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Research Projects/Studies Completed Year-2009-2010

National health services performance

Agency:Ministry of Public Health, Afghanistan and the World Bank

Project Team:SD.Gupta, Dhirendra Kumar, Binay Kumar, Anubhav Agrawal, Manish Kumar and Dushyant Mishra

The Johns Hopkins University Bloomberg School of Public Health (JHU) and the IIHMR were awarded a contract by the Ministry of Public Health (MoPH), Islamic Republic of Afghanistan to provide Monitoring and Technical Support to the Ministry of Public Health. The objectives of the project were: a) to provide an independent assessment of how NGOs and the MoPH are doing to improve the delivery of the basic package of health services (BPHS); b) to strengthen the capacity of the MoPH to evaluate service delivery so that they will be able to do it themselves in the future. IIHMR and JHU have completed successfully the following activities to support Ministry of Public Health, Islamic Republic of Afghanistan

  • Conducted four rounds of National Health Services Performance Assessment at the national level and developed a Balanced Scorecard for the health sector in Afghanistan.
  • Provided the Ministry of Public Health with Community Feedback on the health services.
  • Developed a framework for monitoring and evaluation of the Essential Package of Health Services and other hospital services.
  • Conducted two rounds of the National Hospital Performance Assessment, focusing on delivery of the Essential Package of Health Services and other hospital services.
  • Conducted a household survey in 2006 in order to provide estimates of priority health indicators for rural Afghanistan and to describe case seeking practices and health expenditure patterns across rural Afghanistan.
  • Conducted a Capacity Building and Learning Needs Assessment in close partnership with MOPH's General Directorate for Human Resources.
  • Conducted an assessment of the quality of drugs provided through Basic Package of Health Services (BPHS) facilities in each province and in private pharmacies in five major urban centers of Afghanistan.
  • Designed and analyzed the health module for the 2007 National Risk and Vulnerability Assessment (NRVA).
  • Provided GCMU, senior managers of MoPH, concerned NGOs and donors with user-friendly results of the analyses from all of the above assessments.
  • Trained and advised MoPH provincial and central level staff in the collection, analysis, reporting and dissemination of the data from the assessments so that they can take increasing responsibility for monitoring and analysis of information.
  • Helped develop capacity of the ministerial staff and Afghan Public Health Institute (APHI) to undertake research and health services performance assessment.

Aakash Ganga: Rooftop Rainwater Harvesting

Agency:World Bank's Development Marketplace and RANA

Project Team:Goutam Sadhu

The objectives of the Aakash Ganga project were to develop rainwater harvesting structure in an economically viable, self- sustainable manner with community ownership and to develop a system to use the overflow of rooftop rainwater harvesting structure which would meet the drinking water need as well as generate income for O&M. The Institute has been identified as a nodal agency for implementing through various NGO partners.

The scheme has been implemented in 3 villages of Churu and Jhunjhunu districts. 118 households' tanks and 4 village tanks have been constructed in which the community and the local donors contribute around 30-50% of the construction cost.

The major outcomes of the project are: a) it offers a reliable alternative to ground water and surface water with typical water storage capacity of 10 littres/person/day or 300,000-400,000 Ft3 per village:b) it modernizes the quotidian ingenuity and centuries'oldtraditions to ensure cultural and social sustainability:c) it weans people away from the ' free water' entitlement mindset'e) it ensures the flow of capital. Management and technology through a two-tier social enterprise structure:f) it frees girls and women from the daily chore of fetching water so that they may pursue education and be productive members of society.

The extendion of the project to 70 villages is under active consideration by the Government of Rajasthan.

Technical Support Unit for Rajasthan State AIDS Control Society (RSACS)


Project Team:Alok Mathur, N.S. Godhara, Pritam Pal, Suresh Tehliani, Sunita Nigam, Hemant Mishra, Anil Bahuguna, Ashuthosh Sharma

For effective implementation of National AIDS Control Program in the State of Rajasthan, UNFPA and NACO have entrusted IIHMR with the task of providing technical support to the Rajasthan AIDS Control Society. For this purpose, a well-equipped Technical Support Unit (TSU) has been established at IIHMR. It is providing support to Rajasthan State AIDS Control Society. The key areas for technical support include targeted interventions, capacity building, promoting public-private partnership, and strategic management.

Under strategic management, the TSU has developed the Annual Action Plan for 2008-09 for the State. Now the plans for high priority districts will be prepared with the district authorities. A strategic paper for involving two private hospitals ill the priority district for starting I CTC services is underway

The TSU is preparing modules and training manuals for different personnel working in and with RSACS for HIV prevention, care and support. A training calendar for the year 2008-09 for RSACS has been developed by the TSU. One of the important tasks of the TSU is to monitor the quality of the training.

District Level Household Survey -3 (DLHS-3): Rajasthan, Punjab and Chandigarh under RCH Program

Agency:Ministry of Health and Family Welfare, Government of India/lIPS, Mumbai

Project Team:Rajasthan: J.P. Singh, Santosh Sharma, Sanjay Tripathi, Farida Khan, Nilesh Punjab and Chandigarh: J.P. Singh, N.D. Sharma, Khatibur Rahman Arif, Vidya Bhushan Tripathi, Richa Pandey, Aparna Vaidya, Rohit Jain, Mukesh Gehalot

The District Level Household Survey under the Reproductive and Child Health program was designed to provide information on population, reproductive and child health, immunization, family planning, reproductive tract infection/ sexually transmitted infections, human immunodeficiency virus / acquired immunodeficiency syndrome and women's health status. The survey involved interviewing a randomly selected group of evermarried women who were between 15 and 49 years of age and unmarried women who were between 15 and 24 years of age. lIPS was the nodal agency to design and coordinate this large scale demographic and health survey. lIHMR was identified as the regional agency for Rajasthan and Punjab & Chandigarh for conducting the survey, which included mapping and house listing of selected areas, administering the questionnaires and gathering information from government health facilities and households. The field work and data collection has been completed. Data analysis and preparation of fact sheet is under progress for Punjab and Chandigarh. The fact sheet has been submitted to lIPS for final approval.

External Monitoring Cell for Immunization in Rajasthan

Agency:UNICEF Rajasthan

Project Team: Anoop Khanna, B. Gowtham Ghosh and Manoj Soni

An External Monitoring Cell (EMCI) was set up at lIHMR to monitor the immunization program (sessions, cold chains, logistics and progress) in all the 33 districts of Rajasthan. The monitors visit randomly selected PHCs and four session sites on MCHN day i.e. on every Thursday of the week. Moreover, they have to visit the district headquarters once every month to see the cold chain and logistics. Monitors are also monitored by the EMCI team. The data is then analyzed and classified into three reports, namely the detailed report, the state report and the district-wise report. The state report is sent to the state higher authorities, the detailed report is sent to the authorities next to the state authorities and the district report is sent to the district authorities. There is a review meeting for the monitors every two months at lIHMR with the aim of improving the quality of monitoring.

The external monitoring shows an improvement in inputs, logistics and quality and coverage of immunization. There is a change in the working of the whole immunization system because of the EMCI. The health workers have started showing more attention at the session sites because 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 the three levels 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 program in Rajasthan.

Capacity Assessment Study of NGO Partners on Plan India's Country Program Framework (CPF) for Health

Agency:PLAN International New Delhi

Project Team: L.P. Singh, Nutan Jain, Saumya Verma, Preeti Bajaj

The study aims at critically analyzing health and survival challenges that threaten the lives of children and women in the project areas of the Plan and its partners' involvement, contribution and support towards realizing the Plan health objectives. The specific objectives are: a) to identify and map health challenges and opportunity to work for achieving optimal health in the project areas; b) to assess and report partners current capacity and future needs of the project both in terms of technical and managerial sectors; c) to explore opportunities to coordinate with the government services in the project areas to supplement their efforts and develop synergies; d) to explore possibilities and opportunities for linkage partnerships with the key stakeholders; e) to identify professional institutions in India (national and regional level) with whom the Plan's partners can have linkages for learning, sharing and networking as long-term partnership; and f) to make suggestions for further improvement of the projects, coordination and capacity building needs and their redressal.

Data Quality Assessment of MIS Implemented at the Network of PLHIV s Project

Agency:Population Foundation of India

Project Team:Neetu Purohit, Sunita Nigam, Vidhya Bhushan Tripathi, Nilesh Wavare

The Global Fund and Population Foundation of India (PFI) have signed a grant agreement to implement "Promoting Access to Care and Treatment (PACT)" program in eight highly vulnerable states: Uttar Pradesh, Madhya Pradesh, Rajasthan, Gujarat, Bihar, Chhattisgarh, West Bengal and Orissa. The program offers care and support services to the people living with HIV / AIDS (PLHIV). PFI, being the principal recipient, disburses the allocated fund to sub-recipients i.e. INP+, HLFPPT and CBCl to implement the program in their respective geographical areas. With a view to monitoring the program, PPI had developed an MIS for the networks functioning in the selected states and districts. MIS audit was conceived to use it as a mechanism for assessing the quality of program data and assist sub-recipients to improve the quality of their reporting. Specifically, MIS audit was carried out: 1) to check the reliability of the data recorded in the reports with regard to their accuracy and consistency; and 2) to check the validity of the clients by verifying the authenticity of the enrolled PLHAs.

Catalyzing Community Structures to Support Integrated Health & Nutrition Outcomes for Children in Rajasthan & West Bengal

Agency: Save the Children, Jaipur

Project Team:Rajasthan: Alok Mathur, SP Chatterjee, Sunita igam, B Gautam Ghosh, Saumya Verma, VB Tripathi, Aparna Vaidya, Richa Pandey, West Bengal: Goutam Sadhu, Arindam Das

In India, despite the consistent efforts of different health projects and programs, the FHS 23 finding reflects that modest progress has been made in the direction of ameliorating the status of health and nutrition of mother and child. The data collated by various agencies shows that one woman dies every seventh minute from complications due to pregnancy and child birth. About 43 per cent of all worlds' infants who are born with a low birth weight are born in India. About 55 million i.e. one third of the world's underweight children under age five live in India. Thus, appropriate and adequate care of mother and child is unquestionable.

Save the Children executed a project "Catalyzing community structures to support integrated health and nutrition outcomes for children" from September 2008 to July 2009 with the help of partner NGOs. The aim of the project was to improve the health conditions of mother and child by strengthening the community. The strengthening strategy was to provide one community health volunteer (CHV) in every identified village and form men and women support groups for enabling environment. Broadly, the approach was community-based behaviour change communication through household level counseling and education. IIHMR was requested to conduct a review of the project in Rajasthan and West Bengal with the following objectives:

  • To assess the relevance of CHV model
  • To know the perspective of the beneficiaries on the knowledge gain, practices and services provided by the CHV
  • To document the benefits of the program perceived by different stakeholders
  • To come up with a set of recommendations for the future projects in the area of Health and Nutrition.

Assessing the Role of NGO Partners in UNICEF Assisted Project - Gramshakti and Behaviour Change Communication in Tonk district


Project Team:Neetu Purohit, Vidhya Bhushan Tripati, Nilesh Wavare

To improve the quality of life of women and children of Tonk district in Rajasthan, UNICEF, in partnership with the government, the GOs and like-minded institutions, is on its way to carry forward the reform processes cross cutting all sectors and initiating an action oriented programming through proactive participation of the rural communities. The Gramshakti project has ended and Behaviour Change Communjcation project is being implemented by almost the same NGOs which implemented Gramshakti project from 2005 onwards. The study was conducted with the following objectives: 1) to undertake desk review with respect to the studies conducted on the subject and in the field area in the past; 2) to assess the status of the key indicators among the target community; 3) to explore the extent to which behaviour change could occur among the beneficiaries; 4) to assess the effectiveness of the NGOs with respect to the desired performance; and 5) to make recommendations on the future course of action in supporting BCC partnerships

Food Fortification in the State of Rajasthan

Agency:GAIN, New Delhi

Project Team:Suresh Joshi, Anoop Khanna, Hemant Mishra,Anubhav Agarwal

Nutrition is integral to the first Millennium Development Goal (MDG) on hunger and poverty. Moreover, it is also instrumental in the efforts to achieve other MDGs, particularly those related to improvements in primary education enrollment and attainment, gender equity, child mortality, maternal health, and the ability to combat disease. The problem of malnutrition continues unabated despite significant achievements made in various spheres, particularly agricultural production, food sufficiency and industrial growth. Besides, there have been several programs to provide nutritional support to children and vulnerable population. It is believed that the poverty reduction and strengthening of health care systems alone cannot solve micronutrient deficiency problems

Food fortification is a demonstrated and cost-effective way to ensure that large number of those at risk of vitamin and mineral deficiencies receive the nutrients they need. GAIN, which has already been funding 16 programs in 14 countries, is keen to have its first major project in India launched in Rajasthan. It intends to implement Integrated Food Fortification Project for tackling micronutrient malnutrition. It will work with tri-sector partnership involving public, private and civil society sectors to joindy address the issue of malnutrition. Under this backdrop, IIHMR carried out this scoping study to provide important inputs for designing and implementing the interventions for food fortification in the state of Rajasthan.

The study covered major programs providing nutritional support, like Mid Day Meal Scheme (MDMS), Integrated Child Development Scheme (ICDS) and Public Distribution System (PDS). It also covered industries which could be channelized for food fortification interventions, including oil producers and their association, flour mills and their association and milk federation (SARAS dairy). The methodology included analysis of secondary data, discussions with officials at different levels, and a rapid community survey to understand consumption pattern.

Knowledge Community on Children in india (KCCI) Internship program, Rajasthan 2009


Project Team: Dhirendra Kumar, Deepti Govil

Knowledge Community on Children in India (KCCl) is a unique program initiated by India Country Office, UNICEP, India. Since its inception, Institute of Health Management Research (IIHMR), Jaipur has partnered with UNICEF Rajasthan state office. The current agreement between UNICEF and IIHMR agrees to collaborate on Knowledge Community on Children in India (KCCI) summer internship program, which aims to strengthen and promote knowledge sharing on children's issues by documenting selected interventions in the form of written case studies. The Institute provided technical inputs for publishable research paper on Qualitative and Quantitative Assessment of the Effect of Supportive Supervision on AHSAs under NRHM in Implementing IMNCI in the field using a pre determined research framework to a group of five interns and provided day-to-day supervision to the interns

Project Follow-up and Sustainability of Integrated Water Supply, Sanitation and Health Education Program

Agency: KfW through Government of Germany and Government of Rajasthan

Project Team: Goutam Sadhu, Parvinder Sharma

The Project Follow-up Unit (PFU) was established to develop sustainability mechanism for Aapni Yojna, the Integrated Drinking Water and Sanitation Project, which was implemented in 370 villages of three desert districts of Rajasthan, namely Churu, Hanumangarh and Jhunjhunu.

During the 10-year long project, a regular water supply has been made to the villagers in collaboration with KfW, the GoR and IIHMR. While the GoR developed the infrastructure and the hardware, llHMR led community mobilization for user charges for water consumption, education, water resource management at the local level through Water and Health Committees, installation of sanitary latrines and soakage pits, and water stand posts in the community. The project was a great success and emerged as a sustainable and replicable model at the national and international levels.

The main objective of PFU was to put in place sustainability measures and build the capacity of community based organizations to work as an egual partner with the service providers. It was to ensure that the community and community based organizations can sustain and manage the project. PFU had the following objectives: a) reduction of wastage of water; b) contribution by the community towards cost recovery; c) creating awareness of and responsibilities for the consumption of water; d) implementing the construction of low cost sanitation facilities; and d) implementing ad-hoc measures in the villages

Global Adult Tobacco Survey 2009-India, 2009, in Punjab and Chandigarh

Agency:Ministry of Health and Family Welfare, Government of India

Project Team:Santosh Kumar, N D Sharma, Laxman Sharma, Manoj Soni

The Global Adult Tobacco Survey (GATS) was conducted by the Ministry of Health and Family Welfare with technical and financial support from the World Health Organization, CDC and CDC Foundation, the Johns Hopkins Bloomberg School of Public Health OHBSPH) and the Bloomberg Philanthropies. The survey covered population in the age group 15 + living in households. For carrying out GATS- India project, International Institute for Population Sciences (lIPS), Mumbai was the nodal implementing agency. Institute of Health Management Research IIHMR) carried out survey in the state of Punjab and Chancligarh. Under this study interview responses were captured through a handheld pocket PC/PDA. The survey covered 4400 households.

GATS-India conducted Adult Tobacco Survey in India in all the 29 states (including Delhi) and in the two union territories of Chandigarh and Pondicherry covering about 99.92 percent of the total population (2001 Census of India), to provide estimates of the levels of tobacco use, second hand exposure and cessation attempts, economics of tobacco use, exposure to media and advertisements, knowledge, attitudes and perception among men and women separately for urban and rural areas of India.

Village water Security Plan in Tonk and Rajsamand districts of Rajasthan


Project:Goutam Sadhu, Arindam Das, N.K. Sharma, Parvinder Sharma

Rajasthan is a water scarce state and there is a perennial shortage of drinking water. IIHMR developed a model methodology for village action plans in 20 villages. The broad objective of the project was to develop and demonstrate a simple methodology/process for developing village action plans and detailed project reports (as per NRDWP) in villages with effective community participation that can support PHED in scaling up the development of village action plans across Rajasthan. The study was a combination of quantitative and qualitative one. The pilot study included both social and technical components to develop the most effective process, template and outcome i.e. village action plans duly approved and owned by the community. The purpose of the study was to develop and mainstream socially acceptable, techno-economically viable, sustainable and feasible water supply solutions which, when executed, will be owned, operated, maintained and used by the community. The village action plans for water security plan for all included the demographic, physical features, water sources, and other details of the village; available drinking water infrastructure and gaps; proposed work to augment the existing infrastructure, topography and water sources; and also to understand the community perception in the quality and quantity of water.

The model has been highly appreciated and now adopted by the Government of Rajasthan for developing village based action and water security plans.

Household Survey of Voucher Scheme in Haridwar District in Uttarakhand

Agency:Futures Group, New Delhi

Project TeamSantosh Kumar, SP Chatterjee, Vinay Kumar, Gautam Ghosh, Manoj Soni

The Innovations in Family Planning Services (IFPS) II project focuses USAID /India's support for reproductive and child health (RCH) activities for provision of accessible and high quality reproductive and child health services in three states of northern India, namely Uttar Pradesh, Uttarakhand and Jharkhand. The Futures Group provides technical assistance to the project, especially in program planning, monitoring and evaluation. To effectively address the needs of the project, Voucher Scheme was designed and implemented on a pilot basis m two blocks of Hardwar district. Since the Innovations in Family Planning Services - II Technical Assistance Project (ITAP) was in the concluding phase, it was decided to conduct an end- line survey for the Voucher Scheme in Hardwar. This information would help to identify gaps in the functioning of the Voucher Scheme, and scale up the program in other districts of Uttarakhand or states under IFPS II.

The major objectives of the survey were to a) assess the access to and utilization of antenatal, natal, newborn services and postnatal care services; b) understand the knowledge and practice of family planning methods; c) assess the potential demand for contraception; d) estimate the coverage of child immunization services; e) understand the breastfeeding and food supplementation practices; f) prevalence and treatment pattern of childhood illnesses, such as polio, measles, fever, cough and diarrhea; g) assess awareness and treatment seeking behaviour about RTI/STI and HIV / AIDS; and h) assess utilization of health care facilities and the quality of care.

Quality Assessment of Services under Janani Suraksha Yojna in Rajasthan

Agency:Directorate of Medical & Health,GoR

Project Team:Neetu Purohit, Vivek Lal, Vidya Bhushan Tripathi, Anrirudh Sharma

Rajasthan is one of the states classified as a Low Performing States (LPS) as well as Empowered Action Group (EAG) state in the context of demographic and health status. It is therefore focusing on the improvement of maternal health particularly the increase in institutional delivery. ]anani Suraksha Yojna (JSY), a Pan-India Safe Motherhood Intervention Project under the National Rural Health Mission (NRHM) has led to a remarkable increase in institutional deliveries and the Department of Health and Family Welfare, Government of Rajasthan has reported that the trends in institutional deliveries in the state over the years have shown an increase up to 80 percent

With the availability of services, quality of services is equally important. From this point of view, the present study was conceived to assess the quality of services provided under JSY with the overall objective of assessing the quality of services at the institutional level in terms of access, availability, continuity, technical and managerial competencies of staff, facilities and amenities, and satisfaction of the JSY beneficiaries with the services. Specifically, the objectives were:

  • To conduct facility assessment of the selected 24X7 CHCs (FRU) and PHCs for the availability and functionality of health services under JSY
  • To conduct assessment of the competencies and skills of the healthcare providers at the selected health facility with respect to multi-skill training.
  • To assess the process of service delivery for the mother and the newborn.
  • To assess the process of monitoring and supervision of the process of service delivery under JSY
  • To study the status and feasibility of model sub-centers with respect to desirability of institutional deliveries.
  • To study the status of the private sector with regard to the adherence to accreditation norms for institutional deliveries
  • To study the perception and satisfaction of beneficiaries with JSY at the institutional level
  • To suggest measures for improving institutional quality

Two FRUs and two 24X7 PHCs including all sub-centers corresponding to the selected PHCs were chosen for data collection from each of the three districts visited by the team. The report included findings and recommendations to ensure quality of services. In addition to the government health facilities, two accredited private health facilities were also included from each of the districts. Individual factsheets for each of the visited facilities were prepared on the indicators, which were assessed as part of the study.

Mid-term Evaluation of Urban Slum Health Project under . NRHM/RCH-II program being implemented by NGOs in the state of Orissa

Agency: NRHM,Orissa

Project Team:Neetu Purohit

IIHMR is among the panel of research agencies, which have been selected to conduct research studies under the NRHM, Orissa. The mid-term evaluation of Urban Slum Health project was one of the series of the studies, which the NRHM, Orissa has asked it to evaluate. lIHMR, in collaboration with Sutra Consulting Private Limited has completed two evaluations. The objectives of the evaluation were:

  • To assess the impact of the Urban Slum Health Project based on inputs and process indicators supplemented by indicators available from the baseline survey, performance report and records of UNGO.
  • To identify important programs, institutional strengths and weaknesses of UNGO.
  • To examine the physical and financial performance of the project.
  • To identify the inputs critical in making improvements in the project implementation.
  • To assess the access, availability and utilization of health and family welfare services by the community.
  • To identify innovations carried out by the UNGO on delivering RCH services.
  • To assess the continuity of the program and its funding.
  • To assess the fund-flow from ZSS to UNGO, its utilization and sustainability of project activities.

Qualitative methodology was used and gaps with respect to expected performance were identified and, accordingly, recommendations for improvement were provided.

Evaluation of Adolescent Friendly Health Clinics initiated in Maharashtra

Agency:UNFPA, Maharashta

Project Team: Arindam Das, JP Singh, NK Sharma

Adolescents Reproductive and Sexual Health (ARSH) servIces have received a high priority in health services quite recently. In Jine with the strategy of Ministry of Health and Family Welfare, Government of India, the state of Maharashtra has taken an important initiative to start ARSH and set up Adolescents Friendly Health Clinics (AFHCs) at the district hospitals and sub-district hospitals in the entire state. Since 2008, 73 AFHCs have been created and made functional. The UNFPA, Maharashtra commissioned a quick study of AFHCs to assess the current situation with respect to infrastructure, functional status, and attitude and perceptions of the healthcare providers and adolescents.

The broad objective of the evaluation was to assess whether the basic standards/principles of adolescent friendly health service are being followed. The specific objectives of the evaluation were to assess:

  • Is service environment conducive for adolescents to seek health services? (i) What is the service delivery package? (ii) How are services organized? (clinic location, sign age reflecting location, clinic timings, audio-visual privacy, name of the ARSH clinics that appeals to adolescents) (iii) Are clients, information material, equipment and supplies available at the clinics?
  • Are service providers trained for provision of ARSH services?
  • Is information available to adolescents regarding availability of good quality services? (Activities undertaken to promote availability of AFHC, linkages developed to inform adolescents regarding clinics)
  • Are management systems In place to improve/sustain provision of services?

Out of the 73 facilities, 25 facilities were selected randomly for the study. The study was carried out using quantitative as well as qualitative techniques of data collection. The facility survey was carried out using a semi-structured questionnaire. An observation checklist was prepared to observe service provision. The interviews of the service providers were carried out using semi-structured interview schedules. A semi-structured questionnaire was prepared for the adolescents. Additionally, observations and review of records were undertaken for the existing management in formation system.

Evaluation of General Physician Based Medical Mobile Units in West Bengal

Agency:HSDI- Technical Assistance Support Team (T AST Extension), West Bengal

Project Team:Santosh Kumar, Barun Kanjilal, Rohit Jain, Swadhin, Arnab Mondal, Nilanjan Bhor

The Government of West Bengal has developed a comprehensive Health Sector Strategy 2004-13 (HSS), which provides a unique opportunity for the government to align its own and donor resources to meet the priorities of the state and help address the major shortcomings in both pubbc and private health provision. To enhance access of the poor to primary healthcare services and extending the reach of RCH, immunization, family welfare and clinical services to larger population and underserved areas, Gram Panchayat based Medical Mobile Units were created throughout the state. Under this program, camps were organized every week in each GP headquarters sub-centre, except those which operated from a PHC or any other health facility where regular OPD services were available. Objectives: i) to assess the programmatic inputs and processes, ii) to understand their impact on the beneficiaries in terms of increased accessibility, higher utilization of health services and lesser disease burden, iii) to understand the factors that acted for its successes or failures, iv) to identify key issues which need to be addressed to make the scheme more functional and effective. Methods: The study used both qualitative and quantitative techniques to evaluate the program. Stratified sampling was used in the study. A total of 482 respondents were interviewed from 48 GP based MMU camps held in six districts (3 poor performing districts and 3 high performing districts).

Block and district medical officers were also interviewed in this regard. The quality of MMUs was also evaluated using selected input and process indicators. Results: Most of the camps were held as per the planned schedule. Twenty-three percent of cancellation/postponement of planned camps took place in Birbhum and Murshidabad districts. 93.8% respondents said that the GP based mobile camp was the nearest facility from their house, which means that the camps had improved accessibility of the healthcare services in the state. In response to a question on the cost incurred to avail of the services nearly 62% beneficiaries said that they neither paid any penny on travel, food ete. nor did they pay for the other services at the camp. This proved the point that the mobile health camps had helped people avail of the reasonable services for free. Ninety-five percent of the beneficiaries were satisfied with the services provided by these camps. In fact, more than 75% of them had visited such camps earlier also. This itself is a very good indicator of the success of the program

Among the community members ninety- seven percent people knew about the mobile health camps held, out of which 84% knew that these camps were held on a specific day. Recommendations and Conclusions: The overall evaluation of GP based mobile health camps suggests that the camps were running successfully in terms of regular functioning, availability of drugs and basic infrastructure, healthcare services provided and satisfaction level of the patients. The issues that needed to be addressed were allocation of sufficient funds for organizing camps, shortage of doctors and proper IEC communication to the beneficiaries.

Evaluation of Hypothermic Kit Program in West Bangal

Agency:HSDI- Technical Assistance Support Team (TAST Extension), West Benga

Project Team: Santosh Kumar, Barun Kanjilal, Rohit Jain, Swadhin, Arnab Mondal, Nilanjan Bhor

The Government of West Bengal has developed a comprehensive Health Sector Strategy 2004-13 (HSS), which provides a unique opportunity to the government to align its own and donors' resources to meet the state's priorities and help address the major shortcomings in both public and private health provision. One of the important initiatives taken by the state under the HSS was distribution of hypothermic kit (HT) to new mothers who gave birth at primary health centers and rural hospitals. The initiative aimed to encourage institutional deliveries in the state. To know the impact of the program on rural people and to find out deterrents and motivators encountered during the implementation of the scheme DHFW had commissioned the study.

The objectives of the assignment were: i) to assess the programmatic inputs and processes, ii) to understand their impact on the beneficiaries, iii) to understand the factors that acted for its successes or failures, and iv) to identify key issues which need to be addressed to make the scheme more functional and effective.

Method: The study used both qualitative and quantitative techniques to evaluate the Hypothermic Kit program. Stratified sampling was used in the study. A total of 756 women who had had institutional deliveries during the last two years were interviewed from six districts (3 poor performing districts and 3 high performing districts). Block and district medical officers were also interviewed in this regard. Results: More than half of the women were satisfied by the HT kits. A similar percentage of women received the kits immediately after their deliveries whereas one-third received at the time of discharge. Nearly 88 percent (against 23.4% reported in NFHS report) had breastfed their children immediately after their birth which implies that the program had very positive impact on improving breastfeed practices. Two-thirds of the respondents knew other women in their area who got motivated for institutional deliveries after hearing about the kit.

Interaction with block and district medical officers, revealed that eleven out of twelve block medical officers had either surplus or shortage of supply of HT kits sometime during the last one year. Seven blocks had short supply for more than six months. Over 81 percent of the BMO were satisfied by the quality of HT kits. However, less than one-fifth (19%) of the respondents were not satisfied with the quality of kits (mainly the mosquito nets).

Recommendations: The key recommendations were: i) Among those women who received the promotional activities none were counseled for reading the manual. Therefore, the health workers should make efforts to explain the manual and advise them to read it. ii) No mother got all the components of HT kits. Therefore, the health department should ensure that a complete kit is given to every woman. iii) Since most of the block medical officers and CMOHS reported their unhappiness with the supply of the HT Kits, the government needs to strengthen the supply. iv) Since most of the CMOHs and BMOs faced the problem of space to store the HT Kits, separate space be identified at each facility and/or regular supply system backed by modern inventory management be initiated. v) Since different BMOs maintain different kinds of record, a definite recording protocol be developed and communicated to all the officers.

Capacity Strengthening of Trainers of Health Training Centers in Rajasthan


Project Team:Nutan Jain, SC Gupta

UNFPA Country Program (2008-2012) focuses on the achievement of RCH II and 11th Five Year Plan Priorities of the State. The Rajasthan State Program Action Plan of UNFPA developed in partnership with the Government of Rajasthan strives to facibtate the achievement of specific outputs in the area of Reproductive Health and, as part of the UNFPA "Technical Assistance to the RCH-Il Program, 2009", it was planned to strengthen the capacities of the trainers of health institutions in Rajasthan with the objective of achieving the quality training under the RCH-II. The intervention was discussed with and approved by the Government of Rajasthan and was a part of the State Annual Work plan.

Training for a total of three batches of trainers was conducted. The specific objectives were i) to sensitize the trainers about the type of training programs under NRHM/RCH II; ii) to strengthen the capacities of the trainers in the area of management of training (preparing training plans and calculating training load); iii) to update training methodologies including audio-visual aids to make the training learner -centered; and iv) to appreciate the concepts of total quality management as applied in training transition. A total of 56 officials (principals, nursing superintendents, nursing tutors) from ANMTC and/ or GNMTC of 29 districts in Rajasthan participated.

Understanding and Addressing Adolescent Needs: A Baseline Survey for Adolescent Health Initiative, Uttrakhand

Agency: Futures Group International PVT.LTD

Project TeamAlok Kumar Mathur, S P Chatterjee, Sunita Nigam, Venus Ratnani, Anubhav Agarwal, Mukesh Gehalot

The Innovations in Family Planning Services (IFPS II) project is aimed at improving the access to and quabty of services relating to family planning and reproductive health in a few selected states of India, with support from the US Agency for International Development (USAID), New Delhi. The Futures Group is providing technical assistance to the IFPS II project, especially in program planning, monitoring and evaluation. To effectively address the needs of the IFPS II at different phases, various innovative activities including public private partnerships have been planned by the Futures Group in consultation with the USAID. The Government of Uttarakhand has launched "Understanding and Addressing Adolescent eeds (UDAAN)" project on a pilot basis. In this context, a baseJjne survey has been proposed to assess the health needs of adolescents in Dehradun, Haridwar, Nainital and Uddham Singh Nagar districts. The Institute of Health Management Research is conducting the Basebne Survey in these districts.

The major objectives of this survey are to:

  • assess the health care needs of school-going and out-of school adolescents;
  • understand adolescents' knowledge and perceptions towards healthcare and personal hygiene; and
  • study accessibility and acceptability of health care services to adolescents.

The findings of the study have been communicated to the NRHM of Uttrakhand. On the basis of these findings the NRHM will implement the health programs focused on adolescent boys and girls with the help of Futures Group International.

Market Profile of Jaipur City

Agency:Narayan Hrudayalaya, Jaipur

Project Team:Santosh Kumar

Narayana Hrudayalaya is a chain of multi-super specialty hospital promoted by the renowned cardiac surgeon, Padam Shree Dr. Devi Shetty. With an aim to provide affordable healthcare to the people of India, Dr. Shetty has planned to establish at least one hospital in each of the capital cities of the Indian States. In this series, a 1000-bed multi-specialty hospital at Jaipur was built.

One of the greatest challenges faced by the hospitals today is about knowing how they can respond to the changing health care environment in their market. In view of this, the management had decided to carry out a market analysis through IIHMR, Jaipur. The purpose of this study was to discuss the health care market scenario which would enable the management to visualize the service mix, fix its tariff and identify the prospective medical staff willing to join the hospital.

Major Findings: 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. Out of the total 29,386 beds in the city, 16,947 beds (57.67%) are in the private sector (the majority owned by over 1100 nursing homes with an average bed capacity of 10) and 12,439 beds fall under the public sector.

An exercise of exit interviews and non-participant observation reflects that, although client expectations are set at a low tone, the guality of service available at public hospitals is a matter of concern. In particular, people expect competent carel cure, comfort, communication, cleanliness and courtesy. It is noteworthy that the clients are willing to pay for good quality clinical services

External Data Quality Audit for MIS

Agency:PFI New Delhi

Project Team:Neetu Purohit,D Sharma,Navneet Kapany, Vidya Bhushan Tripathi, Jyoti Kushwaha, Ashok Prasad, Saheli Gine

The Global Fund and Population Foundation of India (PFI) has signed a grant agreement to implement the "Promoting Access to Care and Treatment (PACT)" program in eight highly vulnerable states: Uttar Pradesh, Madhya Pradesh, Rajasthan, Gujarat, Bihar, Chattisgarh, West Bengal and Orissa. The program offers care and support services to people living with HIV/ AIDS (PLHIV). IIHMR conducted the data audit of the MIS program in six states: Uttar Pradesh, Madhya Pradesh, Rajasthan, Bihar, Chattisgarh and Orissa. The objective was to facilitate improvements in service quality by assessing the availability and quality of the data related to program performance. Specifically, the objectives were:

  • To assess the design and implementation of the program's data management and reporting system
  • To verify the data for the selected indicators from source documents and compare the result with the program's reported results

The MIS audit was carried out at all the three levels beginning from the Service Delivery Points (Community Care Centers and District Level Networks) to the Intermediate Aggregation Level and finally the Monitoring and Evaluation at the national level. The MIS Audit involved verification while ensuring that the data found at various levels conforms to the guidelines established by the PFI.

The audit team assessed all the reporting levels and reviewed the data management and reporting systems. This included the monitoring and evaluation structure, its functions and capabilities, clarity with regard to the indicator definitions and reporting guidelines, utility of data collection and reporting formats I tools, understanding of data management processed and the linkage with the national reporting system. Lastly, data quality was examined on the dimensions of accuracy, reliability and timeliness of reports as well as maintenance of confidentiality, precision and integrity.

Assessment of Adolescent Friendly Health Services in Rajasthan (ARSH)

Agency:UNFPA, Rajasthan

Project Team:P Singh, Hemant Mishra

The Government of India (Gol) has identified and initiated Adolescents Reproductive and Sexual Health (ARSH) as a key strategy in the RCH-ll program under NRHM. Several studies have suggested that the use of services by adolescents was extremely limited. In order to influence their health seeking behaviour through the existing public health system and services, the Gol has initiated adolescent friendly health clinics (AFHC) within the existing health facilities that might provide a package of preventive, promotive, curative and counseling services.

In line with the Gol, the Government of Rajasthan (GoR) initiated adolescent health clinics to cater to the health needs of the adolescents. In the first phase during 2006-2008, the government decided to initiate adolescent health clinics (Teen Clinics) in 110 institutions with adolescent friendly services as per the decided service package in eight districts, namely Ajmer, Bhilwara, Udaipur, Rajsamand, Karauli, Sawai-Madhopur, Chittorgarh, and Alwar. These institutions include selected district hospitals, CHCs and PHCs of the State. In each district, the identified institutions have been provided with the required infrastructure, and the key staff have been oriented on adolescent friendly delivery package of ARSH services. These institutions have now been organizing/ conducting adolescent clinics once a week for two hours on Friday or on any selected week day.

UNFPA, Rajasthan State Office, commissioned an assessment study of AFHCs with a broad objective to assess current functional status of the clinic and adolescent friendly health servtees. The specific objectives of the study were:

  • To assess service environment when adolescents seek health services at the AFHCs.
  • To assess the status of the training of service providers in ARSH services.
  • To assess the availability of information to adolescents with regard to ARSH services.
  • To assess preparedness to improve and sustain provision of services.

PAHEL: An Endline survey

Agency:CEDPA, New Delhi

Project Team:Dipti Govil, Nutan Jain, LP Singh, Laxman Sharma, Vivek Khurana

CEDPA and BIPARD implemented a pilot project entitled "PAHEL: Towards Empowered Women" ,a women's leadership program in two blocks i.e. Masaurhi and Punpun Blocks in Patna district of Bihar. The overall aim of the project was to develop a supportive political environment for sexual and reproductive health of young people through capacity building and providing supportive supervision to elected women representatives and by strengthening the public health system. The two-year project was to be accomplished in three phases: 1) Baseline Survey July-August 2008), 2) Intervention Period July - November 2009), and 3) Endline Evaluation Study (Feb 2009).

Indian Institute of Health Management Research, Jaipur conducted an end-line evaluation survey for Cedpa to investigate the benefits received by the community from the intervention carried out by Cedpa. The overall objective was to assess the impact of the intervention carried on women PRI members and health providers i.e ANMs, while analyzing the improvement in the indicators from baseline status.

The endline evaluation was administered in two project blocks (punpun and Masaurhi) and one control block (Phulwarisharif) of Patna district in Bihar in February 2010. Both quantitative and qualitative methods were used to collect the data.

Interviews were conducted with i) young married and unmarried girls and boys (10-24 years), ii) women Panchayati Raj members, iii) ANM, MOs, and iv) angawadi workers (AWWI). The data analysis was carried out using SPSS.