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Research Projects/Studies Completed Year-2012-2013

Health Care Market Study for Rockefeller Foundation

Agency:Rockefeller Foundation (through Johns Hopkins University)

Project Team:Barun Kanjilal

This was a part of a global study on defining Future Strategic Directions for Development Partners in Health Care Markets, sponsored by Rockefeller Foundation and led by the Bloomberg School of Public Health, Johns Hopkins University. The overall program of work entailed (i) a consultative and landscaping phase; (ii) development of briefing documents on specific issues; and (iii) a Bellagio meeting with the aim of facilitating an evidence-informed discussion among different partners on health markets that led to a greater shared understanding and analysis of issues, a common framework for thinking about the action, and possibly a greater alignment of development partner strategies regarding health care markets.

IIHMR was a partner in this study. More specifically, IIHMR’s role was to develop a case study on key issues related to Indian health care market based on a series of in-depth interviews with the key stakeholders in India (academic researchers, practitioners, development agencies, etc.). The case study was incorporated in the main study report.

In the last phase of the initiative, a consultative meeting was held between the donor agencies, other key stakeholders, and the study team at Bellagio Rockefeller Foundation Centre, Italy from 10th to 14th December 2012. Prof. Barun Kanjilal attended the meeting on behalf of IIHMR and presented the Indian case study and participated in the consultation process.

Hospital Management Training and Capacity Development in Kabul, Afghanistan

Agency:Ministry of Public Health, Afghanistan

Project Team:Santosh Kumar, S.K. Puri, Rajesh Bhalla, Vijay Pratap Raghuvanshi

The Ministry of Public Health (MoPH), Islamic Republic of Afghanistan assigned IIHMR the task of training and consulting for improving hospital services in the country. The project was supported by Development Assistance Facility for Afghanistan (DAFA), under Australian Aid. The twin assignments included a gap analysis in 16 central hospitals in Kabul against the best industry standards, and providing coaching and mentoring support to implement the quality improvement interventions. Based on the findings of the gap analysis, training modules were developed. IIHMR organized Master Training programs in Kabul for the selected senior hospital administrators, doctors and nurses. About 450 persons were trained from various categories of the central hospitals in Afghanistan.

A Quality Improvement (QI) project plan was prepared in consultation with the hospital directors. Quality circles were established at each hospital and the staff members were oriented to implement the QI plan. IIHMR did a hand-holding of the staff in order to implement the QI interventions.

Evaluation Study of the Multi-professional Patient Safety Curriculum Guide: Complementary Test Site

Agency:WHO, Geneva

Coordinator:Santosh Kumar

In today's healthcare context, there is growing recognition of the importance of safer care in health-care settings and the consequent need for health professionals and students of health sciences to learn about adverse events in healthcare and the urgent necessity for patient safety.

WHO Geneva introduced a standard curriculum guide on patient safety for building a foundation of knowledge, skills and attitudes that will better prepare students for clinical practice. Before the curriculum guide is integrated in the curriculum of medical and health management students, it is being piloted in various institutions.

IIHMR was selected as a complementary site for piloting the curriculum among its PG students and MDP participants. The Institute has already completed the piloting of the patient safety curriculum on its participants. The report is being finalized and will be submitted to the WHO headquarters.

Rapid Assessment of Janani Shishu Suraksha Yojana and the Chief Minister’ Free Drug Distribution Scheme of the Government of Rajasthan

Agency:Government of Rajasthan and UNICEF

Project Team:Anoop Khanna, Nirmal K. Gurbani, Laxman Sharma, Abhishek Dadhich, Ajay Sharma, Mohammed Sharif, Dinesh Chandra, Anjali Pareva.

The Government of Rajasthan had planned to undertake a rapid assessment of Janani Shishu Suraksha Yojana (JSSY) and the Chief Minister’s Free Drug Distribution Scheme (CMFDS) on implementation processes, resource availability and utilization, barriers and bottlenecks in the implementation and overall perceptions of the beneficiaries. IIHMR was contracted by the Government of Rajasthan with the assistance of UNICEF to undertake a rapid assessment of JSSY and CMFDD schemes to understand the process of implementation and identify related issues to ensure an effective implementation of the schemes in the state.

The rapid assessment was done on a sample basis and the sampling was done at the zonal level. The sampling for the assessment covered 14 districts, two from each zone of the state covering all the seven zones; six medical colleges; fourteen CHCs (one from each selected district); fifty-six PHCs (four from each selected district) and 112 sub-centers (two from each selected PHC). A sample of 1120 recently delivered mothers were interviewed at the sub-center level in order to assess the benefits availed of under JSSY and their level of awareness of the scheme. A total of 1300 beneficiaries were interviewed at different levels of health facilities under the component of CMFDDS.

The study was completed within three months from the signing of the contract in April 2012. The reports were submitted to the Government of Rajasthan and UNICEF at the end of June 2012.

Baseline Survey for ICICI Foundations Project on "Strengthening Convergent Action for Reducing Child Under-nutrition in Baran District, Rajasthan

Agency:ICICI Foundation

Project Team:Sunita Nigam, Anoop Khanna, Kalpa Sharma, Gowtham Ghosh, Manu Gupta, Suresh Sarwal, Ajay Sharma

The ICICI Foundation Centre for Child Health and Nutrition had designed a program to strengthen the delivery of health and nutrition services of ICDS in the rural blocks of Baran. The project launched on a pilot basis in 253 Anganwadi Centres (AWCs) of Shahabad and Kishanganj blocks of Baran District aimed to strengthen the delivery of services in the ICDS and focused on supplementary nutrition, growth monitoring, referrals, health and nutrition education and health checkups, as appropriate, for adolescent girls, pregnant and nursing mothers, 0-3 year olds and 3-6 year olds

The objectives were to carry out the baseline survey for the project and to provide the baseline estimates on the key indicators at the start of the project which could be used to measure the outcomes at the end of the project period in order to refine the project strategies and activity plan.

The project has been successfully completed. Anthropometric measures of the children (6-60 months) were assessed and were found to be below the standard measure and so was the enrollment measure of children in the Anganwadi Centers. The status of the institutional delivery was analyzed and was found to have improved, whereas the awareness and management of diarrhea for children was assessed and only 9% women were aware of homemade ORS formulations. Distribution and Consumption of Take Home Ration (THR) was surveyed and only 23% children were found to be using THR while the supplementary nutrition packets at the Anganwadi center were found to have expired. Assessment of Malnutrition Treatment Centers was done and it was found that they had insufficient human resources and that the staff were uneducated and the follow-up of the admitted children and referral services were poor.

Tabri RI Pehli Pehchan- Mobilizing Civil Society for Ensuring Birth Registration of Girl Children in Rural Rajasthan

Agency:Plan India, Delhi

Project Team:Nutan Jain, Vidya Bhushan Tripathi, Matadin Sharma

The overall objective of the project was to promote universal registration and provision of birth certificates to the girl child as a tool for ensuring the right to survival, protection and identity. The project sought to accomplish this by empowering gram sachivalaya for facilitating birth and death registration coverage of children, with focus on girl children, in selected rural areas of Rajasthan, and to help Government of Rajasthan in distributing birth certificates to the children. The project was implemented by district level partner organizations in seven districts of Rajasthan (Bhilwara, Bikaner, Churu, Jodhpur, Karauli, Nagaur and Pali) and the partner organizations celebrated National Girls Child Day (January 24) to advocate the issue at various levels. Only daughters’ parents were focused on so that they could avail of the government schemes which promote the girl child. During the project, 151 gram panchayats achieved universal birth registration (100%). Adding the previous experiences of birth registration and certification, more than 2.5 lakh children received their birth certificates.

A Study of Prospective Users of Artificial Physical Aids (Jaipur Foot) in Liberia

Agency:Bhagwan Mahaveer Viklang Sahayata Samiti (BMVSS)

Project Team:N.K.Sharma, R.S.Goyal

Bhagwan Mahaveer Viklang Sahayata Samiti (BMVSS), Jaipu,r on the request of Arcelor Mittal, Liberia, organized a camp in Liberia from 20th June to 11th July, 2012. IIHMR conducted an impact assessment of the camp. During the camp, 190 beneficiaries were interviewed. Among them, 129 beneficiaries were the first time users of the artificial limb while the remaining 61 were either current users or old users.

Out of 129 first time users, 59 persons were given above knee Jaipur prosthesis while the remaining 70 were fitted for below knee. Among the current and old users (61 in all), 43 were fitted with above knee prosthesis and the remaining 18 were fitted with below knee prosthesis. Desire of freedom/autonomy, mobility and self esteem were the main reasons which prompted the beneficiaries to come to the camps. Overall 93 percent of the beneficiaries said that the Jaipur prosthesis was very light and comfortable to use. Mostly all the beneficiaries felt that they would have no dependency on others for movement and other daily activities

Impact of Internet Use on Behaviour, Wellbeing and Development of Urban Adolescents in Rajasthan


Project Team:Alok Mathur, Anoop Khanna, Shilpi Mishra, Kanika Pawar, Gunjan Mishra, Shruti Tak, Snighda Pareek, Aditi Vyas

The objective of the study was to assess the gratifying factors for adolescents that result in the consistent use of social networking sites and other commonly accessed websites on the internet. The study also aimed to understand the perspective of teachers, parents and cyber cafe owners on the use of the internet by adolescents. The study had started in July 2011. Five districts of Rajasthan viz. Jodhpur, Udaipur, Kota, Ajmer and Jaipur, were identified. The team used both quantitative and qualitative tools to collect the primary data from students (schools and colleges), parents, teachers and cyber café owners. Software package used for the study was developed by the IT department of IIHMR, Jaipur. The report of the study has been finalized and submitted to the agency.

The key findings from the study illustrates that adolescents spent a quality time on the internet particularly on social network, playing computer games, downloading music and movies and surfing and only one-third of the boys used it within limits whereas the majority used it excessively which could lead to internet addiction. It was also found that almost half of the boys and one-fourth of the girls encountered pornographic content. The perception of parents, teachers and cyber café owners was also recorded. The data revealed that most parents were worried about the children’s academic performance, and their encounter with sexually explicit images, videos and adolescent’s increase in knowledge about self-harm, suicide, anorexia.

The Internet being the most cost and time efficient medium to gather any kind of information, its need cannot be denied for any age group, but the problem arises when the usage goes beyond being need centered and hence a few recommendations were reported which would have implications for policy making.

Baseline Assessment of the pilot intervention project “Use of Fortified Atta by Community using small chakki for wheat flour fortification in tribal blocks of Udaipur District, Rajasthan”


Project Team:N.D. Sharma, Suresh Joshi, Kalpa Sharma, Dinesh Chandra

This study was aimed to conduct an independent baseline assessment of GAIN’s innovative project in intervention and control block of Udaipur district in Rajasthan. The objectives of the study were to assess the present knowledge among rural families of micro-nutrient fortification and their attitude and behaviour towards regular use of fortified flour for family members. The focus was on pregnant women, lactating women, children under the age of five and adolescent girls. The study also assessed the fortification of flour done at small chakkis in the villages. In addition, the anaemia status among pregnant women, lactating mother, children under the age of five, adolescent girls and selected general population was also assessed. The study was conducted in three blocks of Udaipur District in Rajasthan.

The finding of the study reveals that the families which used fortified flour felt minor change in taste. However, one in three respondents was satisfied by its use. Most of the chakki owners did not know the health benefits of the fortified flour. However, awareness of micronutrients mixed during the process of fortification was found to be relatively better. Prevalence of malnutrition among children under the age of five was found to be high.

Client Satisfaction Exit Interview Survey, 2012

Agency:Marie Stopes

Project Team:Laxman Sharma, N.D. Sharma, Kalpa Sharma, Ajay Sharma

Marie Stopes International (MSI) has been providing family planning and safe abortion services in India. Marie Stopes India (a subsidiary of MSI) also provides similar services in National Rural Health Mission’s high focus states. The specific objectives of the Exit Survey were: to assess the extent of service utilization by the clients; to assess the extent of client satisfaction and quality of care provided by the MSI; to assess the client profile in order to estimate the proportion of the clients under the BPL category; and to assess the existing marketing strategies and suggest necessary modifications required. The data collection has been completed and analyzed.

Systemic Appraisal for Results using Bottleneck Analysis Framework

Agency:UNICEF, Jaipur

Project Team:Vinod Kumar, Suresh Joshi

Based on the Country Program Action Plan between the Government of India and UNICEF, IIHMR was offered this Project. The objectives of the initiative were: 1) to develop operational guidelines and a tool kit for Systemic Appraisal of Results through Bottle-Neck Analysis (SAR-BNA) for each sector and build capacity of officers concerned of UNICEF, Jaipur to undertake the SAR-BNA independently in the respective sector, 2) to undertake a SAR- BNA exercise for program/ policy frame on social security provisions for people living with HIV (PLHIV) in Rajasthan, and 3) to develop a plan for training respective stakeholders and implement the plan in selected areas as a part of the capacity building exercise. The duration of the Project was of six months, from July to December 2012.

A toolkit was developed for program managers titled “Systemic Appraisal for Results using the Bottleneck Analysis Framework”. The approach was then applied to identify bottlenecks and enabling factors in the key social protection schemes being given to the PLHIV in the State of Rajasthan.

The Project has been successfully completed and the final toolkit and report have been submitted to UNICEF (State Office for Rajasthan), Jaipur.

Rational Deployment of Health Human Resources in Rajasthan


Project Team:Neetu Purohit, Nutan Jain, Priyanka Bakhshi, Sonia Luna, Lalit Mohan Nayak, Rakhi Mathur

The overall objective of the study was to assess the deployment and distribution of health human resource in rural Rajasthan with respect to RCH II and identify the factors which affect availability of the human resources and utilization of their services. The specific objectives of the study were to review the existing policies for deploying and developing the human resources at various health facilities in rural areas; the distribution and availability of human resources for health in the government health facilities; and the factors which affect availability of the healthcare staff.

The study was cross-sectional in nature and covered the entire State of Rajasthan. Both quantitative and qualitative methods were used to collect the required information on the availability and deployment of the health staff. While quantitative information was collected for all the 33 districts, qualitative information was collected from the 14 districts where health facilities were visited by the research team. The findings of the study indicated that an acute shortage of staff in the public health sector existed at all levels. The state records of public health system showed that out of the 8762 positions of doctors sanctioned in the state, about 6340 positions had been filled, resulting in a shortage of about 28 percent medical officers. The rural urban inequity in deployment of specialist staff was even greater, with only 7.4 percent anaesthetists, 3.9 percent paediatricians and 5.2 percent gynaecologists posted in rural areas. The government has considered and implemented various policy options to overcome the shortage of health personnel, to bring down geographic inequities in deployment, to reduce attrition and to encourage more doctors to join the public health sector. For this, several steps were taken, such as revising the salaries of medical officers, shortening the period of probation, and posting PG doctors at CHCs. Existing policies related to human resources were not rated as satisfactory by the medical officers, particularly transfer policy (60.3%), posting policy (46.3%), and promotion policy (41.2%). Lack of transparent policies and political interference emerged as reasons which resulted in irrational deployment of health human resource.

Developing training manual for functionaries of Civil Registration System in India

Agency:UNICEF, Delhi

Project Team:Nutan Jain, Vidya Bhushan Tripathi, Snigdha Pareek, Matadin Sharma

Civil Registration System (CRS) hierarchy is not uni-linear i.e. officers at different levels are drawn from one or more departments of the State Government. It is an absolute necessity to acquaint the personnel engaged in registration work at different levels with various aspects of civil registration. The level of efficiency varies within and across the states in the country.

The main objective of developing this manual was to bring in uniformity and optimality in the training programs for all stakeholders across different states /UTs in order to strengthen the CRS across the country. The manual was developed and pre-tested with CRS functionaries in Delhi and Rajasthan. Training of trainers was conducted in four batches (two in Rajasthan, one in Assam and one in MP). The manual was translated into 13 major languages as a guiding material for imparting training in both better performing and poor performing states and as a tool to help sustain 100 per cent registration level in the states which have achieved it, and to improve and achieve the target of complete registration in those which have lagged behind. Using a single manual across all levels will help usher in uniformity of information and its validity.

Health Care Reform for Police Personnel and their Families in Rajasthan


Project Team:Alok Mathur

The intervention projection was built on earlier work of IIHMR on health problems and life styles of police personnel in close collaboration with Rajasthan Police Academy (RPA). The objective of the project was to establish a dedicated Health Resource Centre and Helpline (HRCHL) to provide preventive and counseling services to police personnel and their family members. The project also focused on assessment of treatment-seeking behavior of police personnel and to conduct periodic evaluation of the level of stress, health status and prevalence of substance use on a random basis. The HRCHL had been operational since June 2011 on the RPA campus. IEC material like posters, pamphlets and stickers were developed and distributed in all the 33 districts of Rajasthan. The research team made multimedia presentations at the district level for different cadre of police personnel at police lines, police stations, and SP offices. A toll-free telephone helpline was set up at RPA.

So far, police personnel amounting to 1758 have been registered with the helpline from the level of assistant superintendent police, Dy. S.P, and inspector to constable. The majority of the queries have been from the police personnel of the age group of 18-40 years. Most queries were related to gastro-intestinal problems, endocrinal disorders, lung diseases, heart diseases, skin disorders, HIV and AIDS, diseases of the central nervous system and gynecological problems. The Team is constantly counseling them and developing IEC material to inform the police personnel about the prevention, care and treatment for specific diseases. Additionally, an intervention program called “Swasth Police : Ek Pahal” has been initiated in eight districts and activities like health check-up, yoga and exercise, stress management, de-addiction program and IEC are being conducted.

Mapping of NGOs/CBOs in Rajasthan

Agency:UNICEF, Jaipur

Project Team:N.K.Sharma, Rohit Jain, Shatabdi Bagchi, Mohammed Sharief, Lalit Mohan Nayak, Manu Gupta

The purpose of the study was to map the nature, operations and scope of NGOs/CBOs in the identified districts, thereby providing information that would enable UNICEF to maximize the benefits of partnerships with NGOs/CBOs and communities. IIHMR carried out the assignment in two phases. In Phase I, information about the NGOs/CBOs was procured through secondary sources and was filtered as per the requirement of UNICEF. Given the outcomes of Phase I, the study continued into Phase II where primary data was collected from the NGOs/CBOs. This data gave information regarding various aspects of the NGOs/CBOs working in the sector of health, women and child, and nutrition. The report of the assignment was submitted to UNICEF which would be used to design support mechanisms for NGOs/CBOs to enable them to play a more effective role in development.

Mapping of Existence and Functionality of Birth Registration Centers in Afghanistan

Agency:UNICEF, Kabul

Project Team:Nutan Jain, and L P Singh

Birth registration was established in Afghanistan in the 1960s and it is a legal practice as per Article 32 of the Civil Registration Law (CRL). Registering births is the official function of the Vital Statistic Unit (VSU) within the Civil Registration Department of the Ministry of Interior Affairs, but birth registration level was as low as 6 percent (rural 4%; urban 12%). UNICEF Kabul has decided to map the existing birth registration centers and assess functionality in Afghanistan. The study was conducted by both Delhi and Jaipur campuses. Based on the mapping of the centers in 13 UNICEF high priority provinces of Afghanistan, IIHMR Jaipur developed a strategic action plan to increase availability of birth registration services, with a special focus on remote and hard-to- reach areas. The draft of the plan was shared with key stakeholders in a workshop in Kabul. The plan was well accepted.

Monitoring of Birth Registration under Prashashan ke shehar/ gaon ke sang in selected districts in Rajasthan

Agency:Plan India

Project Team:Nutan Jain, Vidya Bhushan Tripathi, Matadin Sharma

On the request of the Chief Registrar (Births and Deaths), Government of Rajasthan, technical and financial support was provided by the Institute and Plan India as a follow-up of the previous work in the project districts. The partner NGO representatives facilitated the campaign at the local levels and provided IEC material.

Socio-Cultural Dimensions of Sustainability of Sensitizing Self-Help Groups (SHGs) to Reproductive-health via Empowerment and Engagement. (SSSTREE)


Project Team:Nutan Jain, Snigdha Pareek, Matadin Sharma

The study was undertaken by IHMR, Bangalore and IIHMR, Jaipur in 10 SHGs in Chaksu block of Jaipur district in Rajasthan with the following objectives: to familiarize the SGH members with priority problems in health and RCH matters; to create awareness; and to sustain interest and memory through lesson plans in the prioritized problems. For this, the following interrelated women’s health issues were identified: a) menstrual hygiene; b) syndromic recognition of the RTI/STIs; c) peripartum infection recognition; d) cervical cancer; e) to build capacity of SHG core team to monitor access to care and outcomes; and f) to understand the socio-cultural dynamics of the uptake in a sustainable manner in specific communities. FGDs were conducted to understand the baseline status and one round of three-day training was conducted for 40 SHG members.