Research Projects/Studies Completed Year 2014-2015
Development of Training Material for Public Health Management for District Level Managers, WHO SEARO
Agency: WHO SEARO
Team: S.D. Gupta, Vinod Kumar, Anoop Khanna, Suresh Joshi, Nutan P Jain, Anil Kumar NB
The countries in the South-East Asia Region are undergoing epidemiological and demographic transition. Most of them are facing an unfinished agenda of double burden of diseases, and the consequence of the ageing of populations. Against the background of established diseases, many emerging and re-emerging infectious diseases have posed a serious challenge in recent times. To address these challenges, WHO, has emphasized revitalization of primary health care and translation of its values and approaches in developing and strengthening health systems. In this context the need for building skills and competencies in new public health has now been deeply realized. The district health managers need to be equipped with these competencies and skills and re-equipped with core public health skills of epidemiology, biostatistics, environmental health and basic science of prevention and control of diseases in the community.
WHO SEARO has entrusted IIHMR with the task of developing a training curriculum and materials aimed at strengthening management of public health at the district level in developing countries with a focus on emerging infectious diseases. It aims at imparting managerial competencies and skills in critical management functions, such as human resource management, planning and organizing health services and programs, logistics and supply chain management, health information and surveillance, services quality, and health communication. A training module has been prepared for WHO SEARO.
Social Marketing and Communication Activities
Agency: Project Monitoring Unit –Global Alliance for Improved Nutrition
Team: Neetu Purohit, Seema Mehta, Rakhi Mathur, Priyanka
The Global Alliance for Improved Nutrition (GAIN) is driven by the vision of a world without malnutrition. GAIN supports public-private partnerships to increase access to the missing nutrients in diets necessary for people, communities and economies to be stronger and healthier. IIHMR is the Implementing partner of the food fortification project in Rajasthan. The Project Management Unit at IIHMR is entrusted with the responsibility of implementing social marketing and communication activities to increase awareness and acceptance of fortified flour, oil and milk in the community. This work was in continuation of the first part of the project which resulted in development of a strategic framework for social marketing of fortified food. In the second part, different communication materials and activities were designed and implemented.
A plethora of activities were undertaken. Morning walkers were introduced to fortified products. Stalls and canopies of fortified products were set up in local markets. Media was also used to spread the significance of fortified products FM channels, scripts for Nukkad Nataks, posters and pamphlets, newspapers ads etc. are some of the devices used for this purpose.
A plethora of activities ranging from contacting morning walkers of different public parks and gardens, parking lots with brief introduction to fortified products, to putting up stalls and canopies of fortified products in local markets, to pamphlet distribution in local fairs and fests, designing of jingles for FM channels, themes for animated movies, scripts writing for nukkad nataks, student competition for poster and pamphlet design, designing of stickers, trolleys and glow sign boards for retailers, posters for display in clinics, newspaper ads, standees, presentations for school activities and retailers meet to updating of face book page on activities conducted under social marketing, and attending national and international conference for promotion and dissemination of work done under social marketing through research papers. All other means of promotional materials to reach relevant stakeholders were conceptualized and designed.
Training and Capacity Building of the Mid-Day Meal Program Frontline Functionaries in Sustainable Promotion of Fortified Food with Hygiene Practices
Agency: Project Monitoring Unit –Global Alliance for Improved Nutrition
Team: Goutam Sadhu, Tanjul Saxena, Shirish Harshe, Mohammad Sharif
In order to address the problem of micronutrient deficiency in the state, IIHMR Jaipur has signed a Grant Agreement (GA) as Executive Agency (EA) to implement the project on Food Fortification – Integrated Program Strategy in Rajasthan with the Global Alliance for Improved Nutrition (GAIN), Geneva.
The Directorate of Mid-Day Meal Scheme, Rajasthan wanted the Project Management Unit (PMU) to organize Training of Trainers (ToT) for one block level officer or his/her representative and two cook-cum-helpers from each block of all the districts of Rajasthan, regarding food and nutrition, health, hygiene, cooking and storage techniques. The PMU, after receiving the proposal for organizing the training, appointed IIHMR, Jaipur for undertaking the project titled “Training and Capacity Building of the Mid-Day Meal Programme Frontline Functionaries in Sustainable Promotion of Fortified Food and Hygiene Practices” implemented through 16 two-day capacity building programmes.
From GAIN’s perspective, a training program covering the mid-day meal scheme of frontline functionaries was conceived for objectives of sustainable promotion of fortified food, along with the promotion of safe practices of hygiene, imparting awareness of different techniques of storage and precautionary measures while preparing the mid-day meal, which will ultimately impact the higher goals of addressing the malnutrition problem among children. A total of 710 participants, were nominated for the training programme. These participants, in turn, gave training to all the cook-cum-helpers of their respective blocks.
Health and Nutrition Survey in Rajasthan
Agency: Global Alliance for Improved Nutrition (GAIN), Geneva
Team: PR Sodani, ND Sharma, Sunita Nigam, Lalit Mohan Nayak, Suresh Siwal, Priyanka Bakshi, Rakhi Mathur, Sonia Luna
As part of an effort to accelerate plans to collect coverage data in priority countries to measure consumption of adequately fortified foods, the Global Alliance for Improved Nutrition (GAIN) assigned IIHMR to conduct a coverage survey in the State of Rajasthan to assess staple food intakes among women of reproductive age (WRA) and young children.
The objectives of this household survey based on spatial three methods (S3M) were to assess and determine consumption of fortified food by women of reproductive age and children aged 0-24 months; to determine the adequacy of fortification; and to assess the coverage of other vehicles and programs in order to identify gaps in the current programming and future programming opportunities. The survey population consisted of caregivers with a child in the first two years of life. A caregiver may be the child’s biological mother or the person who cares for and gives the child most meals on most days. Under this study, the research team collected data of sample size 4536 from 252 PSUs all over Rajasthan.
A Baseline Study of USAID Funded PIPPSE Project
Agency: USAID India, Delhi
Team: Shilpi Mishra Sharma, Neetu Purohit, Sunita Nigam, Jalpa Thakkar, Akhil Agrawal, Divya Bhati, Lalit Mohan Nayak
A baseline assessment was carried out to generate evidence on the effectiveness of the HIV intervention program carried out under the PIPPSE project for its different activities under different intervention models. This assessment was part of the overall monitoring process and was intended to help in identifying the current situation of the project (in terms of extent of implementation) and issues to be tackled under each of the models.
The PIPPSE project being funded by the United States Agency for International Development (USAID) is a creative and timely response to meet the current priorities of the national HIV program. Managed by a consortium, with Public Health Foundation of India (PHFI) as the prime awardee and Futures Group International India Pvt. Ltd. and Population Services International (PSI) as sub awardees, the PIPPSE project supports the national program through institutional strengthening, evidence generation, piloting of innovative models and enhancing private sector engagement. This five-year project is being implemented from June 1, 2012 to May 31, 2017. The overall aim of the project is to strengthen the institutional and human capacity in prevention programs and private sector engagement through innovative approaches to contribute towards achieving the goal of accelerating the reversal of HIV epidemic at the national and state levels. To fulfil the above goal, the key activities of this project were designed with five key areas viz., innovations, migration programming, system strengthening, private sector engagement and evidence generation and are being implemented in the form of different models.
The broad objective of the baseline study was to assess the situation of the project before implementation of its different intervention models in terms of its strength and capacity.
Developing Competency Framework for Mainstreaming Gender Responsive Healthcare Services
Team: Nutan P Jain, Vidya Bhushan Tripathi, Matadin Sharma, Priyanka Sharma
The study was aimed at assessing health care providers’ and managers’ understanding of and perspective on gender equality and equity with a focus on adolescent health care services in Rajasthan and to develop competency framework for providing gender-responsive services by various levels of health care providers (men and women) including quality characteristics, standard operating procedures, and indicators especially for adolescent reproductive health services using structure, processes and outcome framework of quality. As a first step, a matrix was developed to understand the roles and responsibilities of health functionaries and gender gaps were identified to develop tools for data collection. To finalize the framework on gender competencies, a Delphi technique was used with a total of nine experts.
Situational analysis study was conducted in six districts, namely Banswara, Udaipur, Ajmer, Jodhpur, Bharatpur and Sri Ganganagar. Out of total of medical officers 23 female and an equal number of male medical officers were interviewed. In addition, 465 ANMs and district level officials (CMHO, PMO, RCHO, DPM, and PC & PNDT Coordinator) were also the part of the study.
Based on the key findings of the situational analysis, a draft of competency framework for medical officers and ANMs was prepared and discussed with the Delphi experts in a workshop. The suggestions were incorporated. The framework was pre-tested along with the medical officers and ANMs by having interaction in the study districts.
Assessing the quality of Civil Registration System
Agency: The Institute for Social and Economic Change (ISEC)
Team: Nutan P Jain, Rahul Sharma, Vidya Bhushan Tripathi, Snigdha Pareek, Matadin Sharma
For assessing the quality of Civil Registration Systems (CRS) at the district level, two districts, namely Sikar (high performing) and Dungarpur (low performing) were selected in Rajasthan. The study aimed at facilitating updating exercise of National Population Register (NPR). It involved interviews with the CRS functionaries (Registrar, ANM, ASHA, AWW and Panchayat members. Apart from these, information was also collected from government hospitals, community health centers and private hospitals (with 50+ beds and with less than 50 beds).
Stress, Anxiety and Depression among Adolescents Attending Coaching Institutes in Coaching Hub of Kota
Team: Alok Mathur, Deepti Shukla, Gunjan Mishra, Aditi Vyas
The study was accomplished to examine the level of stress, anxiety and depression faced by the adolescents who were taking coaching for pre-medical and pre-engineering exams in Kota. The broad objective of the study was to assess the level of depression, anxiety and stress among students preparing for competitive exams like IIT, CPMT, RPMT, AFMC, AIEEE, and RPET, and also to find out the difference in the level of stress, anxiety and depression between those who are preparing for engineering and medical entrance exams. The tool used to measure three negative emotional states was DASS (Depression, Anxiety and Stress Scale).The brief of the study is as follows - In the present times there is a mismatch between how schools groom students and what is required to qualify the IIT, pre-Engineering or pre-Medical exam. Thus in India some enterprising individuals/groups started coaching institutes and created a niche for themselves. One can witness the mushrooming growth of these institutes in different states; Rajasthan was amongst the pioneers. These institutes claimed that they specialize in preparing students to get through pre-medical, IIT and engineering exams and proved their point by showing the incremental growth of successful students. During or after completing school education, adolescents spend most of their time to prepare for these entrance exams in these coaching institutes. This hard time-bound preparation sometimes produces stress, anxiety and depression in some of the students. The key findings on the variable of stress supported the pre-generalized notion that adolescents preparing for pre-medical competitive examinations were more stressed than those preparing for pre-engineering competitive examinations. The anxiety level of adolescents was measured on four constructs: autonomic arousal, skeletal muscle effect, situational anxiety, and subjective experience of anxious effect. The major findings suggested that about one-third of adolescents of the sample reported moderate level of anxiety, which was followed by normal, severe, extremely severe and mild level of anxiety. A substantially large number of students were found to be depressed at moderate level. The girls were found to be more depressed and having the feeling of hopelessness, sadness, decreased level of enthusiasm, anhedonia, inertia, etc.
Migration, Poverty and Access to Health Care: A Multi-Centric Study on People’s Access and Health System's Responsiveness in Fast Growing Smaller Cities
Team: Anoop Khanna, Alok Mathur, Mohammed Shah Nawaz
The objectives of this multi-centric study funded by Indian Council of Medical Research, New Delhi were to assess the migrants’ healthcare access in the vulnerability context of migration and livelihood insecurity and to understand the factors (individual/community/system-level) affecting the migrants’ access to healthcare services in fast growing smaller cities. Initially, extensive formative research data (both qualitative and quantitative) was collected from 27 identified slums of Jaipur. Based on the formative research information, key points were identified for developing intervention strategy, like awareness level of ANC, location of health facility, and identity cards to migrants to avail facilities, frequency of visit of health workers, attitude of health care providers etc. A year-long supportive intervention was made in identified slum clusters of Jaipur. For intervention, a two-pronged approach was used: one was to improve as well as sensitize service delivery system and the other was to generate demand from the community for quality services. This was done with the aim of developing the desired levels of acceptability and accessibility of health care services for poor migrants living in Jaipur. The impact of the overall intervention was measured through a systematic scientific evaluation.
Preparatory Assessment for the Launch of the eVIN in All Districts of Uttar Pradesh and Rajasthan
Team: Nutan P Jain, Arindam Das, Vidya Bhushan Tripathi, JP Singh, Vidya Bhushan Tripathi, Matadin Sharma, Shirish Harse, Suresh Siwal
Cold chain is a system of storing and transporting vaccines at recommended temperature range, from the point of manufacture to the point of use. At present the immunization program team does not have real time data to know how well the vaccine supply system is performing, either in terms of vaccine availability or in terms of maintaining cold chain temperatures. Without real-time data, the managers at national, state and district levels have little information to manage the supply side of vaccines, perform course corrections or ensure accountability from those further down the chain. That is the reason for not being able to generate prompt responses to a breakdown in the vaccine supply chain. The Ministry of Health and Family Welfare, Government of India and UNDP decided to support this through the development of a vaccine intelligence system that keeps track of both vaccine stocks and flows as well as temperature levels throughout the cold chain. The overall objective of the assignment was to establish Electronic Vaccine Intelligence Network or eVIN system in all the districts of Rajasthan and UP. The specific objective was to assess the existing mechanisms with regards to the storage facilities and equipment, transport and availability of information technology at different levels. The assessment was conducted during June –July 2014.
In 75 districts of UP, more than 1000 cold chain points at state, district, depot and divisional level, sub-district, community health centres, primary health centres and other facilities were covered. A vast majority of the cold chain points were found functional having necessary equipment, cold chain handler, computer and data entry operators.
In Rajasthan more than 2000 cold chain points were covered at various levels of health facilities (including a few sub-centres). A vast majority of the cold chain points were found functional having necessary equipment, health functionaries, and computer and data entry operators.
Baseline Survey of Adolescent Girl’s Initiative (AGI) in Selected Blocks of Udaipur District, Rajasthan
Team: Nutan P Jain, Arindam Das, Vidya Bhushan Tripathi, Matadin Sharma, Priyanka Sharma
The SABLA programme of the Directorate of Women Empowerment, Government of Rajasthan in collaboration with the UNFPA is contemplating implementation of the Adolescent Girls Initiatives intervention in one of the blocks of Udaipur district in Rajasthan. A baseline survey was conducted with the objectives of: (i) establishing benchmark on key indicators related to knowledge, attitudes and practices among adolescent girls on issues related to their health and well being, which will be compared as measure of success of the project after completion of the interventions; (ii) to provide situational analysis of the current status of adolescent girls; and (iii) to exploring perspectives of the key stakeholders towards adolescents in the project area. The survey was conducted in two blocks: the intervention (Salumber), and control (Gogunda) in Udaipur during September and October 2014. The first phase included listing of houses where adolescent girls in two age groups (10-14; and 15-19 years) were present. During the survey 465 (94.5 percent of the proposed) and 453 (92.1 percent of the proposed) adolescent girls in 10-14 years and 15-19 years were interviewed respectively in the intervention block. The key findings based on data gathered, using both quantitative and qualitative methods, reflected that there was lack of awareness related to adolescent health and changes related to puberty, family planning, spacing methods and STIs. The study also indicated that, although their awareness and practice related to personal hygiene was high, the myths and misconceptions related to menstrual practices also abound. About half of the respondents could recall substance abuse related consequences like lung cancer but awareness relating to HIV/AIDS was abysmally low. Legal and financial literacy was very low and most of the respondents did not even respond to the issue of domestic violence. The respondents were reported to be dependent on others for decisions and even socio-political empowerment and participation was very low.
The girls suffered from gender discrimination and gender-based emotional/ psychological violence and, therefore, importance of group membership is necessary to raise the collective voice. It was recommended that the intervention may focus on building skills of girls as well as key stakeholders to fulfil their daughters’ dreams.
Mobile Technologies and Health-A Pilot Study
Agency: Oxford Department of International Development and Hertford College, Oxford University, United Kingdom
Team: Nutan P Jain, Arindam Das, J P Singh, Vidya Bhushan Tripathi, Matadin Sharma
“Mobile technologies and health: a pilot study in India and China” – a comparative study of Gansu (China) and Rajasthan (India) on mobile phone use and its implications for rural healthcare access was conducted to find answers of the following research questions. The survey followed as a first stage of qualitative research in Rajasthan and Gansu in 2013 to explore people’s behaviour with regard to mobile phones and rural healthcare access with the following objectives:
- What role does the mobile phone play as a conversion factor in the translation of healthcare resources into healthy lifestyles in rural India and rural China?
- Does access to mobile phones influence well-being and healthcare seeking in these contexts?
- How large is the impact of mobile phone use on rural access to healthcare?
The major objectives of the study were to understand technology use as an important upstream element of mHealth as well as to generate further questions for our research agenda. The project was designed to investigate emerging questions for research and policy in developing countries at the intersection between technology, health, and development. It specifically addressed the role of mobile phones in the rural areas of China and India, and its implications for equitable access to healthcare. The outcomes of the study were not only of academic interest, but could also benefit public and private actors working on mobile communications and rural healthcare. Data has been collected from 400 households in a total of 16 villages of Udaipur and Rajsamand districts of Rajasthan. Respondent selection followed a 3-stage stratified cluster sampling approach. In the first stage, villages were selected from the fieldwork districts. In Rajasthan, this was done in proportion to the population size of the villages and stratified by their distance to their sub-district headquarters. In the second step, households in the villages were randomly sampled. Because of flexible resources and strong partners, the survey team listed all households in the selected village segments and drew the sample accordingly. Enumerators were assigned to these selected households and located them with the help of printed satellite maps, compasses, and smart phones with satellite navigation software. In the third step, household members above 18 years of age were randomly recruited for the interview using Kish selection grids.
Financial Resource Flows for Population Activities- RF 2013
Agency: UNFPA and NIDI
Team: Anoop Khanna, Ajay Sharma
The Financial Resource Flows project is a joint collaboration of United Nations Population Fund (UNFPA) and the Netherlands Interdisciplinary Demographic Institute (NIDI). The Resource Flows (RF) project monitors progress achieved by donors and developing countries in implementing the financial resource targets agreed upon at the International Conference on Population and Development in Cairo in 1994 and the Declaration of Commitment adopted at the United Nations Special Session in 2001. The project collects data and subsequently reports on international population assistance and domestic expenditures for population activities in developing countries. IIHMR was contracted by UNFPA and NIDI in 2005 to undertake the RF activities related to the domestic part of the Project. In every financial year the data is collected through a mailed survey for the previous financial year. The Financial Resources Flows for Population Activities – RF 2013 was completed in 2014.
Data on donor assistance and domestic expenditures for population activities in the sample countries are disseminated by means of different publications. Financial Resource Flows for Population Activities Report (FRFPAR) is the most comprehensive publication of the RF project and is annually published by UNFPA. The project also publishes RF Newsletter, which was initiated as a tool to inform the public about resource tracking for population and AIDS activities in general and the role of the RF project in particular.
Study of LAC Region for Financial Resource Flows for Population Activities 2013
Agency: UNFPA and NIDI
Team: Anoop Khanna, Manu Gupta, Ajay Sharma
IIHMR was contracted by the Netherlands Interdisciplinary Demographic Institute (NIDI) to conduct the study on Financial Resource Flows from Population Activities separately in the Latin American and Caribbean countries for the round of financial year 2012. "RF-LAC Project" is a part of the Financial Resource Flows project which is a joint collaboration of United Nations Population Fund (UNFPA) and the Netherlands Interdisciplinary Demographic Institute (NIDI). The Resource Flows (RF) project monitors progress achieved by donors and developing countries in implementing the financial resource targets agreed upon at the International Conference on Population and Development in Cairo in 1994 and the Declaration of Commitment adopted at the United Nations Special Session in 2001. The RF project collects data and subsequently reports on international population assistance and domestic expenditures for population activities in developing countries. The UNFPA country offices of the sampled countries were provided with the survey instruments specially designed and translated in the regional language. IIHMR is responsible to provide full technical support to the offices for data collection.
Coverage of the AP Food’s BAL Amrutham Distributed as take home ration through the ICDS System in Telangana
Agency: Global Alliance for Improved Nutrition (GAIN), Geneva
Team: P.R. Sodani, N.D. Sharma, Gowthamghosh B, Tukaram Khandade, Lalit Mohan Nayak, Akhil Agarwal, Deepanshu Srivastava
The main objective of this study was to determine the coverage of the AP foods product, called BAL Amrutham, distributed as take-home rations to children below 3 years of age living in Telangana. The specific objectives of this study were to assess the coverage of the AWC centres and the take-home rations in children between the ages of 6 and 35 months; to assess the consumption (in grams per day) of the AP foods products by target children; to assess the consumption (in grams per day) of the AP foods products by children less than 6 months of age and by the other household members; to assess children’s and mothers’ nutritional status and mid-upper arm circumference (MUAC); to assess indicators for other health and nutrition conditions to determine their association with the utilization of ICDS services and the consumption of supplementary food. Such indicators may include: (i) multidimensional poverty index (MPI) and household hunger index; (ii) child and caregiver dietary diversity; (iii) indicators of household water, sanitation, and hygiene; (iv) vaccination coverage; (v) micronutrient supplementation coverage (iron, folate and vitamin A); to measure practices of mother and caregivers regarding the use of take-home rations and general feeding of their children of 0-35 months of age; to assess the household’s rice consumption patterns in order to inform a potential future rice fortification program; and to assess the consumption of iodized salt and to measure the iodization level of the salt used at the household level.
A cross-sectional two-stage stratified cluster household survey was conducted is 90 PSUS in Telangana. The IIHMR survey team contacted the AWW of the selected AWC. The AWW provided the information on the geographic coverage of the AWC. This ensured the catchment area of the selected AWC. The IIHMR survey team conducted the mini-census in the defined catchment area of the AWC. For the second stage of sampling, 13 children aged 0-35 months per AWC were randomly selected from the list prepared by the survey team of beneficiaries. The target group consisted of all children between 0 and 35 months and their principal caregiver.
National Key Resource Centre for Drinking Water and Sanitation
Agency: MoDW&S, GoI
Team: Goutam Sadhu, Tanjul Saxena, Mohammed Sharif
IIHMR has been identified by the Ministry of Drinking Water and Sanitation, Government of India, as the Key Resource Centre (KRC) for Sanitation in Rajasthan. The main objectives are: to build capacities of the government officials, PRI representatives, and other stakeholders (key program managers); to provide technical guidance and monitoring support to the State Water and Sanitation Mission (SWSM); and to provide research and advocacy support for the program. The KRC has been working in close collaboration with the Panchayati Raj and Rural Development Department, Department of Health and FW, PHED, and other departments relevant to promoting water and sanitation in the state.
In the current phase of the project, training programs are conducted in cascade mode, developing a District Resource Group (DRG) for each district through TOTs. District Water and Sanitation Mission Members (DWSM) are also involved in DRG. The DRGs will further impart training to the PRIs and VWHSC members and NGOs. So far 206 participants through six four-day capacity building programmes under KRC Sanitation and 176 participants through six four-day capacity building programmes under KRC Water , have been trained. Fresh proposals for undertaking further capacity building initiatives in consultation with CCDU sanitation and WSO Water are under preparation.