We conduct research before a program is designed and implemented, or while a program is being conducted, to understand community in which the project is implemented, and helps implementers understand the interests, characteristics and needs of different groups and individuals in the community. We also research and develop strategies while the program is on-going to help refine and improve program activities.
In India, the recent years have shown a reduction in infant mortality rate 42 (2012) deaths per 1000 live births and maternal mortality ratio190 (2013) deaths per 10,000 live births. Still the country has a long way to achieve the millennium developmental goal (MDG), IMR to 28 and MMR to 109 by the year 2015. An observational study conducted in Karnataka, India revealed that counseling on the major causes of maternal and neonatal deaths at the time of discharge after delivery occurred less than 1%. In the Wardha region of Maharashtra state, India 67% of mothers knew of one danger sign.Another studyin the Wardha region of Maharashtra, India demonstrated health education delivered through simple e-Health messages using local words for newborn danger signs and pictures to pregnant women’s groups significantly improved the mothers' knowledge regarding newborn danger signs. These studies showed that education provided on danger signs with the use of simple appropriate tools increased their knowledge on danger signs. Considering these facts, the Mother/Baby 7-day mCheckprogrammewas developed by WHO Patients for Patient Safety Champions, a network of patients from around the globe who are committed to improving patient safety by empowering patients. The mCheck intervention educated mothers using a paper tool, a video film, and reminder voice messages. The six danger signs for mothers and six danger signs for babies were explained to mother with the help of the paper tool and the video film after delivery. Automated reminder voice messages were sent to mothers on their mobile phone during the first 7 days of delivery. Each day message had one mother and one baby danger sign mentioned and advised the mother to refer to the paper tool given in the hospital and on identifying any danger signs, was advised to seek medical care immediately. After 7- 21 days of getting discharge from the hospital, mothers' knowledge was assessed.
FRHS and WHO with the funding support of Bill and Melinda Gates foundation conducted a study in Mysore district of Karnataka from April- October 2013 to assess the impact of mCheckintervention on educating mothers on danger signs in order to improve their health seeking behavior. The study was conducted in three government health facilities. The study measured the improvements in mother’s knowledge of danger signs, ability to identify complications and their health seeking behaviour as a result of the program interventions. Comparison was made between the knowledge of two groups of mothers- those who did not undergo the mCheck program interventions and those who went through the mCheckintervention.
We partnered with Association for Promoting Social Action, Bangalore (APSA) and developed certain toolkits for their programme, Sexual Health Intervention Programme(SHIP), and helped them evaluate the same. We provide the technical expertise and assistance required to monitor and evaluate the programme.
The toolkits designed and developed for the APSA-SHIP programme included children's sexual health toolkit which was tailored for the largely illiterate population of street children. Creative and fun games were used as a tool to discuss subjects that are often too complex and difficult for both the facilitators and the children. We designed and implemented a training programme for the partner NGOs to make sure that their facilitators were well equipped to deal with complex issues faced by street children.
We used an extensive monitoring and evaluation technique to monitor the APSA-SHIP programme. We constantly monitored and evaluated the materials given to the facilitators to reach out to the street children. We also monitored the response of the street children to these programmes in terms of attendance, behavioral change in the children, and so on.
The World Health Organization's Adolescent Health and Development team (ADH) has developed the Orientation Programme on Adolescent Health and the Adolescent Job Aid to build health care providers (mainly doctors at primary health centres) to respond to health needs of young patients, effectively and sensitively. In collaboration with ICRW, New Delhi, the tools were pilot tested in one block in Gujarat by undertaking training of 25 doctors and after one year assessing the impact of training on provider knowledge and attitudes, client-provider interactions, and facility preparedness to deal with young clients through before and after survey. The project did not have a control block for comparison.
Funding Source: WHO and Government of Gujarat
This project was undertaken in five South Asian countries: Bangladesh, India, Nepal, Pakistan and Sri Lanka. The objective of this work was to develop a simple- practical tool to facilitate evidence-based planning at sub-national level. This Decentralized Action Planning (DAP) Tool was developed in consultation with national experts, using principles of Total Quality Management. The report (Action Planning for Women's Reproductive Health Services in South Asia: A Report) describes decentralized planning experiences at five study sites using the tool in the context of reproductive health of the poor in South Asia. The manual (Manual for Reproductive Health Decentralized Action Planning) guides the user step -by-step on how to use this tool. It provides: templates for compiling the required data/evidence for planning, lists of important stakeholders who should be consulted, exercises to stimulate informed discussion leading to practical planning, guidance to facilitators of the consultative meetings and templates for the resulting action plans. The DAP tool is in use the health systems development program in Srilanka and Karnataka.
The focus of this five-year action research project (2000 - 2005) in Ahmednagar district of Maharashtra was on developing effective reproductive health program appropriate in the broader context of married adolescent's lives, their families and communities, which reluctantly acknowledge if at all, reproductive health problems of adolescent married girls. The intervention involved creating community level groups of adolescent married girls and their husbands and to give them training and support to recognize their health problems and seek treatment. The project tried three strategies: 1- mobilizing community groups only, 2- only sensitizing community level care providers to the reproductive health needs of the adolescent girls; 3- combining the strategies 1 and 2. After testing each strategy in 2 PHC for 18 months, strategy-1 recorded the highest impact and strategy 3 the lowest, on adolescent girls getting treatment for their Gynaecological problems. The lesson: expecting health workers to also mobilize demand for their services might be the least effective strategy; creating community based civic intermediaries for this purpose is likely to be most effective.
This operations research was carried out from July 2000 - June 2003, where a new model of village health committee was piloted in Hunsur block of Mysore district in Karnataka, to re-vitalize community involvement in RCH program. In the new model incorporated 5 distinct features from the earlier committee: 1. villagers nominated members to this committee, not the government; committees were given a small amount for any expenditure, each committee was needed to organize health related to activities in their areas, committee presidents presented their achievements in block level meetings to other committee presidents, committee members viewed their role as of facilitating helping government health staff and not monitoring them. Of the 62 committees formed, 25 percent remained very active during and even after the project period; 65 percent were moderately active underrating one or two health related activities per year, while 10 percent never functioned. Impact evaluation showed that out 7 outcome indicators having low achievement at the baseline (less than 70%), 5 showed significant gain (>5 points) in the pilot block while 3 showed similar gains in the control block where another NGO program was operational (since the state government had permitted us to compare our results with another NGO's program that was implementing WHO decentralized planning model and not with government regular program.
This project was undertaken in two rural blocks of Mysore (resource-rich setting) and Raichur (resource-poor setting) districts in Karnataka. The project aimed at improving quality of care provided by private practitioners operating out of clinic or nursing homes, who are usually the first contact doctors of people living with HIV/AIDS. The pre and post evaluation showed high level of knowledge retention, increased referral from private doctors to NGO, and better confidentiality and sensitivity towards patients. The impact was more pronounced in resource-poor region than in the resource-rich region. A reference manual (HIV/AIDS Management at Primary Level) developed in the project is being used by the St. John's Medical college in training private medical practitioners.
This five year action research project was conducted from 1994- 1999 in Parner block, Ahmednagar district, Maharashtra, in partnership with district health administration. The project was aimed at identifying measures needed to improve accessibility and quality of reproductive health service delivery in rural India. The project tested feasibility and effectiveness of four such measures: (i) moving provision of antenatal care from sub-center to village level on a fixed day, fixed time basis; (ii) ANMs providing RH services at village camps on fixed days instead of she going from house to house in each village; (iii) putting in place stringent monitoring mechanisms through which services to all pregnant women and children were tracked; availability of equipment and supplies ensured (iv) introducing regular on-the-job training for health workers to build their skills and confidence in providing RCH services.
The project demonstrated the feasibility of establishing an efficient service delivery system with minimum additional inputs. The end evaluation of the project after 18 months (Operations Research in Health Systems Development: Innovative Approaches) revealed that "Full" Ante-natal care increased from 46% to 65%. The increase was much higher among those living in remote villages. An ANM kit, designed in this project to take ANC services from Subcenter to villages, is now being used widely in the state.
A retrospective case-control study was carried out to explore non-medical factors responsible for persistent high maternal mortality in India. The study was conducted in three states: Andhra Pradesh, Madhya Pradesh and Orissa. The factors distinguishing between cases of maternal deaths and control of women who experienced complications but survived were not the delays or efforts on part of family members to seek care but the contact they had with health workers during third trimester of pregnancy and during postnatal period. The study highlighted the need for health workers to maintain contact with pregnant women and provide care during third trimester and postnatal period, which still is a weak link in the maternal care program.
This qualitative research study was undertaken in Udaipur district, to understand the community-level constraints in tackling the low-birth weight issue to help develop interventions targeted at adolescents, young couples, pre-pregnancy and early pregnancy periods. Add a few lines of finding.
This qualitative research study was undertaken in Udaipur district, to understand the community-level constraints in tackling the low-birth weight issue to help develop interventions targeted at adolescents, young couples, pre-pregnancy and early pregnancy periods. The study (Care and Support of Unmarried Adolescent Girls in Rajasthan) showed that many parents wanted to take extra care of their daughter's health and nutrition in anticipation of her marriage and childbearing. They believed that early marriage causes poor health outcomes but were not able to overcome the social pressure to marry their daughters, early. After marriage, couples seemed to discuss and agree about when to have the first child, yet almost never resort to using contraception. Hence, many have their first child in the first year of marriage. Among pregnant women, reducing food intake during pregnancy ("eating down") to ensure a small baby and easy delivery is less common than previously thought. However, women and their families frequently reported that women should continue doing their domestic and agricultural work to ensure easy delivery, except the heaviest work.
This study was carried out in three blocks of Ranchi district in Jharkhand, to understand client perceptions of quality of abortion care, and constraints they face in accessing abortion care in the state. In-depth interviews were conducted with abortion service clients, providers, and key informants in the three blocks and district headquarters. Findings (Quality of abortion care: Perspectives of clients and providers in Jharkhand) suggest that while both clients and providers perceive a similar set of elements in their definitions of quality (example: provision of information, confidentiality, provider-client interaction, technical competence, facilities, cost, post-abortion care, and counselling), the priority placed on individual elements varied considerably. While providers ranked technical skills of provider above all, clients gave relatively more priority to confidentiality, provider attitudes, cost and up-keep of the facility. Neither providers nor clients identified the need for information as an important aspect of quality. Not a single client referred to provision of information or absence of spousal consent as being important in her choice of provider. Our findings suggest that the unambiguous stipulations of the MTP Act to ensure provider skills and physical standards of the facility, while obviously necessary, are far from sufficient in attracting clients to certified providers and registered facilities.
As a part of the World Bank SAS/HNP unit's Analytical and Advisory Activity (AAA) on "Better Reproductive Health for Poor Women in South Asia" FRHS carried out a study to understand how poor women define quality of reproductive health (RH) care and what barriers they encounter in accessing quality RH services. The study was carried out in rural areas of Chhattigarh, Karnataka and Rajasthan. This study used an analytical framework to synthesize supply side factors that determined service quality and demand side factors that determined client's willingness to seek care and concluded that reproductive health of women improves only to the extent that both demand and supply sides interventions help to improve client's ability to get quality care. To poor women service "quality" meant physical access, affordability and effective treatment. Their "ability" to get care depended on their awareness of problem, acceptability of service providers and availability of family / financial support.
A study was done in Parner block of Ahmednagar district in Maharashtra to understand the knowledge, attitude and behaviour and the reproductive health needs of married adolescent girls as perceived by them and by their influential members. Data was collected through in-depth interviews from married adolescent girls, their husbands and mothers-in-law.
The data (Use of Reproductive Health Services byMarried Adolescent Females: A Report) showed that childbearing was perceived by all as a normal physiological phenomenon with negligible associated risks, and gynaecological problems as an unavoidable aspect of being a woman. Delivery and post natal period in particular were viewed as entirely "Women's domain" by both the sexes. Modern spacing methods were preferred by girls and natural spacing or "self control" by the mothers-in-law. MTP was seen as an acceptable form of limiting family by a number of husbands.
The girls were either unaware that their reproductive problems were treatable or were discouraged by family members from mentioning their condition. While husbands were either ignorant of or believed that women's illnesses were in "Women's domain". Those aware helped their wives seek treatment. Mothers-in-law, though better informed generally endorsed more traditional treatments, many of which were inconsistent with modern medicine. The study suggested that it would be more realistic to build reproductive health services for adolescent married girls within the existing women's health services and make them gender (male) sensitive as the husbands and mothers-in-law influenced women's health seeking behaviour.