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Research Projects/Studies Completed Year-2010-2011

KAP Survey of Increased Demand for Health Services Utilization in Afghanistan

Agency:Ministry of Public Health,Afghanistan

Project Team:L.P. Singh, Manish Kumar, ACTD Team

The project was mandated to study the factors responsible for the low utilization of basic health services and the factors that can be built up further to enhance use of public health facilities in the six representative provinces of Afghanistan, namely Kabul, Herat, Baghlan, Bamyan, Laghman and Paktya.

The study revealed that people liked to avail themselves of public health services, but perceived poor quality of services, non availability of service providers and their attitude towards health seekers as major deterrents in optimal usage of these services. A major issue raised in quality of health services was that of privacy while examining patients in general and women patients in particular.

Based on the study, a communication strategy to improve the access to health services in Afghanistan has been evolved and submitted to MOPH.

Afghanistan Mortality Survey

Project Team:S.D. Gupta, L.P. Singh, Arindam Das, N.K. Sharma, Laxman Sharma, Manish Kumar, Dushyant Mishra, Manoj Soni, Suhail Ismail Shiekh, Jaya Swarup Mohanty

The Afghanistan mortality survey is a unique and first of its kind project being undertaken in the whole of Afghanistan. It will provide various demographic indicators related to mortality and fertility of the country, with special emphasis on maternal and child mortality. Besides it will also provide data on the socio-economic situation of the population.

The survey including training and pre-testing was started during February 2010 and it was completed in December 2010 covering 714 clusters throughout the country.

A report writing workshop is scheduled in April-May 2011 and the dissemination of the report will be in June 2011.

An Evaluation of the Role of Artificial Limbs and Economic Support in Improving Quality of Life of Physically Challenged People

Agency:Bhagwan Mahaveer Viklang Sahayata Samiti (BMVSS), Jaipur

Project Team:R.S. Goyal

The main objectives of this study were to assess the contribution of artificial limbs and economic support provided by BMVSS, Jaipur in improving the quality of life for physically challenged people. This study is based on individual interviews with nearly 550 randomly selected beneficiaries of the program spread over past ten years. The study has examined the improvement in the quality of life of beneficiaries from the perspective of emotional, personal and social life, ability to perform the activities of daily life as well as ability to follow economic pursuits.

The findings give a deep insight into the process of adaptation of artificial support system to manage the life by physically challenged people.

Determining the Application of Spirituality in Health Care and Patient Care

Agency: Bhakti Vedanta Hospital, Mumbai

Project Team:Santosh Kumar, Atul Mehta, Dushyant Mishra

In due recognition of the significance of spiritual care, the Bhakti Vedanta Hospital, Mumbai had entrusted the Institute with the task to conduct a study on application of spirituality in health and patient care. The study aimed to determine the impact of spiritual care and its application in healthcare.

The study was undertaken in all the functional areas of the Bhakti Vedanta Hospital. A total of 551 patients and 351 hospital staff were interviewed to assess their perception about spiritual care and its effect on their lives. Nearly 70 percent of the patients agreed that spiritual interventions at the hospital had made a significant difference in their life. About 97 percent of the patients reported that their depression level had reduced. Reduction in blood pressure level, de-addiction to smoking and drinking and change in food habits were important benefits reported by the patients.

Pragya: Multi-Sectoral Gendered Approach to Improve Family Planning/Reproductive Health: A Qualitative Retrospective Study

Agency:Pathfinder International, New Delhi

Project Team:Nutan Jain, Vivek Khurana, Navneet Kapany, L.P. Singh

Pathfinder International has been working in Bihar on sexual and reproductive health and the PRACHAR project has worked to improve the health of the women and girls, and adolescents. The overall aim of this study was to develop an understanding of the gendered approach under PRACHAR project phase I and II. The objectives were to review the PRACHAR reports to understand the gender multisectoral factors and explore multisectoral linkages to improve behavioural outcomes.

The findings of the study revealed that the participants were well-informed regarding the benefits of further education as most of them desired educating their sons as well as daughters and that equal importance be accorded to them. The government's support had been substantial in providing incentives to the underprivileged. Likewise, PRACHAR's contribution towards the change was perceived as significant. Despite improvements, there was a need for regular and follow-up training to aid in the desired behaviour change.

The study team recommended efforts to create an equal and enabling environment for growth and prosperity of both the sexes.

Development of Research Policy and Strategy for Afghanistan

Agency:Afghan Institute of Public Health, Kabul

Project Team:S.D. Gupta, L.P. Singh, APHI Team

The Ministry of Public Health, Islamic Republic of Afghanistan has mandated IIHMR to help Afghan Institute of Public Health develop a research policy and strategy. Under the contract, a team of two consultants is leading the process. The situational analysis and mapping of the capacity of MOPH staff for research has been completed.

The draft policy is being prepared which will be shared with MOPH and other stakeholders.

Gender Elements Mainstreamed in State and District Health Plans and Program Interventions

Agency:UNFPA, Jaipur

Project Team: Nutan Jain

The objective of the study was to mainstream gender component in the program planning processes and the various programmatic interventions under the RCH II. The objective was to enhance the capacities of program managers to provide gender sensitive RCH services in terms of program planning, implementation, supervision and monitoring

A situation analysis was undertaken in four districts (Banswara, Bhilwara, Jodhpur and Karauli) of Rajasthan. In view of the findings, a four-day training program on 'Mainstreaming Gender' in the state and district health plans and program interventions was designed and conducted in April 2010.

Pehli Pehchan: Mobilizing Deprived Section of Society for Universal Birth Registration in Rajasthan

Agency: Plan India, New Delhi

Project Team:Nutan Jain, Rakhi Mathur

The initiatives towards mobilizing civil society for universal birth registration in Rajasthan since January 2006 have resulted in increased awareness of the importance of birth registration. The midterm evaluation report (2008) by Plan India laid emphasis on strengthening registration services in rural areas.

Compared to the baseline (2008), birth registration among the children aged up to 18 years from deprived sections of the society increased by more than 50 percentage points in 2010. Less than one percent children had birth certificates at the time of baseline. It follows that this increased by more than 37 points as revealed by the endline survey.

Baseline survey for UNICEFsupported intervention for increasing routine immunization by improving data management

Agency:UNICEF Rajasthan, Gov.t of Rajasthan, CDC Atlanta

Project Team:Suresh Joshi, Anoop Khanna, N.D. Sharma, Saheli Manish Kumar

The objective of the study was to carry out the baseline survey for the UNICEF-supported interventions for increasing routine immunization in the state of Rajasthan. The study was carried out in five districts of Ajmer, Bhilwara, Jaipur, Nagaur and Tonk.

Three components were studied as part of the project: Observation of review meetings being held at different levels; Interview of staff to understand the current knowledge and practices on different issues related to planning, recording and reporting relevant to routine immunization and record review to estimate the level of completeness, correctness and consistency in various reports and records maintained at different levels.

Rapid Assessment of MCHN Services in UNICEF-Focus Five Districts in Rajasthan

Agency:UNICEF Rajasthan

Project Team:Suresh Joshi, N.K. Sharma, N.D. Sharma, Shivani Thakur, Aviral Sharma, Meenu Mathur, Rohit Jain

In relation to the MDGs on health and nutrition, UNICEF proposed to undertake accelerated efforts in Baran, Barmer, Dungarpur, Sawai Madhopur and Tonk districts for ensuring effective results in MCHN interventions.

The objectives of the study were to develop a database on enabling factors and barriers to MCHN services with a frame of service inputs, service implementation process and its output. This was done through an in-depth analysis of the planning process: availability of appropriate and adequate supplies at different service units: understanding community knowledge, behaviour and utilization patterns towards these services; and studying the level of knowledge and skills of frontline workers and the mechanism established for supportive supervision and monitoring of the MCHN intervention.

Community and Facility-level Assessment of Immunization Coverage in Rural NIPI Districts of Rajasthan: A Baseline Study

Agency:Directorate of Medical, Health and Family Welfare, Govt. of Rajasthan

Project Team:Suresh Joshi, N.K. Sharma, Shilpi Mishra Sharma, Sunita Nigam, Hemant Mishra, Rakhi Mathur, Vidya Bhushan Tripathi

The Governments of India and Norway have entered into a partnership to work together towards the attainment of MDG 4 that aims at reducing child mortality. The objective of Norway-India Partnership Initiative (NIPI) is to provide catalytic support that would make a strategic and sustainable difference to the rapid scaling up of quality child health services under the National Rural Health Mission (NRHM) in five states including Rajasthan. In Rajasthan, NIPI has identified three districts (Alwar, Bharatpur and Dausa) to initiate interventions aimed at reducing child mortality.

For this purpose a baseline study was conducted to identify enabling factors and barriers to achieving full immunization coverage. Firstly, and analysis was carried out of the routine immunization program management systems and processes at the district, block and community levels. This was followed by the identification of knowledge, attitude and practice of the community for immunization coverage and a study of the linkages of the immunization program with other child health interventions undertaken by NIPI.

Assessment of Services by YASHODA Scheme under NIPI in Rajasthan

Agency:Government of Rajasthan and Norway India Partnership Initiative (NIPI)

Project Team:Sunita Nigam, Hemant Mishra

The main objective of the study was to assess the relevance and usefulness of introducing a cadre of workers (Yashoda) within the established hospital system for enhancing quality care and support to the mother and the newborn. The study covered three district hospitals and selected CHCs.

The findings revealed that Yashodas effectively counseled mothers regarding institutional delivery, personal hygiene and nutrition and initiation of breast feeding within the first hour. They also provided emotional support to the mother. Yashodas were perceived as supportive by the mothers during their stay in hospital, especially with regard to newborn care. The patient satisfaction was quite high. Another encouraging aspect was that Yashoda was well accepted by the health system and perceived as great support by the nursing staff.

The Yashoda intervention has a potential for improved quality of maternal and newborn care, which implied reduced mortality and morbidity

A Study of Mid-Day Meal Program with Special Focus on Akshay Patra in Three States of Karnataka, Orissa and Rajasthan

Agency: Bhoruka Charitable Trust

Project Team:Alok Kumar Mathur, Venus Ratnani, Prince Purohit, Dushyant Mishra

The specific objectives of the study were to measure the impact of the mid-day meal program on the school enrolment, attendance and drop-out rates and the overall academic performance of the beneficiaries; to assess the nutritional value of the food provided under the mid-day meal program and assess the impact of the Akshay Patra mid-day meal program on the nutritional status of the direct beneficiaries.

The study reported that there were only marginal changes in the school enrolment between 2008 and 2009 in both Akshay Patra and SDMC schools in Karnataka and Orissa, as well as in the 'no mid-day-meal' schools. The dropout rates were very low and there was negligible difference between dropout rates of 'Akshay Patra' and the other two types of schools. There was no definite evidence of mid-day meal program having any effect on the achievement of students.

It was recommended that to effectively enhance the health benefits, schools may be linked to the nearest health centre. The micronutrient deficiency should be addressed through an addition of the required food components in natural form. Area-specific food components which are nutritious and easily available at manageable price need to be provided as part of the mid-day meal.

Midterm Independent Evaluation of National Leprosy Eradication Program (NLEP), Government of India

Agency:DGHS, Government of India

Project Team:Vivek Lal, Vinod Kumar S.V., Suresh Josh, S.D. Gupta, N.K. Sharma, Hemant Mishra, Vivek Khurana, Navneet Kapany, Jyoti Kushwaha, Pallavi Ranjan, Vidya Bhushan Tripathi, Dushyant Mishra

The purpose of the assignment was to carry out a midterm independent evaluation of the NLEP activities in the XIth plan period (2009-2010) and to gain a complete understanding of the immediate project impacts.

The evaluation was conducted to assess the qualitative and quantitative achievement of the program both in rural and urban areas; and the progress on disability prevention and medical rehabilitation services with emphasis on quality management and the technical support provided by partners in leprosy including the local NGOs. The study was carried out across 10 states: Andhra Pradesh, Arunachal Pradesh, Assam, Bihar, Chhattisgarh, Gujarat, Maharashtra, Tamil Nadu, Uttarakhand and Uttar Pradesh.

The study recommended strengthening of general healthcare services in order to provide quality services to leprosy affected people and greater emphasis on creating awareness of curability of the disease. The report has been submitted to the Government of India.

Impact of Home-Based Care and Support Services

Agency:Clinton Foundation, New Delhi

Project Team:L.P. Singh, Vivek Lal, Vinod Kumar S.V., Nutan Jain, J.P. Singh, Manoj Soni

In November 2006, NACO in partnership with the Clinton HIV/AIDS Initiative (CHAI), UNICEF, and the Indian Academy of Pediatrics (IAP), launched the National Pediatric HIV/AIDS Initiative with the aim of ensuring that each child living with HIV/AIDS (CLHA) receives high-quality care, treatment, and support. The Initiative sought to bring the level of access to treatment on par with that of adults and to address a large, unmet need of CLHAs requiring pediatric-specific ART formulations.

The Institute conducted an evaluation of the impact of the Program through data collection across 22 ART centres in 10 states: Manipur, Nagaland, Mizoram, Madhya Pradesh, Rajasthan, Maharashtra, Kerala, Karnataka, Andhra Pradesh, and Delhi.

The report has been submitted.