Research Projects/Studies Completed Year-2007-2008
Establishing External Monitoring System for Immunization Programme in Rajasthan
Agency: UNICEF Rajasthan
Project Team:Manisha Chawla ,T Sudhir Raj, Mittu Muthu Varghese, B.Gowtham Ghosh, Manoj Soni
An External Monitoring Cell set up at IhMR wherein independent monitors monitor the immunization program (sessions, cold chain, logistics and progress at the district level) in all the 33 districts of Rajasthan. The monitors visited randomly selected PhCs as well as its randomly selected four session sites on MChN day i.e. on every Thursday of the week. Besides, they visited the district headquarters once in every month to see the cold chain and logistics. The monitors were monitored by the eMCI team (consisting of research officers) at IhMR. The data collected was sent to IhMR through fax/courier. The data was then analysed and compiled into three reports, namely the detailed report, the state report and the districtwise report. The state report was sent to the state higher authorities, the detailed report was sent to the authorities next to the state authorities and the district report was sent to the district authorities. There were review meetings for the monitors every two months at IhMR with the aim of improving the quality of monitoring. The external monitoring showed an improvement in inputs, logistics and coverage of immunization. There was a change in the working of the whole immunization system as a result of the eMCI. The health workers have started showing more attention at the session sites as a result of the external monitoring. The quality of the cold chain and the availability of logistics have improved in the district as well as at the PhC level. The elaborate system of data management and submission of updated monthly reports within the stipulated time at three levels (state report, detailed report and district report) have helped address the problems in logistics as well as in the cold chain maintenance. It has also helped to improve the functioning of the immunization programme in Rajasthan
Re-thinking of Post-PartumCare: A Strategic Review
Project Team:N. Ravichandran , Uma Bisaria , Devendra Singh
Bringing care closer to women and bringing women closer to care can remove the distance between women and health services. Improving the quality of post-partum care requires a well-considered and carefully implemented approach. Constituting as a major public health problem, post-partum care, assessment on proper intervention through research on the scope, causes, cost and consequences of post-partum care can be useful for advocacy and programme design. The proposed study aimed at assessing the impact of Post-Partum Amenorrhea programme in India on the availability, quality and utilization of and access to post-partum care services. It also sought to examine the reproductive health care services in the light of post-partum care services. The potential importance of the study was to strengthen post-partum services along with reproductive and child health approach to reduce maternal morbidity and mortality. The intervention study promoted and adopted the following strategies:
- help-line through referral transportation scheme
- Adolescent as social agents within family
- Male involvement in family building process
- Monitoring through Panchayati Raj institution in breaking the cultural nexus
- Skill and capacity building programmes for service provides to meet demand
Independent Evaluation of National AIDS Control Programme
Agency:National AIDS Control Organization, Ministry of health and Family Welfare, Government of India
Project Team:S.D. Gupta, Anoop Khanna, Barun Kanjilal, R.S. Goyal, Ch.SatishKumar, Dhirendra Kumar, P.R. Sodani, Manisha Chawla,J.P. Singh, Kshitij Sharma, N.K. Sharma, Sunita Nigam, Rajeev Kamal, T S Sudhir
A consortium of IhMR, JhU and IIM Calcutta had been entrusted with the task of carrying out the evaluation. The broad objective was to evaluate the performance and functioning of the NACP during Phase II. The evaluation covered various programme components including STI clinics, ART centers, VCTCs, Blood banks, NGOs, targeted interventions, community care centers, drop-in-centers, networks of PLhAs, etc. It also covered management aspects of NACO, SACS and other functional units. The management aspects included human resources, IEC, finance management, logistics and supplies management, training, IEC, intersectoral collaboration, inter-departmental coordination, convergence, etc.
The study revealed that in spite of rapid expansion of STD clinics, VCTCs and ART Centers, the problem of accessibility for rural people persisted in most of the states. The drop-out rate among the ART patients was high, which was mainly due to poor mechanism for follow-up and adherence to the treatment. Drug resistance appeared to be an emerging issue, and many ART users were demanding free provision of the more expensive 'second line' drugs that they now required. Targeted interventions appeared to be an effective measure to respond to the epidemic. An important challenge in the implementation of TIs was that the mistrust between government and NGOs still persisted. Moreover, mapping and need assessment were not strong enough to help effectively in planning and implementation of TIs. The study also found that although there was a reduction in the magnitude over the years, stigma and discrimination still persisted. Delayed release and underutilization of funds at the state level appeared to be a key management concern.
The study recommended strong monitoring and follow-up of the clients. Improving data management, timely release of funds, involvement of PLhAs in planning process, strong BCC strategy, promoting publicprivate partnership and inter-sectoral coordination were the major points of recommendations.
Organizational Review of Key Units Divisions of the Department of health and Family Welfare, Government of West Bengal
Agency: IPE/TAST, Kolkata
Project Team:S.C. Gupta, Nutan Jain, Neetu Purohit, Parthasarathi Datta, Sanjay Tripathi, Swati Sarbani Roy, Manish Kumar, Saheli Gine
The study reviewed the current organizational set up of the identified priority areas of reform under health System Development Initiative with a view to recommending appropriate systemic changes to enhance the effectiveness, efficiency and responsiveness of the following key areas:
- a. Nursing Wing of the Directorate of health Services and Non Medical Technical Personnel's cadre;
- b. Directorate of Drug Control;
- c. Clinical Establishment Act
- d. Public-Private Partnership Strategy.
- The study was conducted for five units separately.
- Nursing Wing of the Directorate of health Services
- Non Medical Technical Personnel cadre
- Unit of the DhS administering the Directorate of Drugs Control (DDC)
- Unit of the DhS administering the Clinical Establishment Act
- Unit of the DhS administering the Public Private Partnership (PPP)
Capacity Enhancement for Management of Malda District hospital
Project Team:Santosh kumar
The systems study clearly found that the hospital lacked the basic systems. It had a very poor monitoring and supervision system. Therefore, the emphasis was put on developing systems. Standards for operating procedures were developed for utility services such as housekeeping, maintenance, and security departments. Supervisory reporting formats were also developed.
A patient satisfaction questionnaire was developed and daily feedback was taken from OPD and IPD patients to monitor the monthly progress of the project.
Initially a very cold response was received from the hospital staff including the consultants and the medical superintendant. The staff's view was that, being a government-run hospital, nothing could happen to the district hospital. The project team, therefore, strategically did not initiate any intervention in the first month of the project; rather, this period was used for understanding the key issues and developing a rapport with the hospital staff.
hIV/AIDS Prevention and Care Programme for Rural and Tribal Youth in India
Agency:OXFAM (GB) India
Project Team:R.S. Goyal, SP Chattopadhyay
The study was carried out with an objective to create benchmarks and provide baseline information for an intervention project to increase young people's access to information, skills, services and treatment for reproductive and sexual health problems and hIV/AIDS. It was one of the few programmes seeking capacity building of the out-of-school rural and tribal youth in the states of Orissa and Rajasthan. The specific objectives of the project were:
- To identify current gaps in access to information, treatment and services; and assess the current sexual, reproductive health status, information and health needs and sexual behaviour patterns of young people in the context of hIV/AIDS prevention and care.
- To increase access of young people to appropriate sources of information and services for sexual health and hIV/AIDS prevention and care,
- Capacity building of civil society organizations and private/public sector organizations to manage and implement gender and culture sensitive, community appropriate programmes on hIV/AIDS prevention, care and reproductive health for young people, especially girls.
- To facilitate a supportive environment to meet the reproductive and sexual health as well as hIV/AIDS prevention and care needs of young people.
- To facilitate alliance building between NGOs, private and public sector organizations.
The baseline study was based on interactions with the youth and adolescents, parents, community leaders and local health care providers (ANM, AWW, TBA etc.). Both quantitative and qualitative data were collected. Major observations and recommendations of the base line study were as follows:
Study on Global Ageing and Adult health (SAGE)- India 2006 in Rajasthan and Uttar Pradesh
Agency: IIPS, Mumbai
Project Team:Dhirendra Kumar, Santosh Kumar, N.K. Sharma, Sanjay Rode, Janisar Akhtar, B. Gowtham Ghosh, Rohit Jain
The Study on Global Ageing and Adult health (SAGE) India, 2006 was initiated by the World health Organization in six of the seventy countries that participated in the World health survey, 2003. SAGE is a longitudinal, cross-sequential household face-to-face survey. The current survey was the first baseline for SAGE survey programme. The SAGE results intended to inform how health, social, environmental and economic policies, programmes and realities across different countries affected the health status of individuals and populations over a life time and at old age. Institute of health Management Research (IhMR), Jaipur conducted the field work for SAGE, India in the state of Rajasthan.
The overall objectives of SAGE 2006 were; a) to strengthen India's demographic and health database by estimating reliable state-level 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.
SAGE 2006 provided information on; a) the estimates of the levels of fertility, infant and child mortality, and other family welfare and health indicators by background characteristics at the national and state levels; and b) the measurement trends in family welfare and health indicators over time at the national and state levels.
Sage-2006 also intended to provide 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.
Evaluation of National Child Labour Project in Rajasthan
Agency: V V Giri National Labour Institute and Ministry of Labour and Employment, Government of India
Project Team: L P Singh, Nutan Jain, Alok Mathur, Manish Kumar, Sanjay Tripathi, T. Sudhir Ra
The National Child Labour Project (NCLP) is a gradual and sequential approach with focused and concerted efforts for eliminating child labour. The NCLP was initiated under the National Child Labour Policy, 1987 and, therefore, in addition to the legislative action and convergence with general development programmes, it envisaged a project-based plan of action in areas of high concentration of child labour. The NCLP programme addresses the issue of child labour through a number of parallel interventions, such as establishment of special schools, provision of vocational training and involvement of parents in various income and employment generation activities.
The objective of the evaluation was to determine the effectiveness and impact of the National Child Labour Project by carrying out a quick assessment of the functioning of the National Child Labour Projects, locating the role of special schools in the elimination of child labour and the working of the project societies. The specific objectives of the evaluation were:
Lastly, to benchmark panel data at the district level and to supplement existing secondary documentation with a view to updating the existing information and helping in analyzing the approaches and strategies of MoLE to eliminate child labour . The evaluation reviewed strategic frameworks, objectives, activities of the NCLPs, and the participation of various stakeholders and social partners. The evaluation involved visiting the NCLP schools and reaching out to different sections of the population ranging from the children attending NCLP schools, their parents and teachers, project directors and their staff, NGO representatives, and community to elicit their views on the functioning of the schools and the project and to assess their significant inputs. The results revealed that the special schools were being run satisfactorily by the NGOs. The key areas of improvement were related to management of the projects including full-time appointment of project directors, teachers' training, timeliness in funds management, mainstreaming, and convergence.
Five-Year Global Fund Evaluation ' Partnering with ORC MACRO International, USA
Agency: MACRO International Inc.
Project Team: S.D. Gupta, L.P. Singh, Anoop Khanna, Manish Kumar
The Global Fund is a financial institution founded on principles of performance, flexibility and learning. Since its inception in 2002, the organization has grown from creation to a portfolio of 450 grants in 136 countries worth nearly US$ 8 billion. Since it has reached a point where the five-year lifecycle of its first grants is nearing completion, the Global Fund has launched a Five-Year Evaluation, which marks an exciting and critical milestone in the development of the Global Fund. The Global Fund was created to finance a dramatic turn-around in the fight against AIDS, tuberculosis and malaria. These diseases kill over 6 million people each year, and the numbers are growing.
Under the overseeing of the Technical Evaluation Reference Group (TERG), the Five-Year Evaluation is a major effort to review the functioning and performance of the Global Fund as an institution and a partnership, and to identify areas of strength and weakness that will lead to improving day-to-day operations. One of the most unique aspects of this evaluation is its attempt to measure impact, that is, to assess the reduction in the burden of hIV, TB and malaria associated with the collective scale-up of prevention and treatment activities by all partners.
The TERG selected MACRO International Inc. as the lead contractor for both the consortium conducting Study Areas 1 and 2 on Global Fund organizational efficiency and partner environment and the consortium conducting Study Area 3 looking at health impact. The partner environment consortium partners include: MACRO, Johns hopkins Bloomberg School of Public health, Institute for health Management Research, the CORE Group (civil society), AXIOS International and Development Finance International.
health impact study consortium partners included: MACRO, the World health Organization-Evidence and Information for Policy (WhO-EIP), Johns hopkins University, Johns hopkins Bloomberg School of Public health, harvard University and the African Population and health Research Center (APhRC).
IhMR is a partner in study areas one and two. Under this, we are the agency primarily responsible for country partnership assessments in Yemen, Nepal and Vietnam. The country partnership assessments have been completed in all these countries. During evaluation, the country teams liaison directly with country-level counterparts including the Country Coordinating Mechanisms (CCMs), Principal Recipients (PRs), Local Fund Agents (LFAs), UNAIDS Country Coordinators, WhO Representatives and Impact Evaluation Task Force members.
The examination of the Global Fund's organizational efficiency and its partnership environment will be completed in a relatively short timeframe. The first report has been presented in November 2007. The examination of impact on the three diseases is far more extensive and will require ongoing efforts at country level throughout 2008. The final evaluation report will be presented to the Global Fund's Board at its meeting in November 2008.
Establishing a Professional Training Programme on Evaluation in South Asia
Agency: UNICEF ROSA
Project Team: R.S. Goyal, P.R. Sodani, Anoop Khanna, Atal Khandelwal and, Rohit Jain
UNICEF Regional Office for South Asia (UNICEF ROSA) has undertaken an initiative to establish a professional training programme on evaluation in academic institutions in South Asia. IhMR developed a course curriculum in evaluation for professionals (mid career and senior level) as well as postgraduate students desiring to pursue a career in evaluation. The Institute will offer the programme early next year. University of Carleton, Canada and London Metropolitan University, UK will facilitate the development of curriculum and training of trainers. In the two workshops held in Katmandu, Nepal, the course structure has been given a shape. IhMR hosted a training of trainers' workshop during December 1-6, 2007 for 30 participating institutions from South Asia. It was facilitated by the University of Carleton, Canada and London Metropolitan University, UK.
The institute will offer the first executive level course in November 2008.
Developing Training Modules on health Management Development for National Trainers of South-East Asia Region
Agency: WhO, SEARO
Project Team: Nutan Jain, S. C. Gupta, Sunita Nigam
Based on the Leadership and Management Framework developed by the WhO headquarters and SEARO, health and management development modules have been developed aiming to improve competency of the facilitators to initiate and implement the following issues:
The Regional Workshop for Trainers on Sub-national/ District health Systems was held in Bali, Indonesia, during April 22-26, 2008. IhMR team members acted as facilitators. The modules would help the member countries in strengthening management system, availability of good health managers with improved leadership skills and managerial capacity and a good enabling working environment. An approved set of module would be used by the member countries with necessary modifications as per the local needs.
Rapid Assessment of health Facility Survey in UP
Agency: Constella Futures Group, on behalf of the Ministry of health and Family Welfare, Government of India
Project Team:L.P. Singh, Santosh Kumar, Suresh Tahiliani, Monica Garg, Manish Kumar, Swati Roy, hemant Mishra, Surbhi Saxena, Richa Pandey
To reduce MMR and to meet the goal of less than 100 per 100,000 live births by the year 2010, the Government of India has provisioned for skilled attendance at every birth and emergency obstetric care to pregnant women having complications through nearly 2,000 FRUs, all ChCs and 50% of PhCs in the country. Selected FRUs, ChCs and 24x7 PhCs were upgraded as per the guidelines developed for this purpose. As a part of this effort, Constella Futures Group had undertaken a rapid assessment of facilities in Uttar Pradesh, Uttaranchal and Jharkhand. health sector varies considerably against the critical criteria of functionality of each type of facility. IhMR was entrusted withthe field work, data analysis and report preparation for Uttar Pradesh.
The major objective of the rapid assessment was to understand the functioning of FRUs and 24x7 PhCs as per the Government of India guidelines and to provide the feedback. The specific objectives were to:
As per the guidelines, FRUs must be equipped to provide delivery services on a 24-hours basis. however, it was found that nearly 10 percent FRUs failed to provide the 24-hour delivery service. New districts were partially operational and a few districts did not have a district hospital. Most of the hospitals failed to maintain proper records of date and time of delivery and discharges. Only one out of four district hospitals and two out of five PhCs had proper recording of date and time of delivery and discharges.
Review and Revision of Medical Manual, Madhya Pradesh
Agency:Directorate of health Services, Government of Madhya Pradesh
Project Team: P.R. Sodani, G S Sachdev
The Department of Public health and Family Welfare, Government of Madhya Pradesh approached the Institute for review and revision of the existing medical manual. The objectives of the assignment were as follows :
In-depth consultations were conducted with policy makers and state level health officials on various issues pertaining to the existing Medical Manual and scope for improvement. The existing Medical Manual was critically reviewed and areas were identified for possible revisions. In this process, apart from reviewing the existing Medical Manual, the Medical Manuals of other departments and other State governments were also referred. Other documents referred to for this purpose included: Guidelines of Uttar Pradesh and Tamil Nadu, MP Police Regulations, MP Budget Manual, RTI handbook of DohFW, Tamil Nadu and IPhS Guidelines. The Revised Medical Manual (draft) has been submitted to the State Government. It has also been shared with the state health officials in a meeting held at the Directorate of health Services.
Measuring Patient Satisfaction at Public health Facilities in Madhya Pradesh
Agency:Directorate of health Services, Government of Madhya Pradesh
Project Team: P.R. Sodani, Jayati Srivastava, Rajeev Kamal Kumar
The Directorate of health Services, Government of Madhya Pradesh, had recognized that the health services must be driven by focus on the user and, consequently, pursue a sustained quality improvement initiative. The main aim of the study was to measure patient satisfaction and to study health service providers' perspective to understand the constraints in providing better health care services. The specific objectives of the study were as follows:
In all, eight districts were selected from the State, one from each division of Madhya Pradesh. From each district, a sample of public health institutions was selected from various public health facilities to measure the patient satisfaction. In total, 1121 patients were interviewed from OPD (561), investigative facilities (280) and IPD (280). In-depth interviews of health care providers including MOIC/hospital superintendents, MO/specialists, nursing staff and technical staff were also conducted. The study showed that quality of health services in public hospitals was poor and the level of patient satisfaction was also low. Some of the recommendations of the study to improve patient satisfaction in public health facilities were as follows:
Measuring Patient Satisfaction at Public health Facilities in Madhya Pradesh Evaluation of Integrated Child Development Scheme-Rajgarh Block
Agency: Bhoruka Charitable Trust
Project Team:Manisha Chawla, Monica Garg, Mittu Muthu Verghese, Gowtham Ghosh B, Khatibur Rehman Arif, Manoj Soni
An evaluation of the Integrated Child Development Scheme was conducted in Rajgarh block of Churu district of Rajasthan. The 30 cluster sampling technique was used to sample a group of 30 AWCs from the block. The salient findings of the study are as follows :
A study to assess health status and behaviour of police personnel in Rajasthan
Agency: Police Department, Government of Rajasthan
Project Team: Sunita Nigam
The study was undertaken to examine the morbidity pattern, social, economic and working environment of police personnel and their effect on their health and family life.
The study revealed that as many as one-fifth of them faced health related problems due to standing for long hours (20%) and walking long distances (15%). A majority of them said that they were exposed to dust, fume and radiation (82%), and one-fourth had joint stiffness and pain. Nearly one-fifth had back pain, but a very large percent (83 percent) complained of depression. One-third of them also complained about problems related to vision.
Stress was due to long working hours. The reporting of mental, physical, and personal problems was quite high. Nearly 73 percent were able to have regular meals in time, which could be because all the thanas were linked with the mess at the district level.
One-fourth of them admitted having violent behaviour. Nearly 42 percent agreed that they smoked because of stress and tension. As many as one in four drank due to pressure of peer group or in the company of friends.
Preparation of District Action Plans under NRhM
Agency:Department of Medical, health and Family Welfare, Government of Rajasthan.
Project Team:P.R. Sodani, Laxman Sharma, N.D. Sharma, Santosh Kumar Sharma, hemant Mishra, Jayati Srivastava, Santosh Sharma, Manoj Soni
The Government of Rajasthan selected IhMR for providing technical support in developing five-year District Action Plans under NRhM. IhMR provided technical assistance for five districts, namely Bundi, Kota, Tonk, Sawai Madhopur and Karauli.
The District Action Plans were prepared in consultation with the district and state officials for a period of five years from 2007-08 to 2011-12. For preparation of the plans, various activities were undertaken in each of the selected districts, such as orientation workshops for District Planning Teams and Block Planning Teams. The stakeholders consultations were held at the block level in each district. The village consultations were also conducted in 15-16 villages in each of the selected districts. As a part of planning process, a facility survey was also carried out in each of the districts at primary health centers (PhCs) and sub-centers to assess the gap at the public health facilities with respect to IPhS. The findings of the facility survey, stakeholders' consultations, and village consultations were used in developing the plans.
Each component of the plan consisted of the following sections: situational analysis, objectives, strategies, activities to be implemented, time line, estimated budget and work plan for five years. The District Action Plans were reviewed by the respective district health officials. The revised and modified plans were submitted to Government of Rajasthan for necessary implementation.
Mapping of health Facilities in Madhya Pradesh
Agency: Directorate of health Services, Government of Madhya Pradesh
Project Team: P.R. Sodani ,Rajeev Kamal Kumar, Laxman Sharma, D.S. Surybanshi, Abha Richhariya, Uma Shankar, Aparna Vaidya, Manoj Soni
The study on mapping of health facilities in Madhya Pradesh was sponsored by the Directorate of health Services, Government of Madhya Pradesh. The major objective of the study was to carry out mapping of health facilities in all the 48 districts in both public and private sectors. The specific objectives of the study were to collect information on:
The study covered all the 48 districts of MP. The data was collected from the following public and private facilities: district hospital, civil hospital, ChC, PhC, medical colleges and hospitals, specialized hospitals, railway hospitals, military hospitals, police hospitals, ESI hospitals, MPEB hospitals, Central Government hospitals, other State Government hospitals, blood banks, ICTC, AYUSh hospitals, PSU hospitals, private hospitals, nursing homes, and diagnostic centers. The data analysis was completed and district level reports on mapping of health facilities are in progress. This was perhaps the first study of its kind in the state of Madhya Pradesh. It provides a comprehensive picture of public and private health facilities in the districts and contains vital information on location, operational timings, type and ownership pattern, availability of services, physical infrastructure, wards and beds, diagnostic services, major equipment, human resources, level of utilization of basic services and structure of fees and charges. The present database would be useful for micro-level planning and implementation of health programmes in the state. It would also help the State Government and other agencies in assessing availability of services, duplication or overlapping between the public and private facilities, identifying the underserved areas to quantify the level of additional investment required and relocating of existing facilities for achieving better efficiency. The information would also facilitate in strengthening public private partnership (PPP) in implementing various health programmes.
Reviewing and Redesigning of Village and Sub-health Center Level Records
Agency: Directorate of health Services, Government of Madhya Pradesh
Project Team: Suresh Joshi, Santosh Kumar, hemant Mishra, Parthasarthi Datta
In order to improve the performance of the health sector and achieve the MDGs, the State Government will have to do a better job of tracking its performance on key indicators. Tracking performance more effectively will require that: (i) the quality of data collected is improved and that weaknesses in data quality are understood; and (ii) the resulting data is being used for making decisions. Currently, in India, there are serious issues of quality affecting many of the sources of data. Unfortunately, even when reasonably good data are available, they are not always used for decision-aking, policy improvement, and program implementation.
In view of the above, a study was carried out in Guna district of Madhya Pradesh to strengthen the existing information system. Village and subhealth center level records and registers for the health workers were redesigned so that they could understand the utility of data they were submitting to the stakeholders or to the government. Process documentation of piloting the new tools was also described.
To strengthen maintenance of sub-center level health records and registers in Madhya Pradesh, IhMR worked closely with the Department of Public health and Family Welfare, Government of Madhya Pradesh. Guna district of Madhya Pradesh was selected for piloting the project within a period of six months.
The overall objective of the pilot study was to review all records and reports generated under various programmes at different levels in consultation with different stakeholders to design the requisite records and report formats, which ensured ease of data capture and its use by the concerned functionarie
Key findings of the record review were as follows:
Based on the findings of the record review, the research team designed a 'Daily Service Diary' with supportive reporting format and a 'Village Register'. A three-tier training programme was designed and implemented for the district officers, supervisors and health workers. Logistics were provided to the health workers for four months through the Block Medical Officer. To build the capacity of the health workers regarding new tools, monitoring and supervisions were made for three consecutive months.
- The extent of physical closeness and sexual relationship between adolescent boys and girls living in rural areas was as large as observed in metros or other large cities in India. In most cases, such sexual relationships were unsafe. The community was not against the initiatives to build awareness for reproductive and sexual health among the adolescents. It provided ample space for interventions.
- Risk behaviour related to unsafe sex and substance abuse was quite significant in the youth in the study area
- There was little communication between the parents and children on issues related to future, marriage, health etc. There was a need to bridge these gaps.
- To determine the effectiveness and impact of NCLP by carrying out a quick assessment of the functioning of project societies and special schools working under NCLP
- To capture the perception of various stakeholders: the children, parents of the beneficiaries, implementing agencies, community etc
- To study the impact of various components of the project, mapping their focus, their coverage and reported impacts of these interventions on child labour elimination
- To focus on the termination of the NCLP projects where targets have been achieved
- To examine the degree of involvement of the state government in the implementation and monitoring of NCLP
- To understand the impact of additional components assessing the strengths and limitations of the partners and the types of interventions undertaken
- Ensuring availability of health managers
- Strengthening competency of health service managers
- Improving health workforce management
- Improving management of health care service delivery
- Creating an enabling working environment for good management
- Assess the operational status of the designated/functional First Referral Units in keeping with the critical parameters as prescribed in the guidelines issued by GOI.
- Assess the operational status of the designated/functional 24x7 ChCs and PhCs in keeping with the critical parameters as prescribed in the guidelines issued by GOI.
- Identify gaps in operationalization in those FRUs and PhCs which do not qualify as functional facilities.
- Review of the Medical Manual of the Department of Public health & Family Welfare, GoMP in the backdrop of current policies, programmes and priorities and identify the changes that need to be effected in its structure and content.
- Propose a revised version of the Medical Manual.
- Assist the Department in the dissemination of the revised Medical Manual.
- To overview the system of quality assurance followed in the the hospitals.
- To assess quality of services from the perspective of patients at the health facilities.
- To assess quality of services from the perspective of the health care providers.
- To identify factors influencing poor quality of care and providing recommendations for improving the quality of services offered by the hospitals.
- Improving the infrastructure including building and other basic amenities
- Improving skilled manpower in the public health facilities
- Proper equipment and furniture in the health facilities
- Improving the quality of OPD, IPD and investigating services
- Capacity building of MOIC/hospital superintendents
- BCC training to the medical and para-medical staff
- Reducing the work load from technical and nursing staff
- Internal quality measurement mechanism for taking care of the hospital performance and patient satisfaction at regular interval.
- The infant mortality rate was 38 per 1000 live births in the area. It declined significantly from 54 per 1000 live births in 2005. The infant mortality rate was lower than the state average.
- Birth registration for children from zero to six months was 60%
- As many as 90% of the children received colostrum and nearly half of them were breast fed within half an hour of their birth
- Nearly two-thirds of the children between 0-6 months were weighed during the last one month and none of the children was in grade III/ IV of malnutrition. Nearly 65% of the children were fully immunized and only 3 per cent were not immunized.
- As many as three-fourths of the pregnant women were registered for ANC check up and half of them got three or more ANC check-ups.
- Institutional deliveries constituted only two-thirds of the total deliveries.
- location, type, ownership, operational timings and contact details of the health facilities;
- availability of services, types of wards and beds;
- availability of infrastructure facilities;
- diagnostic and investigating services; availability of major equipment;
- availability of full-time and part-time human resources including medical professionals, para-medical and support staff;
- utilization data for the last one year;
- and fees structure and charges
- Nearly 22 types of registers were maintained at sub-health center level whereas at the PhC level village health registers, but daily diaries were not maintained.
- health workers were specifically maintaining a working register to record activities during field visits
- Working registers mainly focused on MCh related information but also had columns on different registers provided by GoMP.
- Information columns in service registers and frequency of reports generated varied from ANM to ANM.
- All these led to overburden workload among health workers.
- Further multiple reporting of the same information by the workers resulted in occasional submission of incomplete /inconsistent and incorrect reports.
- There was no system of supportive supervision and feedback on registers.
- It was also found that there was no mechanism for removal of obsolete and useless records after the completion of a programme.
- Lack of continuous supply of printed registers and records and when supply of printed records got exhausted, workers tended to prepare handmade records and registers with different columns.
- The following was the feedback on the pilot test of daily service diary and village health registers The simple language and systematic tabular form of daily service diary helped them to get the information faster, so the ANM did not need to put the data in the register once again for preparing the monthly report.
- It was easier for the health workers to find out any data from DSD and for crosschecking for future reference.
- Classification of data was much easier in the new diary as compared to the earlier one.
- New modified NRhM Form 6 had solved the problem by keeping provision for every programme in one common format. As a result, paper work was also reduced.