFHS-3) in the year 2005-2006. The Government of India had designated the International Institute for Population Sciences (IIPS), Mumbai as the nodal agency for coordinating the project United States Agency for Interational Development (USAID) provided the funding for NFHS-3 with supplementary funding from UNICEF for the nutrition component of the survey. NFHS-3 also received a part of its funding from the Gates Foundation, DFID and UNFPA. Macro International, USA provided technical assistance. The fieldwork was carried out by different field organisation working in the areas of population, health and family welfare. Institute of Health Management Research (IIHMR), Jaipur had been assigned to conduct the fieldwork in the states of Rajasthan and Madhya Pradesh.

The overall objectives of NFHS porgramme were: a) to strengthen India's demographic and health database by estimating reliable state-level and national-level indicators of population, maternal and child health, HIV/AIDS, and nutrition; b) to facilitate evidence-based decision making in population, health and nutrition; and c) to strengthen the survey research capabilities of Indian institutions and to provide high quality data to policy makers, family welfare and health programme managers, government agencies, NGOs, international agencies, and researchers

Specific Scope and Objectives of NFHS-3:

NFHS-3 provided the estimates of the levels of fertility, infant and child mortality, and other family welfare and health indicators by background characteristics and measure trends in family and welfare and health indicators over time at the national and state levels.

NFHS-3 also provided information on several new and emerging issues including: a) perinatal mortality, male involvement in family welfare, adolescent reproductive health, high-risk sexual behaviour, family life education, safe injections, tuberculosis, and malaria; b) family welfare and health conditions among slum and non-slum dwellers from eight cities of Chennai, Delhi, Hyderabad, Kolkata, Meerut, Mumbai and Nagpur; and c) HIV prevalence for adult women and men at the national level and for each of the six high HIV prevalence states, namely Andhra Pradesh, Karnataka, Maharashtra, Manipur, Nagaland, and Tamil Nadu.

Feasibility of a Hospital in Jaipur City

Agency:Divine Hospital, Kolkata

Project Team:Santosh Kumar and S.K. Puri

The promoters of the Divine Nursing Home, an 80-bedded hospital in Kolkata had decided to start another unit of its hospital in the Jaipur city. The proposed place for the health facility is at Bapunagar, Jaipur and it aimed at fulfilling the health needs of people primarily residing in and around Bapunagar, Gopalpura, C-Scheme, Jawahar Nagar etc.

IIHMR was entrusted for doing feasibility study and preparing the Project Report, which enumerated the following:

  • Environmental Scan
  • Project Design ' Facilities Plan
  • Techno-commercial Feasibility including Financial Projections for five years

Environmental scan was done using both primary and secondary data. General physicians, senior consultants, hospital administrators, diagnostics facilities, healthcare experts were interviewed to understand the supply side needs and issues. Household Survey was also done using conveniences sampling to understand the customer perception about present healthcare facilities in town, need of new hospital and expectations from the new facility.

The health care provision in Jaipur is dominated by the private sector comprising Charitable Trust Hospitals and Nursing Homes. According to the Rajasthan Patrika (2005) Jaipur has nearly 24 government hospitals and 91 private hospitals. A rapid survey about bed utilization observed that most of the hospitals are working at more than 70% occupation rate, which clearly is an indication of scarcity of new beds in the city.

Most of the consultants were just satisfied with the present status of patient care and patient care facilities in hospitals in Jaipur city. The experts opined that these hospitals lack comprehensive care units for cardiology, cosmetic surgery, replacement surgery, open transplant, trauma care, and neurology.

It was found that among those households, who visited the hospitals in last one year, nearly 19% visited SMS first, 18% had opted for general practitioners and approximately 14% opted for SDMH. Among other preferred hospitals were Soni, Janana, Tongia etc. Among those who visited the hospitals, only 30% were satisfied by the services of respective hospitals and 13% were unsatisfied. A huge proportion, 57% of respondents said they were not aware of the satisfaction level.

In response to the expectations from a new hospital most of the households opined that the hospital should offer quality treatment, correct and timely diagnose, good infrastructure, affordable price, availability of qualified, punctual & experienced doctors, cleanliness, patient friendly attitude of doctor, punctuality and care from other staff, ethical practices, availability of all diagnostic services under one roof, and last but not the least near by facility in the given order.

Following are the snapshots of hospitals in Jaipur:

  • Jaipur lacks the state of the art super specialty hospitals, as most super specialty services are part of general hospitals as thrust areas
  • Even though the cases of Neurology and Diabetes have increased tremendously, most hospitals of Jaipur do not include these in their major thrust areas.
  • Jaipur hospitals need comprehensive care units for cardiology, cosmetic surgery, replacement surgery, open transplant, trauma care, neurology and diabetic care centre.
  • Affordable quality care using good infrastructure, qualified and experienced doctors are the most important expectation from the new hospitals. Promptness, patient friendliness and ethical practices are other important aspects a new hospital should look for.