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Research Projects/Studies Completed Year-2011-2012

Pharmaceutical Manufacturing Industry Assessment Study in Afghanistan under the Capacity Building and Access to Medicine (CBAM) Project

Agency:Health Partners International of Canada

Project Team:L.P. Singh, Nirmal K. Gurbani, Jatinder Bir Singh, ACTD Team

The aim of the assessment study was to determine the current capacities, strengths and weaknesses of the pharmaceutical manufacturing industry in Afghanistan. The assessment covered all sectors of the drug manufacturing industry in the country, including the private, public and non-profit sectors. Past successes and failures in the industry were also explored to better understand the current situation and to learn from past experiences. The results of the study have been disseminated among the health planners, policy makers and stakeholders to provide information and recommenda-tions in drafting next-step strategies through a stakeholders meeting. The report provided current situation of drug production and manufacturing, access and availability, quality of medicines and recommendations for how industry, government and non-government players in the pharmaceutical production industry could move forward to increase access to pharmaceuticals for the people of Afghanistan.

Baseline Studies for Developing Implementation Model for Strengthening Maternal and Newborn Health Services in District Bharatpur, Rajasthan using Health Systems Approach under NRHM

Agency:WHO India

Project Team:P.R. Sodani, S.D. Gupta, Kalpa Sharma

WHO is contemplating development of an effective implementation model for strenthening maternal and newborn health services at the district level in order to reduce maternal and newborn morbidity and mortality. The baseline assessment was carried out to identify the existing gaps in the district health system and service delivery mechanism vis-a-vis maternal and newborn health at all levels of care in Bharatpur district of Rajasthan. The baseline assessment included the following five areas: facility assessment, training needs assessment, techno-managerial capacity assessment, quality of care assessment and community needs assessment. The facility assessment was done at public health facilities in the district. The training needs assessment was carried out by interviewing health functionaries, which included medical officers and nursing staff at DH, FRU/CHC, and 24x7 PHCs in the district. The third assessment study was focused on to assess techno-managerial capacity of the district / block level officials. The quality of care assessment was done by observing service provisions and conducting exit interviews of patients and/or relatives at public health facilities. The client satisfaction survey included information related to access to health care facility, utilization of health services and client-provider interaction.

Promotion of Roof-top Rainwater Harvesting Structures in the Villages of Churu District in Rajasthan

Agency:Safe Water Network, USA

Project Team:Goutam Sadhu, Monika Chaudhary, N.K. Sharma, Parvinder Sharma, Mangalika Tripathi

With the support of Safe Water Network, USA, Phase II of the project was undertaken by IIHMR. It was designed for the development of a cost-effective technical model for rainwater harvesting structures; a micro-financing model incorporating community participation; and for the construction of rainwater harvesting structures. IIHMR accomplished this project in association with Centre for Micro Finance (CMF) and Bhoruka Charitable Trust (BCT). The objectives of Phase II were to provide safe drinking water for rural residents in 40 villages in Rajgarh Block of Churu district and, through experience and lessons learnt from Phase-I, to make the project more sustainable, affordable and scalable. The studies undertaken were: risk assessment study; socio-economic household surveys; and health impact study. Training of villagers on health and hygienic parameters was conducted and technical support was given for the identification and promotion of low-cost and effective treatment methods for micro-biological pollutants.

Impact Assessment Study of Aapni Yojna (Integrated Safe Drinking Water and Sanitation Project), Churu

Agency: KfW, Government of Germany.

Project Team:Goutam Sadhu, Parvinder Sharma, Soibam Nepola

To improve the rural water supply situation and community health in north-western Rajasthan, the Government of Rajasthan implemented Phase-I of ’Aapni Yojna’- the Integrated Water Supply, Sanitation and Health Education Program- in two districts of Rajasthan. To support the Government in this project, the German Government had provided financial co-operation funds of Euro 95 million. The project was started in 1994 and 350 villages were connected to the system. Social mobilisation and community participation through a specialized consortium of NGOs —Community Participation Unit (CPU) were at the core of the project.

The objectives of the study were to assess the impact of Aapni Yojna in improving the living conditions of women and children through the reliable provision of clean and safe drinking water, sanitation facilities, health education, and to assess the behavioral changes in the target population affecting their daily lives. It was also aimed at assessing the viability of Aapni Yojna Model for future projects in Rajasthan and India and by making proposals for policy makers. The results of the study provided an insight into how effectively CPU and the other project partners reached and changed the lives of the beneficiaries in terms of their health, living conditions local level participation and self-governance.

Preparing the Hospital for Implementation of NABH Standards

Agency:Bhakti Vedanta Hospital, Mumbai

Project Team:Santosh Kumar, Gouri Sirke

Bhakti Vedanta Hospital, Mumbai entrusted the Institute with the task of preparing the hospital for the implementation of NABH. the beginning, a quality coordination team comprising of medical administrator, an assistant nursing superintendent, a staff nurse and IIHMR NABH coordinator was constituted. The hospital’s system audit was done using a specially designed checklist with an aim to find out the gaps against the NABH standards. All Heads of Departments were trained on NABH standards during a two-day training program. Based on the gap analysis, SOPs were defined and communicated to the management along with GANTT chart. More than 15 committees. were constituted to monitor quality in the hospital in its various departments. IIHMR coordinated the meetings of these committees. Training plans on various issues were made and more than 35 training sessions were organized to orient the hospital staff about NABH Program, patient perspectives, safety guidelines, waste management system and disaster management.

External Monitoring System for Medical Mobile Unit in Rajasthan

Agency: Directorate of Medical and Health, Government of Rajasthan

Project Team:Santosh Kumar, Atul Mehta, Manoj Soni

Rajasthan has typically difficult access and reach to health care, especially in its rural areas. With the objective to take health care to the door steps of the people in the rural areas, Mobile Medical Units (MMUs) have been provided for each district under NRHM. The Government of Rajasthan has given these MMUs to various NGOs working in the state to manage and operate the system. To ensure that the program fulfils its objectives and maintains performance norms, IIHMR has been identified by the government to establish an external monitoring system and conduct monitoring as an external agency. The major lacunae observed during the initial phases of the monitoring were insufficient staff, lack of medicines and equipment, absence of a female doctor and lack of proper publicity. Based on these observations, performance reports of each NGO were shared with the Mission Director, NRHM, Rajasthan.

Evaluation of Health Sector Development Initiative (HSDI), West Bengal

Agency:DFID, New Delhi

Project Team:Barun Kanjilal, Manasee Mishra, Swadhin Mondal, Debjani Barman, Moumita Mukherjee, Arnab Mandal, Lalitha Swathi, Sulagna Das, Suman Chakroborty, Suresh Joshi.

HSDI was a five-year reform program which was launched in August 2005 by the Department of Health and Family Welfare, Government of West Bengal with support from DFID (India). The broad objective of this initiative was to support and operationalize the state’s health sector strategy developed in 2003 (HSS, 2004-13). IIHMR was selected through a national bidding process to carry out the end-line evaluation of HSDI in the state. The key objective of the evaluation was to assess the effectiveness, efficiency and economy of the initiative. The evaluation was carried out on the basis of the primary data collected through community level survey, in-depth consultations with multiple stakeholders at all levels of health care system, and field trips to three districts. In addition, the secondary data including various reports, studies, database and documents related to HSDI were also reviewed. The first phase of the evaluation, which focused on the health component of the initiative, was completed in June 2010. The second phase, which focused on the nutrition component, started in July 2010 and continued until March, 2011. The evaluation reports and key findings were shared with all key stakeholders.

Monitoring the Performance of Accredited Social Health Activist (ASHA Sahayogini) in Rajasthan

Agency:Department of Medical, Health and Family Welfare, Government of Rajasthan

Project Team:Dipti Govil, Neetu Purohit, Rakhi Mathur, Vrinda Mehra

Since the introduction of ASHA Sahayoginis, evaluation studies conducted on the performance assessment have indicated that the focus on motivation of ASHA remained unaddressed, resulting in deviation from achieving the overall objective of NRHM. Thus, there seemed a need to monitor ASHA intervention in Rajasthan to achieve the desired outcome or the objective of NRHM to provide door-to-door quality services. The Government of Rajasthan commissioned IIHMR to monitor the performance of the ASHA Sahayogini in the state and provide regular feedback to the state government.

An Assessment of Mobile Health Vans in Uttarakhand

Agency:Futures Group International, New Delhi

Project Team:Neetu Purohit, Dipti Govil, Sonia Luna, Lalit Mohan Nayak

The Government of Uttarakhand has adopted several innovations to improve the access to health care services for disadvantaged people in the state. One of the innovations is the introduction of Mobile Health Vans (MHVs) with the objective of serving the underserved areas, especially the BPL families and women. Through these vans, while the BPL families have been availing themselves of free of cost health care services, APL beneficiaries are required to pay nominal charges. Currently, the state is operating 30 mobile health vans under a different set of mechanisms in all the 13 districts of Uttarakhand. Futures Group which provided technical support to the government of Uttarakhand hired the services of IIHMR to assess the functioning of various vans, its allied concerns and subsequent ways to solve them. The specific objectives of the study were to review the management of the vans to gain an understanding of the operational issues and to study the demand generation and client satisfaction with the services.

Implement the Empowering Dairy Cooperatives on Reproductive and Sexual Health through Knowledge Power

Agency:Indian Council of Medical Research, New Delhi

Project Team:Goutam Sadhu, Santosh Kumar

The objectives of the project were to undertake health and empowerment pre-intervention audit with both providers and clients regarding the reproductive and sexual health issues; to build the capacity of the cooperative agencies and its leaders/staff as resource persons/change agents to improve the overall health status of the families/community involved in dairy collectives; and to evaluate the impact of educational intervention and the level of capacity building on dairy collectives. IIHMR was responsible for the planning, designing and implementing, both from executive and functional points of view and monitoring and evaluating the project and executive agency for the administration of the project. The Institute engaged Gramodaya Samagic Sansthan NGO to do the field work.

Capacity Building of Basic Health Workers and Link Workers for Creating Awareness and Demand Generation for Revitalization of PPIUCD

Agency:JHPIEGO Corp. USA

Project Team:Shilpi M. Sharma, Vinod Kumar SV, Priyanka Bakshi

The aim of the study was to create awareness and generation of demand for PPFP/PPIUCD SERVICES in Rajasthan. The objectives of the research study were to develop a state-specific strategy on BCC for PPFP/PPIUCD services; to develop training packages and job aides on counselling for community/facility based link workers; to train the community/facility based workers of Jaipur and NIPI Focus districts namely Alwar, Bharatpur and Dausa; and to render support to the implementation of the demand generation strategy. IIHMR in collaboration with JHPIEGO, India identified key barriers in PPFP/PPIUCD program in Rajasthan and developed a learning resource package for ASHAs and Yashodas. The training manual and reference manual were approved by the Government of Rajasthan and also incorporated the manual to existing training module number 3 for ASHA. A total of 633 ASHAs/Yashodas were trained in the three districts. There was a noted improvement in the level of knowledge of the participants after the training. The training ended successfully, imparting the message that proper counselling to ASHAs and Yashodas at the right time would be beneficial as they would be able to assist clients for the adoption of PPFP/PPIUCD, which would help in moving towards the overall aim of reducing the number of unwanted pregnancies finally resulting in the reduction of MMR and IMR in the long run.

End-line Survey: Maternal Anaemia Reduction (A2Z)

Agency:Academy for Education Development

Project Team:Anoop Khanna, J.P. Singh, Gowtham Ghosh B, Saheli Manish Kumar, Roma Bhowmik, Ajay Sharma

The project was designed and applied through the government system packages to scale up anaemia prevention in pregnant women in selected three districts of Uttar Pradesh and three districts of Jharkhand. A baseline study was conducted in the year 2007 in Jharkhand and in 2008 in Uttar Pradesh to measure the ANC coverage, provision of services, utilization of services and anaemia prevalence and its related factors. The intervention then was carried out using a system strengthening approach and efforts were made to improve the existing system rather than creating a new one. The objective of the end-line survey was to document the improvement in the coverage and utilization of services and reduction of anaemia prevalence. Further, the study also documented the lessons learnt that could be used for scaling up the intervention to other blocks of the districts and to other districts of the state. The end-line survey provided representative, valid and reliable population-based estimates of intervention coverage, participation and knowledge, attitude and practice related to anaemia and anaemia prevalence in the target populations within the intervention and non-intervention blocks. The results were also compared against baseline measures to assess whether the intervention package achieved the desired changes in key performance and outcome indicators.

Access to Health Care and Health Care Seeking Behavior among the Urban Poor in Rajasthan

Agency:HUP Project, IIHMR, Jaipur

Project Team:Dipti Govil, Jyoti Dua

Population projections suggest that slum growth in future is expected to surpass the capacities of civic authorities to respond to the health and infrastructure needs of this population group. Managing urban health, thus, assumes critical importance in the overall objective to achieve better health outcomes in the country. There was an apparent/urgent need to understand the health care needs of the urban poor. IIHMR, Jaipur is a part of Health of the Urban Poor (HUP) project consortium. The purpose of the project is to improve the delivery of a comprehensive package of maternal and child health and nutrition interventions, including the promotion of water supply, sanitation and hygiene services in urban communities. Under this project, a small study was commissioned to examine the health care needs and health care seeking behaviour of the urban poor in Jaipur city, Rajasthan. The specific objectives of the study were to assess the health needs and health seeking behaviour of the slum residents and identify the barriers to access to health care services.

Reaching out Youth in Secondary Schools in Bihar with Information and Skill for Improvement of Health and Well Being: Baseline Survey in Bihar

Agency:CEDPA, New Delhi

Project Team: Nutan Jain, Abdul Jaleel, Dinesh Pant, Laxman Sharma, Vidya Bhushan Tripathi, Jatinder Bir, L P Singh

The aim of the project was to empower young people in secondary schools with information and skills for improved health (including reproductive and sexual health) and well-being and to reinforce an enabling environment in schools, home and community settings for adolescents to achieve full potential and build capacity in the Department of HRD, GoB to implement and sustain the program. In order to capture the current status of the knowledge and attitude among students, teachers, principals and DEOs, CEDPA India decided to collaborate with IIHMR, Jaipur to conduct the baseline survey in Bihar with the following objectives:

  • to assess the knowledge and attitudes of adolescents towards issues related to their health and well-being;
  • to assess the adolescents’ abilities to apply life skills in the context of their health and well-being;
  • to assess the knowledge and attitudes of teachers, (including nodal teachers) towards adolescent health and well-being;
  • to determine the need and perception of AEP on students, peers, teachers and parents
  • to assess the capacity of the Education Department at the state and district levels in implementing and sustaining the program

A case-control study was conducted in Darbhanga, Gaya, Khagaria, Nalanda and PurniaSupaul while the control districts included Madhepura, Nawada and Rohtas. A total of 3147 students, 225 teachers and 7 district education officials were covered under the study.

Client Exit Interviews Survey 2010 in Rajasthan

Agency:Marie Stopes India, New Delhi

Project Team:Santosh Kumar

Marie Stopes India (MSI) assists the government to improve their public health system and service delivery practices for delivery of quality sexual reproductive health services. MSI is involved in two types of camps: MSI- Supported Government camps and MSI Clinical Outreach Team camps. In the first type, MSI provides support to the government camps on demand generation, client motivation, camp management and quality improvement. The second type of camps are MSI’s own camps in which MSI clinical outreach teams perform all the functions. A client exit interview survey was carried out in January 2011 in selected districts of Rajasthan to assess the client satisfaction, utilization of sexual and reproductive health services and quality of care provided by MSI’s to the clients attending these camps.

Promotion of Rain Water Harvesting in the Villages of Nagaur District, Rajasthan

Agency:Indiabulls Foundation, New Delhi, India

Project Team:Goutam Sadhu, Monika Choudhary, SM Gupta, Prince Purohit, Parvinder Sharma

The objectives of the project were to provide safe water in the villages of Nagaur district to document evidence based research on rain water harvesting and to further up-scale in 300 villages of the district to encourage the community to take up measures to use surplus rain water of their household for recharge purposes and construct sanitation units and to develop other sanitation habits among the community. IIHMR was the lead partner in the project. The Institute provided substantial inputs in the areas of concept development, water quality management, health and hygiene promotion, research, development of MIS, and documentation for policy makers. The activities carried out in the project were: risk assessment, socio-economic household surveys, health assessment, hygiene education, water quality test and technical support of the same, identifying and promoting low-cost and effective treatment methods for micro-biological pollutants, impact assessment, and technology innovation or improvement.

Project Review Survey: Saving Children Lives through Community Empowerment

Agency: Save the Children, India

Project Team:Vinod Kumar SV, J.P. Singh, Arindam Das, Gowtham Ghosh B, S.P. Chattopadhyay, Saheli Manish Kumar, Pradeep Singh

The project was a two-year program to reduce mortality rates and under-nutrition prevalence among children of age 0-5 years in selected districts of Bihar, Rajasthan and West Bengal. IIHMR was entrusted with the responsibility to conduct an end-line assessment in the intervention districts of the three states where the project was operational. The study involved collection of quantitative as well as qualitative data which was then compared with the Baseline to assess the project outcomes.Three State Specific Reports and a Consolidated Report were submitted.

Client Satisfaction Exit Interview Survey, 2011, Rajasthan

Agency: Marie Stopes India, New Delhi

Project Team:Laxman Sharma, Sunita Nigam, Bhavik Shah, Praful Kumar, Manoj Son

The aim of the project was to increase the percentage of first time family planning users and overall client satisfaction with the following objectives:

  • 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 get the percentage of the clients under the BPL category.
  • To assess the existing marketing strategies and to suggest nece-ssary modifications required.

The study was carried out in 13 districts of Rajasthan, namely Dholpur, Bharatpur Bhilwara, Nagaur, Sikar, Udaipur, Rajsamand, Banswara, Chittorgarh, Jaipur, Alwar, Dungarpur and Ajmer. A total of 60 sites were taken for the exit survey with a sample size of 320.

Development of Comprehensive Package of Short Program Review of RCH (SPR RCH)

Agency:WHO India Country Office

Project Team: Suresh Joshi, Vinod Kumar SV, Gowtham Ghosh B

The objective of the assignment was to develop an India adapted integrated package to review the reproductive and child health program at district and state levels. The exercise included review of existing packages in Short Program Review of child health; maternal health; rapid program review of Adolescent Health; and available data sources to develop the final packages. SPR RCH packages were developed for the district and state levels and were presented to stakeholders in a consultation meeting in New Delhi. Based on the feedback, the packages were finalized and delivered to WHO India.

Assessing Janani Suraksha Yojana for Cost Effectiveness: A Case of Rajasthan

Agency:UNFPA, Bangkok

Project Team:S.D. Gupta, Dipti Govil, Neetu Purohit, Shilpi M Sharma, Vrinda Mehra, Lalit Mohan Nayak, Sonia Luna

With a view to preventing the deaths due to preventable causes, the Government of India introduced a centrally sponsored scheme- Janani Suraksha Yojana (JSY) —as a demand side intervention for promoting safe delivery under National Rural Health Mission. After five years of the intervention, JSY was recognized as a successful scheme. The overall objective of the study was to provide the evidence on the effectiveness and efficiency of JSY in terms of its cost effectiveness. The positive and negative roles of the incentive driven scheme in terms of the benefits for maternal health provided valuable insights into the implementation of JSY. The study was conducted in four districts of Rajasthan.

Quality Public Health Training Course in Afghanistan

Agency:Afghan Centre for Training and Development (ACTD) and Ministry of Public Health, Islamic Republic of Afghanistan, Kabul

Project Team:Nutan Jain, L P Singh, Arindam Das, Suresh Joshi, Swadesh K Puri

The Institute in collaboration with the Afghan Centre for Training and Development conducted Public Health Management Course for the Provincial Health Team of the Ministry of Public Health for Quality Public Health Training Course in Afghanistan. It aimed at building capacity of provincial public health officers of Afghanistan on public health management. IIHMR developed course modules and shared them with the Ministry. It also conducted a three-day training program for trainers on each module in Kabul. In addition, general training of trainers for three days was also conducted.