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Research Projects Ongoing

National Family Health Survey-4, Uttarakhand

Agency: IIPS Mumbai

Team: Neetu Purohit, J. P. Singh, Preetha G S, Rashmi Nair, Satish Singh, Suresh Siwal, Lalchand Sharma, Rohit Jain, Paras Kumar, Danish Ahmad

Ministry of Health & Family Welfare, Government of India (MoHFW-GoI) is conducting CAPI based National Family Health Survey-4 (NFHS-4) in all 35 States and Union territories of India. NFHS is being undertaken with the main objective of strengthening India’s demographic and health database by providing information that is both valid and reliable. 

MoHFW-GoI has entrusted IIHMR with the task of conducting field work in Uttarakhand for NFHS-4. IIHMR is conducting district wise household survey in all 13 districts of Uttarakhand from January to June 2015. As per the estimate, 14620 households will be covered from 731 PSUs of Uttarakhand. The sample spreads in all 13 districts. Each district will have 40-70 Primary Sampling Units (PSUs) covering rural and urban representation as per the percentage of rural and urban population of the state. From each PSU pre-determined 22 households are being surveyed.

One of the components of the household survey is Clinical Anthropometry Biochemical Testing (CAB). The CAB component includes measurements of height, weight, blood pressure, hemoglobin and random blood sugar for men, women and children in the selected households. In a subsection of the households, Dried Blood Spots (DBS) are being taken from men and women for HIV testing.

National Family Health Survey-4, Madhya Pradesh (East)

Agency: International Institute for Population Sciences, Mumbai

Team: Santosh Kumar, Arindam Das, BS Singh, Amlan Dutta, Rohit Jain, Shyam Chatterjee, Laxman Sharma, Tukaram, Praful Barla, Shirish Harse, Kailash Prajapati, Ravi Tulayat

Ministry of Health & Family Welfare, Government of India is conducting CAPI based (mini laptop) National Family Health Survey-4 (NFHS-4) in all 35 States and Union territories of India. NFHS-4 is being undertaken with the main objective of strengthening India’s demographic and health database by providing information that is both valid and reliable. 

MoHFW, GoI has entrusted IIHMR, Jaipur with the task of conducting household interviews in 22 districts of Madhya Pradesh-East for NFHS-4. As per the estimate, 21,758 households will be covered from 989 PSUs of MP-East. Each district will have 43-86 Primary Sampling Units (PSUs) covering rural and urban representation as per the percentage of rural and urban population of the state. 

 Apart from household interviews, Clinical Anthropometry Biochemical Testing (CAB) tests are also being done on selected respondents. The CAB component includes measurements of height, weight, blood pressure, haemoglobin and random blood sugar for men, women and children in the selected households. In a subsection of the households, blood samples (using Dried Blood Spots techniques) are being taken from men and women for HIV testing.

Technical Support for Improved Delivery of Comprehensive Package of Health Services to the Urban Poor

Agency: USAID India, Delhi

Team: Goutam Sadhu, Rajendran Thambi,  Ambey Srivastava, Himani Tiwari, B.L. Tailor and Madhur Mathur (Rajasthan); Sanjoy Samaddar, Rakesh Kumar, Hemant Kumar Mishra and Yagyesh Srivastava (Chhattisgarh)

Health of the Urban Poor (HUP) program is being implemented by Institute of Health Management Research, Jaipur in two empowered action group (EAG) states i.e. Rajasthan and Chhattisgarh. The program aims at improving the health status of the urban poor by adopting effective, efficient and sustainable strategic intervention approaches, adopting the principle of convergence of the various development programs. The program is supported by the Government of India and funded by United States Agency for International Development (USAID), India. The objectives of the program are: 1) to provide quality technical assistance to the Government of India, to the states and the cities for effective implementation of the National Urban Health Mission (NUHM); 2) to expand partnerships in urban health engaging the commercial sector in public private partnership activities; 3) to promote the convergence of different Government of India urban health and development efforts; and 4) to strengthen urban planning initiatives by the state through evidence-based city-level demonstration and learning efforts.

IIHMR launched the HUP program on 27th September 2010. HUP Rajasthan and Chhattisgarh have been involved with the respective state governments as key technical assistance agencies for effective planning and roll out of NUHM. The HUP teams are supporting the states in the adoption of the five HUP approaches that are aligned with the NUHM framework, viz. a) Mahila Arogya Samiti (MAS); b) Urban Health and Nutrition Day (UHND); c) City Health Planning; d) Ward/City Coordination Committee; e) Health Management Information System (HMIS); f) Mahila Arogya Samiti; g) Health Management Information System; h) Ward Coordination Committee; and i) Water and Sanitation in Urban Areas. The unit has prepared a training module for frontline workers on WASH. It facilitates data collection through daily diary system and strengthens HMIS and initiates multi stakeholder convergence consultation. The HUP Rajasthan and Chhattisgarh teams are also supporting the respective states in the development of integrated city and state health plans under NUHM and institutionalizing a knowledge repository on urban health at the state level.

The HUP has also established itself as a leader in implementing select models and approaches to urban health that are in line with the NUHM Framework for Implementation. HUP’s technical assistance to the Government of India on the National Urban Health Mission resulted in the Union Cabinet of Ministers approving the National Urban Health Mission (NUHM) on May 1, 2013.

Integrated Programme Strategy in Rajasthan - Food Fortification Project

Agency: Global Alliance for Improved Nutrition (GAIN), New Delhi

Team: Rahul Sharma, Suresh Joshi, R.S. Rathore, Rajeev Baghel, Sudeep Sharma, Ranjeeta Rani, Rajkapoor Raghav

The project aims to reduce the prevalence of micronutrient deficiencies in the State of Rajasthan by making available fortified wheat flour, oil, milk and soya dal analogue through both the open market and government distribution channels. The project focuses on ensuring that the fortified foods are sold through open market channels and also distributed through the Public Distribution System and through other public funded programs, such as the Integrated Child and Development Scheme and Mid-Day Meal. The core project components are: production and distribution, social marketing and communication, legislation and quality control, and monitoring and evaluation. A Project Management Unit (PMU) is set up at IIHMR for the execution of the project. In the last two years of implementation, the project has succeeded in making large scale flour mills to produce fortified wheat flour, three major milk dairies in Rajasthan, namely Saras Dairy, Lotus Dairy and Divya Dairy to fortify toned and double toned milk, and major oil refineries like Ruchi Soya Industries Ltd., Bunge India Pvt. Ltd., Mahesh Edible Oil Industries and Ajanta Soya Ltd. to produce fortified refined soyabean oil, mustard oil and palmolein oil for open market. Centralized kitchens, namely Akshaya Patra Foundation, Naandi Foundation and Adamya Chetna Foundation used soya dal analogue with the project support for Mid-Day Meal preparation covering over a million school children in Rajasthan. Various social marketing and communication approaches have been implemented to create the awareness to use fortified food in the community. Special efforts are being made to involve print and electronic media to promote the consumption of fortified food.

A small scale operation research project has been undertaken which is called “Village Level Wheat Flour Fortification Project” in two tribal blocks of Udaipur district, namely Salumber and Sarada, where small chakkis are helping in fortifying wheat flour for the public, especially for BPL families who receive wheat grain through Public Distribution System. The project aims to work out the feasibility in terms of sustained interest among grinders and cost implication of small scale fortification initiative.

Financial Resource Flows for Population Activities- RF 2014

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 Resource Flows for Population Activities – RF 2014 will be completed by the end of 2015.

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.

Future Health Systems: Research Programme Consortium on Effective Health Service Delivery (FHS)

Agency: DFID, UK and FHS, Johns Hopkins University

Team: Barun Kanjilal, Debjani Barman, Upasona Ghosh, Arnab Mandal, Shibaji Bose (consultant), Lalitha Swathi Vadrevu, Rittika Brahmachari, Rohit Jain

The Future Health System (FHS) research project in India was initiated by IIHMR in 2006 as a part of a Research Program Consortium led by the Bloomberg School of Public Health, the Johns Hopkins University and in partnership with six other institutions across the world. The primary objective of this project was to prepare a knowledge base on which an appropriate strategy for a more equitable health system would be developed. In India, the FHS research is implemented by IIHMR with the primary focus on the health care delivery system in the Indian part of the Sundarbans. The main focus of this research is to generate knowledge on the barriers to delivery and access of health care services for children and find out the ways by which they can be made more effective in the Sundarbans. It tries to understand the multidimensional nature of the crisis in health care access in the Sundarbans to plan effective service delivery mechanism. The generation of knowledge primarily relates to the what, where, and how of an effective service delivery system.

The research is currently in its second phase (2011-16).  During the year, several studies were conducted on sample households, health care providers, and various institutions in one block of the Sundarbans (PatharPratima).  Based on the survey results, the first Sundarbans Health Watch Report on child health issues and their solutions was published and disseminated. The project is currently in its fourth year. Four studies were completed in 2013-14. They were: exploring the role of media in health system ecology, photo-voice exploration in the Sundarbans, social network approach to understand child health in women-headed households, and psychosocial care practices for child development in 2013-14. The evidence from these studies will be disseminated to a wide range of stakeholders working for child health through a state level consultation meet in April 2015.

Khushi Baby: Efficacy and Impact assessment of Novel Mobile Health Solution for Vaccination Record Keeping in rural Udaipur, Rajasthan, India.

Agency: DFID, UK and FHS, Johns Hopkins University

Team: Mohammed Shahnawaz

Future Health System (FHS) Young Researcher awardee, Mohammed Shahnawaz (Senior Research Fellow at Indian Institute of Health Management Research (IIHMR)), has been using his award to assess whether a “near field communication” chip-based mobile phone application for the remote, real-time monitoring of immunisation progress contributes to immunisation adherence, coverage, and resource conservation in rural Udaipur, Rajasthan. Via a project called Khushi Baby, this new technology comes in the form of a pendant on a necklace, similar to the traditional black thread with amulets worn by children in the area to ward off disease. The pendant contains a chip which stores the vaccine history of each child and can be scanned by health care workers to quickly obtain and update the child’s vaccination records. This data is stored in a cloud and can also be accessed by the Ministry of Health and other health officials.

BBC News has recently featured a story about this innovative project, which hopes to expand their coverage over the next year to up to 4,000 children across 100 villages.

Asian Region Capacity Development for Research on Social Determinants of Health (ARCADE)

Agency: Karolinska Institute, Sweden                     

Team: Barun Kanjilal, Neetu Purohit, Manu Gupta

The project is coordinated by Karolinska Institute in Sweden, involving twelve partners across Europe , Asia and Africa including IIHMR. These four-year projects (2011-2015) are funded by the European Commission’s 7th Framework Program. The ARCADE project uses innovative educational technologies to strengthen health research across Asia. Focusing on post-graduate, doctoral and post-doctoral training, partner institutions are developing cutting-edge online courses, blended with learning modules and joint programs that will enable training of researchers in low- and middle-income countries who might not otherwise have access to such material. Under this project, IIHMR has produced a self-learning module on “Climate, Society and Health” for prospective PH.D students in developing countries.   The next modules are on "Health and Development" and “Behaviour Change and Communication for Health Researchers” that will be used as a resource material for the PhD students of IIHMR University.

Technical Assistance for IDA assisted ICDS Systems Strengthening and Nutrition Improvement Project (ISSNIP)

Agency: Ministry of Women and Child Development, Government of India

Team: S.D.Gupta, Anoop Khanna, Vinod Kumar SV, Pradeep Singh Kachhawa, Vivek Shukla, Shiv Kumar Acharya, Kanaram Saran

The Ministry of Women and Child Development (MWCD) has initiated several measures to direct a strong focus on child nutrition and development. Conceptualizing the International Development Association (IDA) supported Integrated Child Development Services (ICDS), Strengthening Nutrition Improvement Project (ISSNIP) is one of its unique initiatives that complements the Government of India's larger efforts and is aligned with the key decisions made by the Council to support 200 high burden districts in the country. Of these, ISSNIP will be implemented in 162 high burden districts in eight states. The Institute has been a consortium partner with PricewaterhouseCoopers Private Ltd (PwC) and Child in Need Institute (CINI) to work as the Technical Agency (TA) for ISSNIP. The TA has a structure comprising of the Central TA team, consisting of the Project Director, Team Leader, Deputy Team Leader, Advisors and the five Technical Programme Coordinators (TPCs) leading each of the technical task areas. At the State level, State Team Leaders (STLs) are engaged in leading the state level activities. There is a team of four Regional Managers (RMs) in the state to assist the STL in the implementation of TA activities. The Technical Assistance Agency has been providing support, guidance and assistance in achieving the key objectives of Phase 1 of the ISSNIP with interventions designed across the four key components: 

  • Component 1: Institutional and Systems Strengthening
  • Component 2: Community Mobilization and Behaviour Change Communication (BCC)
  •  Component 3: Piloting Convergent Nutrition Actions
  • Component 4: Project Management, Technical Assistance, Monitoring & Evaluation.

The TA Agency has been providing specialized and focused technical expertise to the ICDS programme considering the need for techno-managerial support required for strengthening the policy framework, systems and capacities at the national and state levels. The project also entails design and conduct of a range of specific pilots in limited areas to generate concrete evidence for approaches that are likely to work at a scale to improve programme outcomes.

Assessment of Alcohol Situation in Urban Sphere: in the Context of Violence against Women in Private and Public Spaces

Agency: Family Health International FHI 360

Team: Nutan Jain, Arindam Das, Vibhu Tripathi, Priyanka, Kailash Prajapati, Matadin Sharma

IIHMR has been subcontracted by FHI360 for conducting DFID supported research study entitled Assessment of Alcohol Situation in Urban Sphere: in the Context of Violence against Women in Private and Public spaces in the state of Madhya Pradesh to examine the linkage between alcohol and violence against women. The goal of the study is to understand the existing scenario of alcohol use and violence against women which will provide guidance in policy making to prevent violence against women. The objectives of the study are:

  • To better understand the relationship between alcohol consumption and violence against women;
  • To understand the patterns of sale, purchase and consumption of alcohol at the community level; and
  • To review the existing state of alcohol policies and regulatory mechanisms to make recommendations.

The study is being conducted in two urban cities of Madhya Pradesh, Bhopal and Jabalpur. The target population for gathering evidence consists of married men and women who are 18 years or above in age. They include government officials, NGO workers, and staff of alcohol outlets, doctors, drivers and others.

WHO-SAGE India Wave 2 Field Work for Rajasthan

Agency: IIPS, Mumbai

Team: Santosh Kumar, ND Sharma, Deepanshu Srivastava, Akhil Agarwal, Rohit Jain, Rakesh Sharma

The Study on Global Ageing and Adult Health (SAGE) India Wave – 1 initiated by the World Health Organization was conducted by the International Institute for Population Sciences (IIPS), Mumbai, as a part of multi-country in six of the seventy countries that participated in the World Health survey, 2003. SAGE is a longitudinal, cross-sequential household face-to-face survey.  IIHMR was also selected as field agency for conducting SAGE Wave - 1 in Rajasthan in the year 2007.  IIHMR has been retained to conduct WHO-SAGE Wave – 2 in Rajasthan this year. The objectives of the survey are  (i) to obtain reliable, valid and comparable data on levels of health on a range of key domains for older adult population (50 years and above); (ii) to examine patterns and dynamics of age-related changes in health and well-being using longitudinal follow-up of survey respondents as they age, and to investigate socio-economic consequences of these health changes; (iii) to supplement and cross-validate self-reported measures of health and the anchoring vignette approach to improving comparability of self-reported measures through measured performance tests for selected health domains; (iv) to collect data on health examinations and biomarkers to improve reliability of data on morbidity, risk factors and monitor the effect of interventions;  and (v) to obtain data on contraceptive use and its continuation, morbidity conditions during various stages of reproduction and responsiveness of health system towards these conditions for adult population in age 18-49. The Survey will target 1800 individual interviews in the state of Rajasthan.

Training of Frontline Workers on Water, Sanitation and Hygiene in 7 District of Madhya Pradesh

Agency: MPTAST, India

Team: DK Mangal, SP Chattopadhyay, Laxman Sharma, Mohd. Sheriff, Melvin John Baxla, NK Sharma, Sunita Nigam

The WASH component of MPTAST is led by WaterAid and contributes to MPTAST objective on WASH by promoting skills, systems and sustainable services with attention on safe, equitable, inclusive and sustainable access to water supply, sanitation services and improved hygiene behaviors.

WaterAid works to identify problem areas and provide technical assistance to the departments concerned of GoMP, i.e. PHED and Rural Development Department to improve WASH planning, budget utilization and strengthen WASH delivery at state and in priority districts.

One of the important components of the MPWASH program is to the develop capacity at community level for greater community awareness and action on WASH.  The program involves training of Frontline workers (ASHA, ANM, AWW, Teachers, MATE NREGA and Village Motivator Saakshar Bharat), who play an important role to assist communities in raising their awareness and motivation in order to help integrate WASH in their core activities.  

It is expected that the training of FLWs will lead to:

  • Building capacities of Frontline workers to support implementation of WASH programme in the districts.
  • Improve knowledge, increase demand and access for WASH services through community mobilisation processes.
  • Strengthen linkages with government service providers to ensure access to quality WASH services.

IIHMR has been identified by the WaterAid for conducting training of about 15000 FLWs mainly ASHA and certain number of AWWs in 7 districts in Madhya Pradesh, namely Jabalpur,  Mandla,  Rewa,  Satna,  Sidhi,  Chhatarpur and  Damoh. The IIHMR team is implementing the FLWs training program and it is expected that by the end of June, 2015 the team will reach the target.

End-line Evaluation for Diabetes prevention and Control in Jodhpur District, Rajasthan

Agency: Humana People to People in India (HPPI)

Team: Sunita Nigam

The Diabetes Community Care & Support Project of Humana People to People India was launched in Jodhpur in December 2012, as a complementary initiative to support rolling out of NPCDCS (The National Programme for Prevention & Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke).  Through this study HPPI aims to conduct an end-line evaluation of the Diabetes Community Care and Support project by following similar principles and methodologies of the baseline survey with a basic objective to understand the impact of the intervention and find out the grey areas, if any, for further improvement of the implementation in future.

The specific objectives of the project evaluation are  

(1) to evaluate the status of the target population (beneficiaries under project area) on:

    (a) knowledge of diabetes, risk factors, symptoms,

    (b) health-seeking practices in terms of screening for diabetes,

    (c) current load of diabetes and other non-communicable diseases in terms of treatment-seeking,

    (d) attitude of the people to help diabetic affected people, and (e) local food-habits;

(2) To measure the degree of changes on KAP on Diabetes Community Care & Support project among the target community before and after the implementation of the project;

3) To document good practices and success stories of the project for up scaling the project activities in other areas in near future.

The End-line evaluation study adopted both the quantitative as well as qualitative techniques to develop the measurable indicators to verify the changes under the project. The sample frame for the evaluation survey was developed based on the number of village covered under the project. The structured questionnaires were used for the household level survey and checklist for the In-depth interview.  For qualitative aspects, community level FGD were organized separate for men & women group. In depth interview were  carried out for the frontline health workers(ANM& ASHA),knowledgeable/PRI  members of the community, project staff /field workers of HPPI and NPCDCS staff (specially looking after the Diabetes) along with District level health officials , MoIC of Mandor block of Jodhpur District.