Background Paper on Tobacco Taxation In South-East Asia Region Countries
Funding Agency: SEARO, WHO
Team: Sanjiv Kumar, Pradeep Panda, Pankaj Talreja, Sumesh Kumar, Preetha G.S.
Tobacco taxation is one of the evidence-based “best buys” for tobacco control. Increases in tobacco taxes which result in significant increases in prices are highly effective in reducing tobacco use, particularly by youth and the poor. Based on the example of tobacco taxation, fiscal interventions are also being recommended and implemented for alcohol and for sugar sweetened beverages, recognised as a risk factors for non-communicable diseases (NCDs). In order to understand the implementation of various tax measures and other policy options to promote behaviour change and lessons learnt from such efforts in South-East Asia Region countries, a background paper is currently being prepared with the following objectives: (a) to provide empirical data on tobacco products price and affordability in SEAR countries, (b) to give an overview of fiscal interventions/taxation in tobacco, alcohol and SSBs (sugar sweetened beverages), (c) to analyse best practices in tax design and administration for evidence on the impact of tax and price on use of tobacco, alcohol and SSBs and revenue objectives, (d) to study price sensitivity and behaviour change in response to fiscal interventions/tax approaches and administration, (e) to provide examples of lessons learnt in earmarking of tobacco or alcohol taxes for health and a brief analysis of their feasibility, practicality, success and challenges, and (f) to identify gaps and challenges in implementing tax and trade policies with respect to tobacco, alcohol and SSBs.
Study on Rotavirus Vaccine In Uttar Pradesh
Funding Agency: Save the Children
Team: B.S. Singh and Dhananjay Srivastava
Diarrheal diseases are a major cause of hospitalizations and child deaths globally and together they account for approximately one in six deaths among children younger than five years. Rotavirus is the leading cause of severe diarrhoea in children and in India and if severe diarrhoea not treated properly, it can lead to severe dehydration, hospitalization or even death. This also can lead to complications such as malnutrition and delay in physical and cognitive development. The objectives of this study were to understand demand and usage of Rotavirus vaccine by parents, frequency of administration (daily, weekly, monthly) of the Rotavirus vaccine by pediatricians, profile of the clients with demand of Rotavirus vaccine for their child, experience on side effects, reoccurrence of the Diarrhoea to the vaccinated children, challenges related to demand and acceptance of Rotavirus vaccine at parents level and suggestions of pediatricians for higher usage of Rotavirus vaccine. This study had been conducted in Lucknow city and 4 Stop Diarrhoea Initiative (SDI) districts i.e. Bahraich, Balrampur, Pilibhit and Shravasti. Some randomly selected clients had also been approached for detailed profile of the children receiving or refusing Rotavirus vaccine and experience on side effects and details related to reoccurrence or occurrence of the diarrhoea to the child based on details available with pediatricians or doctors. Pediatricians or Doctor has been selected randomly with the help of SDI project team members of the Save the Children. Respondent were interview with the help of semi – structured questionnaire and separate questionnaire has been used for the each type of respondents. It was observed that Rotavirus vaccine is available mainly at Private Nursing Homes, Private Clinics, and Medical Shops of district headquarters, and because of limited availability and affordability demand and uses of Rotavirus vaccine is also limited to private nursing homes and private clinics. In most of the cases doctor suggested to parent to give Rotavirus vaccine to child as most of the parents are not aware about benefit, side effect of Rotavirus vaccine. Gender preference also observed among parents in regard to vaccination and they are keen to vaccinate their male child in compare to female child. Since Rotavirus vaccines are available only at nursing home/clinic and it cost too much, economically poor people were unable to get Rotavirus vaccine. Development of an action plan is recommended to map the government health facility/provider and increasing awareness regarding use of Rotavirus vaccine in the community through IEC and BCC. Detailed study and dissemination of need, benefit and timing receiving rotavirus vaccine through Print and Mass media is also required and study highly recommend to address WASH issue i.e. Safe drinking water, hygiene and open defecation in the community.
Masters’ Fellowship: Research Capacity Building Program Within India Research Initiative On Peri-Urban Human-Animal-Environment Interfac
Funding Agency: ILRI and PHFI
Team: Study Supervisors: Dr. Dipanjan Roy (till 17th Feb 2017), Dr. Sanjiv Kumar, Ms. Divya Aggarwal, Dr. Dhananjay Srivastava; Masters’ Fellow : Ms. Akshita Singh, Dr. Purnima Rai, Dr. Priya Chinchwadkar, Dr. Sonam Barak, Ms. Shruti Pahwa, Ms. Mansi Jatwani, Dr. Vaibhavi Khadayata, Dr. Navita Yadav, Ms. Ikra Ahmed
The Public Health Foundation of India/Roadmap to Combat Zoonoses in India (RZCI) Initiative in collaboration with the International Livestock Research Institute (ILRI) announced a Research Capacity Building Programme for Masters candidates under the India Research Initiative on Peri-Urban Human-Animal Environment Interface (PERIMILK study) with funding support from the International Development Research Centre (IDRC, Canada). The Initiative aims to generate a stronger evidence-based cross-sector policy and local capacity for integrating public health, animal/livestock health, urban planning, local food production and social development in select peri-urban sites in India. Establishing a policy-relevant research platform and creating sustainable multidisciplinary and multi-actor partnerships would be the eventual outcomes of the study. Selected Researchers explored the EcoHealth approach to research, applied it to local healthy food production, healthy livestock, and prevention and control of zoonotic diseases in peri urban settings. The research findings will help develop and improve the understanding of interactions between livestock rearing practices and epidemiology of diseases associated with these practices, transmission dynamics and its implications on human health and environment with a view to promote health, livelihood and sustainable development across the country’s different peri-urban settings. Nine students were shortlisted by PHFI-ILRI team and were awarded fellowship for duration of 06 months. The students have worked rigorously in their chosen area of interest in the peri-urban settings of India under the faculty supervisors and experts from PHFI. Out of nine, seven studies were conducted in the peri-urban areas of Delhi and other two were conducted in the states of Rajasthan and Gujarat. Two fellows have done qualitative study and others have carried out quantitative study and they presented interesting findings in the form of a report to the funding agency.
Review and Evaluation of M-Tobacco Cessation Program In India
Funding Agency: WHO
Team: Preetha GS, Pradeep Panda, Sumant Swain and Vivek Pathak
Nearly 35% of Indians over the age of 15, or some 275 million people, use tobacco. The current cost of tobacco use in India includes 1 million deaths per year (approximately 1/6 of all tobacco-related deaths worldwide), and billions of dollars of direct attributable health cost. The World Health Organization (WHO) and the International Telecommunications Union (ITU) have formed a partnership called the ‘Be He@lthy, Be Mobile’ Initiative to use mobile technology – in particular text messaging and apps – to help combat non communicable diseases. In 2015, the Ministry of Health and Family Welfare and the Ministry of Communication and Information Technology of Government of India partnered with BeHe@lthy, Be Mobile to create a mHealth programme to help those who want to quit tobacco use. This evaluation is being conducted with the expectation that information on quitting experiences of the registered users as well as their perceptions and experiences related to the programme would provide key inputs to further improving the programme. The objectives of the evaluation were to determine the quit rates, 6 months after enrolment and to understand the user experiences. Telephonic interviews of mCessation subscribers were conducted to assess quit rates. The sample size determined for this estimation was 4500, with the assumption that this sample should provide good precision for an estimate of the prevalence of quitting at 3% in the overall population of 1.7 million registered mCessation programme users. Accordingly, a sampling frame was constructed, of the registered subscribers of mCessation programme between 21 June and 20 September 2016, who numbered to 453990. Telephonic interviews were conducted of 228 subscribers who had not responded after enrolment to assess user experiences. The study findings were presented as one month quit rates, 6 months after enrolment, frequency and patterns of tobacco use, quit attempts among current tobacco users, opinions of the subscribers regarding the programme as well as recommendations for improvement.
Assessment of Urban Primary Health Centres in Nct Delhi
Funding Agency: NHSRC
Team: Pradeep Panda, Kirti Udayai, and Shikha Bassi
IIHMR Delhi, with financial support from The National Health Systems Resource Centre (NHSRC) carried out a study to assess the selected 131 Urban Primary Health Centres (U-PHCs) in NCT of Delhi (50% of all U-PHCs) using thematic checklists of U-PHCs defined under the National Quality Assurance Standards, Ministry of Health and Family Welfare, Government of India. The study generated scorecards based on the assessment, and prepared baseline assessment reports for assessed facilities and provided recommendations for improvement in the quality of services at the facilities. In order to strengthen the public health research capacity, IIHMR facilitated the students to have a bird’s eye view of public health systems and functioning of the facilities. IIHMR and NHSRC jointly provided the necessary training to the students on the evaluation methodology and use of quality assurance standard to assess the facilities. The students collected and analyzed the data as per guidelines and quality parameters, and identified the gaps of each U-PHC. This study presents a successful example of engaging the students in research projects to generate insights and find solutions by applying their knowledge and analytical skills in the urban community health settings.
Geospatial Mapping of Diabetes, Cvd and Cancer Risk Hotspots and Study Of Risk Assessment
Funding Agency: DST, India
Team: Anandhi Ramachandran, Sumant Swain, Vivek Kumar Pathak, Ashgar Abbas & Iyyanki V MuraliKrishna
Non-communicable diseases (NCDs) are a major cause of morbidity and mortality in India. People of all age are affected and it is gaining prominence among rural population also. All this necessitates seeking best practices to raise awareness; education and prevention around NCDs. Geographical Information System (GIS) are being extensively used to map the epidemiological information of chronic diseases with reference to space and time. Its applicability to NCDs, especially in tracking individual context is less. The current study has been carried out in the rural areas of North East Delhi (Delhi) and Jhajjar (Haryana) The main focus is to explore the possibility of using GIS to develop maps based on modifiable risk factors. Using the WHO stepwise approach, a cross-sectional study was carried out among a total of 3200 rural people of 15-64 years age-group in the districts covering nearly 18 villages. Information on common modifiable risk factors of diabetes, cardiovascular disease and cancer was obtained through standardized protocol though household survey. Trends related to smoking, use of smokeless tobacco, alcohol drinking, average consumption of fruits and vegetables, salt and fat consumption between males and females and different age group have been calculated. Prevalence of overweight and obesity was calculated among men and women in all age-groups. In addition presence of second hand smoking, family history related to NCD occurrence, awareness to risk factors and health seeking behaviour have also been examined. In addition categorization of the risk groups into high, moderate, low is expected based on the identified risk factor for developing thematic maps using GIS. It is hoped that the results will provide an insight of utilizing GIS as a best practice to map NCD risk factors that can be further used for a targeted approach of community based health promotion and monitoring of NCDs.
Climate Change & Malaria in Sub- Himalayan Region & Central India
Funding Agency: DST, India
Team: Vinay Tripathi, Rais Akhtar, Preetha GS, Nemika Relhan, Sumant Swain, Asghar Abbas, Gaurav Srivastava, Vivek Kumar Pathak
Climate change is a matter of concern and deliberation, both at the national and international level, due to its potential consequences and direct and indirect impacts on human wellbeing. Human health is one of the spheres where the impact of climate change is inevitable. The impacts on human health ranges from events like deaths or diseases to events, such as, wider spread of different vector-borne diseases, which are sensitive to climate change. Malaria is one such vector-borne disease which is most sensitive to long-term environmental change. Three main climatic factors, namely, temperature, precipitation, and relative humidity predict (to a large degree) the natural distribution of malaria. Other environmental variables, such as, land use and land cover change also affects vector dynamics. Further, the role of socio-economic determinants cannot be undermined in the case of malaria. All these factors- climatological, environmental and socio-economic factors- can affect malaria occurrences. Accordingly, in this study, which was funded by the DST, an attempt was made to study the relationship between climate change and malaria from the holistic perspective. There were three main objectives of the study, namely, to (i) identify the association between malaria and mean temperatures, and rainfall and mean humidity; (ii) study the impact of social and environmental determinants and climate change on malaria in physically and socio-economically distinct districts; and (iii) study how non climatic factors modify the relationship between climate variables and malaria. Mixed method approach, which provided the scope of combining both quantitative and qualitative research techniques, was used to achieve the objectives of the study. Out of many findings, few significant one are mentioned here: Firstly, community, at large, could not decipher the meaning of the term climate change (or its literal translation in vernacular language). However, when assisted with probes like changes observed in temperature, rainfall and humidity, many agreed to experience such changes mainly on temperature and rainfall variables. Secondly, with respect to the impact of climate change on human health in concerned, it was found that community found it hard to relate climate change to the diseases such as malaria without any probing assistance. Thirdly, so far as the health related data collection is concerned, the presence of private health facilities and penetration of local unregistered medical practitioners in interior pockets make it difficult to account malaria cases treated by them into the national reporting system. Fourthly, in terms of awareness and knowledge related to malaria transmission, its symptoms, treatments, and prevention strategies, more or less half of community members had complete and correct knowledge.
Health warning labels on cigarette packs: do they really work for smokers?
Funding Agency: IIHMR In-house Grant
Team: Vivek Kumar Pathak
The research project is an investigation into the effects of cigarette-pack health warning labels (HWLs) on smokers. To effectively address the disease burden and death due to smoking, India introduced the concept of health warning labels on cigarette packs in 2009. HWLs have been found to be effective in increasing awareness about health risks and influencing quitting behavior in various settings all across the globe, but, there is a lack of evidence regarding the same in Indian settings. Investigating the effect of the existing cigarette-pack HWL on smokers can provide evidence for better implementation of HWLs in future and maximize impact. Method used in this project was entirely qualitative based on IDIs and FGDs and the results stem from the respondents’ own words about the existing cigarette-pack HWL. The respondents recruited for this study were all young-smokers and were selected using non-probability purposive sampling from South-West District of Delhi. From a tobacco control perspective, the results of the study are concerning. The key results show that there does not seem to be much reduction in cigarette use as a result of the label. An intention-behavior gap was found. The HWL was able to induce intention to quit but was not strong enough to motivate smokers to translate this intention into action. Smokers were found to be immune to the label and ignored the warning. To assure the possibility that such labels are effective in the country, more stringent labeling policies should be formulated and more emphatic warning labels should be designed.
Life Skills Assessment Data Collection
Funding Agency: Room to Read
Team: Vanishree, Sumesh Kumar, Anandhi Ramachandran & A K Khokhar
Life Skills Education (LSE) is an important activity which enables children to identify the problems in their lives, think of probable solutions and practice them. The LSE Assessment toolkit ‘(LSAT) developed by Room to Read (R2R) discusses the various dimensions related to life skills education based on the WHO conceptual framework and adopted by R2R as a part of the Girls Education Program (GEP) curriculum in all their project countries. Ten dimensions of life skills are assessed through this tool kit that involves various methods like Likert type questions, mind mapping games, mirror drawing, short stories and self assessment questions. Totally nine Government schools from Phalodi and one from Jasola where selected and a total of 350 samples of students from various age groups and grades were inducted for the survey. The tool was checked for reliability and effectiveness. The overall reliability of the tool was found to be 0.70. The major observations are that the tool is validated and can be adopted for rapid Life Skill assessment in a scalable way with larger samples. Positive aspects of the tool are the sections related to scenarios, relationship building, short stories and mirror drawing. These extracted quick responses from students invariable of the age. The tool seems to have clearly defined sections that can be administered together or separately. Overall the tool is effective in capturing all the dimensions mentioned in WHO framework and can be easily adopted by all - social workers, educators, trainers, program mangers etc who are working towards imparting Life Skill Training to the young girls so that they become capacitated to take safe, healthy and own decisions in profession and personal lives.
National Family Health Survey (Nfhs) With Iihmr Jaipur – Phase 2 – Odisha State
Funding Agency: IIPS, Mumbai
Team: Pradeep Panda, Ranjan Prusty, Amiya Mahanta, & Sarthak Mahapatra
The National Family Health Survey 2015-16 (NFHS-4), the fourth in the NFHS series, provides information on population, health and nutrition for India and each State / Union territory. NFHS-4, for the first time, provides district-level estimates for many important indicators. In this round, information on malaria prevention, migration in the context of HIV, abortion, violence during pregnancy etc. have been added. The scope of clinical, anthropometric, and biochemical testing (CAB) or Biomarker component has been expanded to include measurement of blood pressure and blood glucose levels. NFHS-4 sample has been designed to provide district and higher level estimates of various indicators covered in the survey. However, estimates of indicators of sexual behaviour, husband’s background and woman’s work, HIV/AIDS knowledge, attitudes and behaviour, and, domestic violence will be available at State and national level only. As in the earlier rounds, the Ministry of Health and Family Welfare, Government of India designated International Institute for Population Sciences, Mumbai as the nodal agency to conduct NFHS-4. The main objective of each successive round of the NFHS has been to provide essential data on health and family welfare and emerging issues in this area. NFHS-4 data will be useful in setting benchmarks and examining the progress in health sector the country has made over time. Besides providing evidence for the effectiveness of the ongoing programmes, the data from NFHS-4 help in identifying need for new programmes with area specific focus. IIHMR gathered information from Odisha (30,242 Households, 33,721 Women, and 4,209 Men.
National Family Health Survey (Nfhs)-4: (Rajasthan) With Iihmr Jaipur – Phase 2
Funding Agency: IIPS, Mumbai
Team: Anoop Khanna, B S Singh, Kailash Prajapati, Rajendra Rathore
The National Family Health Survey 2015-16 (NFHS-4), the fourth in the NFHS series, provides information on population, health and nutrition for India and each State / Union territory. NFHS-4, for the first time, provides district-level estimates for many important indicators. In this round, information on malaria prevention, migration in the context of HIV, abortion, violence during pregnancy etc. have been added. The scope of clinical, anthropometric, and biochemical testing (CAB) or Biomarker component has been expanded to include measurement of blood pressure and blood glucose levels. NFHS-4 sample has been designed to provide district and higher level estimates of various indicators covered in the survey. However, estimates of indicators of sexual behaviour, husband’s background and woman’s work, HIV/AIDS knowledge, attitudes and behaviour, and, domestic violence will be available at State and national level only. As in the earlier rounds, the Ministry of Health and Family Welfare, Government of India designated International Institute for Population Sciences, Mumbai as the nodal agency to conduct NFHS-4. The main objective of each successive round of the NFHS has been to provide essential data on health and family welfare and emerging issues in this area. NFHS-4 data will be useful in setting benchmarks and examining the progress in health sector the country has made over time. Besides providing evidence for the effectiveness of the ongoing programmes, the data from NFHS-4 help in identifying need for new programmes with area specific focus. IIHMR gathered information from Rajasthan (34,915 Households, 41,965 Women, and 5,892 Men )
Study To Review Mis Of Social Protection Schemes
Funding Agency: Save the Children
Team: Anandhi Ramachandran, B.S. Singh, Dhanajay Srivastava, Veena Sarkar Nair, Sumant Swain
Save the Children - Nokia Resilience Program “Using Connectivity to Build Resilience of Children and their Communities in India” are focused on building resilience (i.e. “ability to face stress and shock in a sustainable manner”) of vulnerable children, their families and communities. They propose to use an integrated approach using Disaster Risk Reduction (DRR) and Social protection framework (SPF) using Information Communication Technology. Based on this IIHMR Delhi has been allotted the project to study and review the Management of Information Systems (MIS) related to social protection schemes in India and Abroad. Currently the project is in the first phase of implementation where literature survey is being carried out for development of tools. The purpose is to improve access to government social protection through mapping of vulnerable children & MIS of schemes. The proposed study will be a review of successful MIS systems used in social protection programmes in India to develop an understanding of such MIS and based on the lessons learned develop a framework for a social protection related MIS. Additionally, the study will look to comprehensively understand the gaps in the program in relation to flow of data in MIS, bring forth successes and shortcomings in its processes and outcomes that will provide pointers towards sustainability beyond the project lifetime. The methodology adopted is a detailed literature survey using PRISMA tool, quantitative and qualitative data collection methods. The allocation of the project was delayed by more than 1.5 months from the funder side. Currently all the field work has been completed and the project is in the final state of report writing.
National Family Health Survey-4 (Nfhs) In The State Of Uttarakhand And Madhya Pradesh With Iihmr Jaipur
Funding Agency: IIPS
Team: Neetu Purohit, Santosh Kumar, Arindam Das, BS Singh, Preetha GS, Amlan Dutta, Lalchand Sharma, Kailash Prajapati
National Family Health Survey (NFHS)- 4 2014-15 is being conducted under the stewardship of the Ministry of Health and Family Welfare (MoHFW), Government of India, with the International Institute for Population Sciences (IIPS) Mumbai as the nodal agency, and technical assistance provided by United States Agency for International Development (USAID) through ICF Macro (presently known as ICF International). During Phase-I, IIHMR was selected as Field Agency to implement NFHS-4 2014-15 for 2 states- Uttarakhand and Madhya Pradesh -East. For the survey, information on fertility, mortality, maternal and child health, family planning, nutrition, utilization of services, etc was collected using Computer Assisted Personal Interviewing (CAPI) on mini laptops in 731 PSUs of 13 districts of Uttarakhand and 989 PSUs of 22 districts of Eastern Madhya Pradesh. The Clinical, Anthropometric and Biochemical (CAB) tests in NFHS-4 is expected to generate district level estimates for nutritional status and estimates of certain health indicators among eligible members of households CAB testing: a. Anaemia level: Children aged 6-59 months, women aged 15-49 and men aged 15-54; (b) Height: Children aged 0-59 months, women aged 15-49, and men aged 15-54; (c) Weight: Children aged 0-59 months, women aged 15-49 and men aged 15-54; (d) Blood Pressure: Women aged 15-49 and men aged 15-54; (e) Blood Glucose: Women aged 15-49 and men aged 15-54; (g) HIV Testing: Only selected respondents of men and women in a subsample of households (only in 50% of the households in 30% of the PSUs, i.e.,in 15% of HHs). Implementation was by IIHMR society through the campuses of Delhi, Jaipur, Bangalore and Kolkata. NFHS 4 field offices were established in the states of Dehradun in Uttarakhand and Jabalpur in MP. Mapping listing exercise was carried out in the states and field investigation teams were recruited. The core NFHS state team consisting of Project Coordinator, Demographer, Health Coordinator and IT Consultant attended a one month training of trainers (TOT) programme conducted by IIPS. State field investigation teams were provided 35 day training by the core team following which data collection was initiated. Data collection was wrapped up in both states in July 2015.
A Study On ‘Regional Profile On Health Workforce Education & Training In Countries Of The Searo
Funding Agency: WHO
Team: AK Khokhar and Shikha Bassi
A study on the “Assessment of Health Workforce Education and Training in Countries of the South-East Asia Region (SEARO)” was undertaken as a part of the resolutions of the sixty-fifth session of the WHO Regional Committee held in September 2012. A review of the current situation of health workforce education and training was conducted by the IIHMR in October 2014. The study reviewed the current situation of health workforce education and training using a ‘common protocol’ developed by WHO SEARO, to enable the formulation of an evidence-based policy for implementation. This report presents a cross-country analysis of the findings from the participating SEARO countries that would help in formulating a holistic document for development of regional strategies for strengthening education and training of the health workforce in the Region. This report is divided into four broad chapters. The first chapter provides an introduction to the review and assessments carried out by SEARO member countries. The second chapter discusses the national context of the health workforce development in SEARO countries, focussing on national basic indicators relating to country governance, economy, geographic and demographic scenario and the health status. The third chapter discusses the current state of Human Resources for Health (HRH) development in SEARO countries including the national health workforce education policies, strategies and plans, as well as the regional production capacities of medical, nursing, paramedical and public health colleges and Community Health Workers (CHW) training centres. The fourth chapter discusses the new initiatives and interventions, and future HRH development strategies in SEARO countries, including future HRH policies, strategies, plans, and the way forward
Delivery of Healthcare Services Among Migrant Population In Urban Areas Of India
Funding Agency: ICMR
Team: Preetha G S, Ganesh Ch Malick, Debasis Das, Anindya Basu, Suparto Majumdar and Dharmesh Lal
Most of the health problems in urban areas are vested in the urban slums where migrant population is concentrated. The health of urban poor is a great deal worse than that of urban middle and high-income groups, and is as pitiable as that of the rural population. The broad objectives of the study were to; (i) develop an association between poverty and migrant status and non-utilization of the existing healthcare, (ii) understand the health systems response towards the demand of growing mobile population in the urban areas and (iii) analyse the interventions for improving the healthcare delivery system among these migrants. The study was carried out among the migrant population of Kolkata and explored the effect of few selected interventions in improving the access to maternal and child health services.
Process Documentation of Drive Against Unqualified Practicing Doctors (Quack) In Haryana
Funding Agency: NHM, Haryana
Team: L.P. Singh, Radhika S. Adholeya and Sumant Swain
The process documentation of Anti Quackery drive was carried out in Jhajjar, Rohtak, Faridabad and Panipat districts of Haryana. Quacks were running parallel medical clinics and involved illegal practices which caused low sex ratio, high MMR and IMR. Health department conducted many anti quackery drive in both rural and urban areas, to stop illegal practices of quack leading to disastrous imbalance in sex ratio. The main theory behind the anti-quackery drive was to deter quacks to do such illegal activities and educate people for not doing these in-human activities. Anti-quackery Drive (AQD) was considered to be very well planned, confidential and astounding exercise. It involved multi dimensional approach and lots of melo-dramatic events. The main participants of such operations were FDA, Health care professionals, law enforcement department (Police), administrative department and legal cell.
Anemia Tracking Module (Atm): Process Documentation
Funding Agency: NHM, Haryana
Team: L.P. Singh, Anandhi Ramachandran and Arnika Sharma
Haryana has started using information technology for direct reporting of many of its health programs through its web portal for real time monitoring. One such initiative is the use of web portal for reverse tracking of anemia management. The program, known as ‘Anemia Tracking Module (ATM)’ has integrated ICT into the delivery of health care services in way that can effectively secure the goals of safe motherhood and child survival during delivery. The program was conceived by the State Rural Health Mission, Haryana, in 2012. It has been targeted to strengthen the provision of ANC services to pregnant mothers by reverse tracking those women suffering from anemia during pregnancy and coming to public facilities for institutional delivery.
The study deals primarily with process documentation of reverse tracking interventions of anemia of pregnant mothers through web portal. It summarizes the various steps involved from the data collection to the final tracking, and briefly discusses the flow of events. The key stakeholders involved, the flow of data, the main activities involved, the conceptual mapping of the web pages are summarized to provide a clear understanding of the system and its inter- related components to the program managers, developers, users and policy makers. The study also highlights the challenges as perceived by the stakeholders, impact of the process and the lessons learnt. Use of data and its interpretation, quality of the data gathered have also been analyzed and reported.
Descriptive Evaluation of Postpartum Family Planning Integration Models In India
Funding Agency: Jhpiego, India
Team: LP Singh, BS Singh, Preetha GS, Vinay Tripathi, Vanishree MR, Gaurav Srivastava, Asghar Abbas
IIHMR Delhi carried out a descriptive evaluation of various integrated PPFP implementation models, implemented by Jhpiego India and supported by United States Agency for International Development (USAID) and The Bill and Melinda Gates Foundation. The objectives of evaluation were to describe the implementation models used to integrate PPFP into the following service areas: antenatal care (ANC), labor and delivery (L&D), PNC, maternal, infant and young child nutrition (MIYCN), and outreach services, to understand the barriers and facilitating factors related to the implementation and scale up of model, to describe client perceptions of each model and understand client satisfaction with the integrated nature and quality of care received. Mix method- quantitative and qualitative approach was adopted under this study. Under this study, 6 district hospitals from three districts in Bihar (Muzaffarpur, Bhagalpur & Gaya) and three districts in Jharkhand (Simdega, Latehar & Dumka) and 15 sub-center in Muzaffarpur, Bhagalpur & Gaya districts of Bihar has been selected using purposive sampling to carry out this study. The CommCare platform on a six Nexus 2013 7-inch tablets has been used to administer the structured quantitative surveys. Once a survey instrument has been entered and reviewed, an internet connection via Wi-Fi was used to upload the data to a cloud server. The method of data collection were (a) IDIs with key informant- Health Administrators, Health Managers (b) IDIs with Facility in-charge (c) IDIs with Facility-based service provider- Gynecologist, Child specialist (d) IDIs with Facility based service provider- ANMs, Nurse (e) Community-based service provider- ASHAs (f) interview with pregnant and newly-delivered women at hospital and collection of Integration client flow form at Hospital. Report on data collection was submitted to Jhpiego.
Assessing Value for Money of Health Interventions of Dfid In Bihar, Madhya Pradesh And Orissa
Funding Agency: Itad-Opm
Team: Preetha GS, Anupama Sharma, Vinay Tripathi, Kirti Udayai, Anandhi Ramachandran, L P Singh, Sumant Swain, Nemika Relhan, Gaurav Srivastava, Isha Rani
DFID supports interventions in the form of either financial or technical assistance in health, nutrition and sanitation areas in its three focus states in India – Bihar, Madhya Pradesh and Orissa. As a part of the ITAD-OPM led evaluation of DFID’s value for money in these states, five case studies are being conducted by IIHMR Delhi to inform the core evaluation team about the ground level evidences on whether or to what extent DFID-supported interventions are successful in aligning to DFID’s sectoral policy goals and to supplement the general knowledge on the value for money of DFID’s investment in these three states. Each case study is focusing on economy, efficiency, effectiveness, and equity aspects of the interventions addressing community mobilization, quality of services, access to priority services in underserved areas, strengthening demand for and supply of water, sanitation and hygiene and strengthening public health management system.
Let Girls Be Born
Funding Agency: Plan International
Team: Minakshi Gautam, Sumant Swain, Nutan Jain, L.P. Singh
The female-male sex ratio is alarming in the states of Uttar Pradesh, Uttaranchal, Rajasthan, Jharkhand, Bihar and Union Territory of Delhi. The data on birth registration also gives a grey picture. Comparing with the national data, the birth registration percentage is at a lowers side in all these regions. The main objective of the study is to realize a gender balance in society by eliminating female foeticide and infanticide and ensuring the right to identify, name and citizenship. The project is implemented in 20 Panchayats of two districts in each region. Plan India is implementing this project in intervention areas with support of eight NGO partners. The project is in the second year of intervention. Efforts for MIS collection, district and state level advocacy is going on. IIHMR Delhi has strengthening MIS collection part in the project and did district and state level advocacy. The final report is being compiled.
Introduction Of User Fees In District Hospital, Mon, Nagaland
Funding Agency: MÉDECINS SANS FRONTIÈRES (MSF)
Team: Preetha G.S, Vanishree MR and L P Singh
The overall objective of the study is to propose a User Fee Model for Mon District Hospital, Nagaland focusing towards mobilization of collected funds for effective maintenance of selected hospital services with appropriate accountability and transparency at all level of the system. Viewpoints of different stakeholders- Commissioner Secretary Health, MD NRHM and other officials of the Department of Health, Government of Nagaland - Finally, Standardized User Fee has been proposed on various health services delivered (excluding drugs & diagnostic) for Mon District Hospital, Nagaland.
The Cigarettes and Other Tobacco Products Act (Cotpa): Compliance Assessment Survey In 3 Districts In India
Funding Agency: PSI
Team: Dharmesh Lal, Pawan Kumar Taneja, Sumant Swain, Pradip Kumar, Asghar Abbas
Tobacco use is the largest cause of preventable death among adults in India. Nearly 4.52 trillion cigarettes and 40.3 trillion bidis have been produced between 1910 and 2010. Tobacco is responsible for nearly 100 million premature deaths in adult men of greater and equal to 35 years between 1910 and 2010. According to an estimate, one in every 10 adult deaths in India is smoking related. According to GATS 2010 survey, more than one-third of adults in India use tobacco in some form or the other. Indian Parliament has enacted Indian Tobacco Control Act titled “The Cigarettes and other Tobacco Products Act (COTPA)” in 2003. The main objective of the study was to study the level of compliance of people and entities such as public places and workplaces with section 4, 5, 6 of the Act.
Mapping Of Existence And Functionality Of Birth Registration Centres In Afghanistan
Funding Agency: UNICEF, Afghanistan
Team: Anupama Sharma, Nutan Jain, L.P. Singh
UNICEF Kabul is supporting the Civil Registration Department of the Ministry of Interior, Islamic Republic of Afghanistan in assessing the functionality of existing birth registration centres and thereby developing cost effective strategies to enhance birth registration status at community level. IIHMR conducted the study on “Mapping of Existence and Functionality of Birth Registration Centres in Afghanistan” in 13 priority provinces, funded by UNICEF and supported by Ministry of Interior. This mapping exercise provided a window of opportunity for the Civil Registration Department and other stakeholders involved in birth registration to assess the status, gaps and challenges lies at central, provincial and district level. This is first phase of the comprehensive national assessment. The second phase pertaining 21 provinces is scheduled for later 2013. Post successful completion of birth registration system analysis national strategic plan was formulated. The study findings and plan were discussed among stakeholders representing various ministries and UN organizations in workshop held at Kabul.
Comprehensive Non-Communicable Diseases (Ncd) Initiative in India: Phase I Partnership
Funding Agency: Medtronic Foundation, USA
Team: Preetha G.S, Vinay Tripathi, Anandhi Ramachandran, L P Singh, Isha Rani
The project involved a situational analysis of the prevalence of the NCD risk factors in the general population, knowledge, attitudes and practices regarding NCDs and Continuum of care and an assessment of the health system’s capacity to respond to their needs. The study areas were Udaipur in Rajasthan and Shimla in Himachal Pradesh. The situational analysis was carried out to develop a district plan of action, which would be implemented in later stages.
A Qualitative Research to Understand the Perceived Opportunities and Barriers For Prevention and Management Of Diabetes and Hbp Among General Population in Sonepat District Of Haryana
Funding Agency: PSI
Team: Preetha G.S, Vinay Tripathi, L P Singh, Sumant Swain, Gaurav, Asghar Abbas
Main goal of this study was to determine awareness & knowledge level about diabetes and high blood pressure among population aged 30 years or above, self management/care skills among those diagnosed with diabetes and HBP in the Sonepat district of Haryana. The specific objectives of the study were: (i) to determine the awareness about symptoms, course, management and complications of diabetes mellitus and HBP among the general population; (ii) to understand perceived risk and susceptibility due to diabetes mellitus, HBP and related symptoms among general population; (iii) to assess the behaviour and practices of those affected with diabetes mellitus and HBP in managing their condition; (iv) to understand the opportunities and barriers to utilize health care services especially among those suffering with DM & HBP. The respondents under the study were self reported diabetic, hypertensive, diabetic and hypertensive (co-morbidity) as well as those who were neither diabetic nor hypertensive (healthy) cases or subjects.
Consulting Services on District Level Network Approaches for Scaling Impact, Family Health Learning And Knowledge Sharing India Initiative In Bihar
Funding Agency: Bill & Melinda Gates Foundation
Team: Anupama Sharma, L P Singh, Dharmesh Lal, Pawan Kumar Taneja, Meenakshi Gautam, Kirti Udayai, Vanishree MR, Suparna Pal
The objective of the study was to identify and leverage those government officials uniquely positioned to influence: the initiation of scale-up MNCH solutions (brokers), the adoption of scale-up practices (connectors), and the feedback or real-time assessment of scale-up implementation (sensors). The study was conducted in 16 innovation and scale up districts of Bihar. The study aimed at facilitating government and non-government organizations achieving Ananya program goals. It was found that overall the density of all networks is low, signifying a (relatively) low number of links between the government officials in the network. People have about twice as many links within their block/district as outside their block district. Most contacts take place a weekly or monthly basis. These relationships are most often used to share knowledge and to a (marginally) lesser extent for advice and influence. The number of links correlates strongly with the roles of health officials. Lady supervisors are poorly connected where as civil surgeons are strongly connected to others in the field. The overall readiness to adopt new family health innovations is high and so is the (perceived) likelihood that officials will be influenced by their peers. The readiness varies per district and is higher for scale up district.
Appraisal of Save A Mother –Effective Persuasion Platform, Maternal Health Interventions Under Rajiv Gandhi Mahila Vikas Pariyojna (Rgmvp) In Amethi, Up
Funding Agency: Rajiv Gandhi Foundation
Team: Anupama Sharma, Shikha Bassi, L.P. Singh
The study was carried out to validate the process and procedures undertaken by Save A Mother for improving maternal health in Amethi district. Using Effective Social Persuasion Platform (ESP), Save A Mother Foundation (SAM) under Rajiv Gandhi Mahila Vikas Pariyojna (RGMVP) introduced Swasthya Sakhi (female health volunteers) per village. This model was evaluated by IIHMR for further scaling up in districts of UP. The methodology consisted of focus group discussions and in depth interviews of the intervention group. The study showed SHG and community support were effectively utilized for generating demand for maternal services.
Situation Analysis and Need Assessment of Mon District Hospital, Mon, Nagaland
Funding Agency: Médecins Sans Frontières (MSF)
Team: Nutan Jain, Minakshi Gautam, Asghar Abbas, L.P. Singh
The objective of the study was to develop the road map for MSF to attain its objectives of making hospital well functional. Situation analysis was carried out through external and internal environment analysis and issues related to governance and its impact on health system, infrastructure, drug and supplies, policy and planning, decision making, human resources and communications were considered for the study. The study focused on investigating the gaps creating roadblocks for MSF and the Government of Nagaland from forming a successful collaboration. Case-control study design was selected. Organization culture was studied using human resource development instruments to analyze the two important aspects of organizational ethos and organizational climate. An action plan was developed as a guiding map for MSG to successfully achieve their deliverables.
Testing and Validating Key Strategies of Urban Health Initiative to Increase Contraceptive Prevalence in Uttar Pradesh (Up)
Funding Agency: UHI
Team: Preetha G S, Sangram Kishor Patel, Pawan Kumar Taneja, Sumant Swain, Pradip Kumar, Asghar Abbas
The project was funded by Bill and Melinda Gates Foundation and subcontracted by FHI to IIHMR. The study areas were Agra and Aligarh in UP. The methodology consisted of qualitative data collection and hence study techniques consisted of in depth interviews, focus group discussions, observations and facility assessments. Data collection was done during 2012. A total of 6 briefs were prepared and shared with UHI. The team made presentations at a dissemination meeting organized by UHI in September 2012.
Landscaping Analysis for Misoprostol and Other Uterotonics for Pph Management
Funding Agency: PSI
Team: Dharmesh Lal, Anandhi Ramachandran, Pawan Kumar Taneja, Pradip Kumar, Asghar Abbas
The study provided a comprehensive field perspective of use and availability of Misoprostol and other Uterotonics for the prevention and treatment of post-partum haemorrhage (PPH) in the states of Bihar and UP. The methodology consisted of in-depth interviews among state, district,block officials and other stakeholders of PPH prevention and treatment, survey through structured questionnaires among the providers and chemists. The districts of Patna and Gaya of Bihar, Kanpur Nagar and Barabanki of UP were the area where study was conducted.
Health Seeking Behavior Among Slum People Including Coverage and Practice Of Exclusive Breast Feeding, Essential Immunization And Its Impact on Health Of Children
Funding Agency: Plan International
Team: Pawan Kumar Taneja, Dharmesh Lal, Sangram Kishor Patel, Preetha G S, Sumant Swain
Disadvantaged children have reduced chances of survival, higher risks of preventable and curable illness and malnutrition, primarily because their right to healthcare and treatment is often denied. The plan International has implemented a project in the slum areas of Delhi -Dwarka, Uttamnagar, Holambi Kalan and Rangpuri Pahadi to access health facilities and health programs. The aim of the study was to understand the health care seeking behavior of the community for child health including childhood immunizations as well as assess the child rearing practices including breast feeding. The findings of the study were that the average family size (6.1%) was much higher than the national average 4.8% (NFHS-3) which has indirect negative effects on the health status of community. Majority of the population were using local government/private facilities for routine ailments but for serious medical conditions they usually preferred to visit government hospitals. More than half of the pregnant women had 3 or more ANC visits.
Conduct the End Line Evaluation of The Ors-Zinc Project In Lalitpur District Of Uttar Pradesh
Funding Agency: HLFPPT and UNICEF, Lucknow
Team: Pawan Kumar Taneja, Dharmesh Lal, Sanjiv Kumar, Sumant Swain
Diarrhea is one of the major causes of death among children under five years of age in the Lalitpur District of Uttar Pradesh. The UNICEF in partnership with HLFPPT implemented a project to promote access, awareness and use of ORS and Zinc through social marketing in Lalitpur district of Uttar Pradesh. The project was conceived after realizing the expressed needs of the district officials to increase the awareness, availability and use of ORS and Zinc. The main aim of the study was to educate the health care providers and the community to improve the use of ORS and ZINC in children with diarrhea. The findings revealed that the prevalence of diarrhea among children declined from 22.7% to 18.2% and there was a substantial increase in hand washing practices of mothers before feeding their children. This project successfully established a network for distribution of ORS & Zinc using the chain of supply available in the private market.
Conduct The Rapid Assessment Of The Utilization Of Converted Dry Latrines In Badaun District Of Uttar Pradesh
Funding Agency: UNICEF, Lucknow
Team: Sanjiv Kumar, Dharmesh Lal, Pawan Kumar Taneja, Sangram Kishor Patel
Converting Dry Latrines (CDL) was seen as an urgent priority in elimination of transmission of wild polio virus (WPV) in Badaun district of Uttar Pradesh. A campaign to convert dry latrines into flush latrines was launched in October 2009 under the leadership of the District Magistrate. A rapid assessment study had been carried out in partnership with UNICEF, Lucknow by the IIHMR team. The primary objective of the study was to assess and understand the utilization/non-utilization of the converted dry latrines (CDL) within the overall context of acceleration in rural sanitation coverage particularly through Government efforts including the national flagship programme of Total Sanitation Campaign (TSC). The study results suggested that the households who have converted dry latrines experienced a decline in diseases like diarrhea and wild polio virus (WPV). Conversion also showed a marked improvement in cleanliness and hygiene. The toilet was easy to clean and maintain which resulted in lesser episodes of illnesses amongst children.
Assessment of Vulnerability, Impact and Adaptation for Climate Sensitive Diseases at the Local Level in India
Team: Nitish K. Dogra, Sangram Kishor Patel, Maitreyi Kollegal, Barun Kanjilal and Gautam Sadhu
Vulnerability, Impact and Adaptation Assessment for climate-sensitive health outcomes are undoubtedly the need of hour at global, national, regional and local levels. IIHMR conducted the study of climate sensitive diseases i.e. diarrhea, vector-borne diseases and malnutrition among vulnerable rural populations in drought and flood prone block located in two districts of Haryana. The primary objective of the study was to assess the current vulnerability, impact and adaptation at the local level to climate-sensitive diseases. The key findings of the study were that Mewat emerged as the most vulnerable district in the Haryana state on the Climate Vulnerability Index where as the comparison district of Rewari ranked at 13 out of 20 districts. On impact assessment temperature was founded to be related to diarrhea in both districts even after adjustment for confounders. Adaptation measures for climate and climate sensitive diseases were more strongly adopted in Rewari as compared to Mewat.
Empowering Dairy Cooperatives on Reproductive and Social Health Through Knowledge Power
Funding Agency: ICMR
Team: N Ravichandran and Sandhya Ramakrishnan
The knowledge and awareness regarding the reproductive health is very poor among the Dairy Cooperative members. To generate awareness and knowledge amongst them, this project was designed to implement in Rewari District of Haryana with support from ICMR. This was the pilot project which was implemented with the support of Non Governmental Organization for a period of two years. The main objective was to undertake a pre-intervention audit regarding health and empowerment with both providers and clients (women, men and cooperative leaders). It focused on the reproductive and sexual health issues to set the bench mark for intervention impact. The project included organizing health as well as skill building programs for young people and community members with the support of active leaders within the community. To improve the health status of dairy collectives, one representative of each village from Rewari district and 60% of the village representatives from Mahendergarh district were covered for awareness and skill building trainings were organized to address the above issues.
To Study the Quality of Iucd Services for Promoting the Spacing Between Children in Madhya Pradesh
Funding Agency: JSK, MoHFW, Govt of India
Team: Dharmesh Lal, Sangram Kishor Patel, Sumanta Swain, Devendra Tanwar
Acceptance of IUCD is one of the important contraceptive methods for spacing between children which has linkages with the decline in fertility and population growth. The study was conducted in Datia, Rajgarh and Katni district of Madhya Pradesh. The specific objectives were to study the quality of IUCD services, the causes of retention and discontinuation and the potential solutions for promoting the spacing between children in the state of Madhya Pradesh. The study found that in majority of cases the women generally used IUCD after the birth of their second child only. Retention rate of IUCD was not good enough in the state and its main reasons were the couple’s desire for more children, switching to other methods (mainly sterilization), irregular bleeding, backache, pain after insertion, induced menstrual problems, feeling of discomfort after IUCD insertion, infection or increase in vaginal discharge etc. Main complications faced by acceptors after the insertion of IUCD were backache, irregular bleeding, pain abdomen, white watery discharge, swelling of abdominal, mennorhagia and abnormal menstrual cycle.
Providing Mentoring Support to Nhsrc For Planning And Implementation Of National Rural Health Mission In The State Of Haryana
Funding Agency: NHSRC
Team: Sandeep Bhalla, Nitish Dogra, Sangram Kishor Patel and Sumant Swain
The District Health Action Plan is the most important unit of the planning process as the Government of India and the state government would monitor the progress of NRHM implementation district wise. To make District health Plans more meaningful and address local health problems, preparation of Block Health Plans was considered essential. The main objective of the project was to develop the capacity building among the district health personnel to prepare the District and Village Health Action Plan in the district of Gurgaon, Rewari, Sonepat and Mewat of Haryana. The institute prepared the Block and District Health Action Plan in all the district of Haryana from 2008 to 2010.The team developed capacity building among local health care providers and managers for sustainability and use of District and Village Health Action Plan.
Independent Evaluation of National Leprosy Eradication Programme In India (Nlep)
Team: S D Gupta, N Ravichandran, Barun Kanjilal, Santosh Kumar, Neetu Purohit, Sumant Swain
The study attempted to assess the quantitative and qualitative achievement made under different components of NLEP until March 2007 and build complete understanding of the programme impact. The main objectives were to assess leprosy activities on specified indicators of elimination, integration, quality of MDT services, and adequacy of drug supply. It also aimed at monitoring and assessing the disability prevention and medical rehabilitation services provided. The decentralization and integration of the leprosy programme with general health services resulted in reducing the prevalence rate at the end of March 2007 to 0.72, from 3.74 in 2001 with a slight increment of 0.77 at the end of the December 2007. During the study it was found that the high endemic states ranked high in new case detection.
Out of Pocket Revenue Models In Indian Health Care System
Agency: European Commission
Team: N Ravichandran and Sandhya Ramakrishnan
India is one among the developing countries where households spend a disproportionate share of their consumption expenditure on health care, with the Government’s contribution being minimal. The main objective of the project was to analyze the emerging out of pocket revenue model in Indian health care and its possible impact on the poor. The findings included Out of Pocket Revenue Models which showed that subscribers have complained of high out-of-pocket expenses due to slow reimbursement and incomplete coverage for private health care. In most of the cases only 80% of cost is reimbursed if referral is made to private facility. Such referrals are made for the services which are not available with the CGHS.
Access, Variety And Cost In Regional Health Care
Agency: European Commission
Team: N Ravichandran and Sandhya Ramakrishnan
In healthcare most of services require that patient’s meet a prepared provider in person; therefore services become time and location constraint and regional in nature. Continuity of care also refers to care provided for 24 hours a day, 7 days a week and 365 days per year. This includes access to non-urgent or long-term care as well as acute care integrated within local or regional healthcare systems. The main objective was to assess the time and trouble a patient experiences from his or her first contact with a health care provider, the range and level of specialization available at a point of service and the unit cost of treatment in rural and remote areas. A positive correlation was found to be present between the availability of health workers and better health outcomes, as well as increased coverage of essential health interventions. The absence of well educated and properly managed health workers was also identified as one of the health systems constraints to achieve the MDGs. The other constraints included poor infrastructure, poor drugs supply systems, and poor information systems. In most of cases rural and remote areas are lacking sufficient numbers of health workers.
Measurement of Client Satisfaction In Employees State Insurance Corporation (Esic) Hospitals
Agency: ESIC, New Delhi
Team: N Ravichandran, Sandhya Ramakrishnan, Santosh Kumar and Sumant Swain
Quality of service and satisfaction of both employees and patients is prerequisite indicator of the effectiveness of the hospital services. Measurement of Client Satisfaction in Employees State Insurance Corporation (ESIC) was carried out in 21 ESIC hospitals spreading over 17 states in India. The aim of the study was to measure the satisfaction level of all stake holders viz. insured persons, dependents, employers and ESI Corporation employees. The study concluded that overall satisfaction level of all stakeholders in all the ESICs hospital services was high in comparison to State-run dispensaries where it was found to be satisfactory. This reflected that nearly one out of ten patients had not shown any interest to reuse the ESICs hospital services.