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India

New Born Survival Project (NBS) Endline Report

Care India carried out in the Newborn Survival project in Ajaygarh block in Panna district of Madhya Pradesh. The project focused on strengthening services in maternal and child health by training of frontline health workers, GNMs/ANMs and creating community awareness on health parameters to be taken care of during pregnancy and delivery. A baseline survey was conducted in the beginning of the project to record the then status of health services being provided and community knowledge and perception on the same. This report presents the end line survey findings after the completion of the project. [92 pages] Read More...

Urban Health Initiative (UHI) Endline Report

The benefits of family planning go beyond the prevention of maternal and child mortality and extend to poverty alleviation, environmental sustainability and the empowerment of women. The Bill & Melinda Gates Foundation is committed to reducing unintended pregnancy in the developing world by increasing access to high-quality, voluntary family planning services. The Urban Reproductive Health (RH) Initiative, initiated in 2009, is one component of the foundation’s strategy that targets the expansion of quality family planning services in selected urban areas of Uttar Pradesh, India; Kenya; Nigeria; and Senegal. To build scientific evidence for urban family planning efforts, the Measurement, Learning & Evaluation (MLE) Project, led by the Carolina Population Center at the University of North Carolina at Chapel Hill (UNC-CH), in partnership with the International Center for Research on Women (ICRW), conducted an impact evaluation of the country-specific Urban Health Initiative (UHI) program in Uttar Pradesh, India. [102 pages] Read More...

‘We Pledge to Improve the Health of Our Entire Community’

Motivation is critical to health worker performance and work quality. In Bihar, India, frontline health workers provide essential health services for the state’s poorest citizens. Yet, there is a shortfall of motivated and skilled providers and a lack of coordination between two cadres of frontline health workers and their supervisors. CARE India developed an approach aimed at improving health workers’ performance by shifting work culture and strengthening teamwork and motivation. The intervention—“Team-Based Goals and Incentives”—supported health workers to work as teams towards collective goals and rewarded success with public recognition and non-financial incentives. [19 pages] Read More...

Pathways- Global Baseline Report

CARE’s Pathways program focuses on improving poor women farmers’ productivity by empowering them to more fully engage in equitable agriculture systems. The program is funded by the Bill and Melinda Gates Foundation and implemented in Bangladesh, Ghana, India, Malawi, Mali, and Tanzania. Aligned with other CARE initiatives, such as CARE Australia’s WE-RISE program, Pathways is designed to overcome the constraints to women’s productive and equitable engagement in agriculture. Utilizing a strong gender focus, the program’s Theory of Change posits that marginalized, poor women farmers will be more productive, and their families more food secure when:
 women have increased capacity (skills, knowledge, resources), capabilities (confidence, bargaining power, collective voice), and support
 local governance and institutions have/implement gender-sensitive policies and programming that are responsive to the rights and needs of poor women farmers
 agricultural service, value chain, and market environments of relevance to women are more competitive, gender-inclusive, and environmentally sustainable. [104 pages] Read More...

mHealth Experiences: from Rigorous Research to Transformative Scale

This report outlines the background, data, and results of a mobile health program for continuum of care services. [28 slides] Read More...

Bihar Story 2017: PowerPoint Presentation

This presentation contains data collected from a household survey regarding socio-demographic profile, maternal & newborn health, nutrition, and immunizations. [114 slides] Read More...

Evaluation of the Team-Based Goals and Performance Based Incentives (TBGI) Intervention in Bihar

The Team-Based Goals and Performance-Based Incentives (TBGI) intervention, which CARE conceptualized, developed, and implemented as part of the Ananya program in Bihar, leverages the power of incentives and lessons from motivational theory on teamwork and goal-setting to help improve maternal and child health. Under the intervention, CARE set targets for the percentage of eligible beneficiaries in a subcenter catchment area who should have adopted each of seven key health behaviors or goals (Box 1). All frontline health workers (FLWs) in a given subcenter, including the accredited social health activists (ASHAs), Anganwadi workers (AWWs), and the subcenters’ auxiliary nurse midwives (ANMs), received nonmonetary incentives (consisting of small household items) if their subcenters met five of seven goals in a given quarter. The intervention explicitly sought to encourage teamwork and cooperation among FLWs by providing these incentives for achievements by the subcenter as a whole rather than by individual FLWs, and by providing FLWs with information on the concept and importance of teamwork. It included additional elements to motivate the FLWs in each subcenter, such as a service pledge they recited together and a certificate of recognition for subcenters that met their targets in all quarters. Overall, the intervention was expected to lead to improvements in the incentivized outcomes and to broader changes in related, but nonincentivized, outcomes through increased FLW motivation and teamwork. [82 pages]
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Integrated Family Health Initiative: Catalysing change for healthy communities

Recent trends in the Infant Mortality Rate (IMR), Maternal Mortality Rate (MMR), nutritional status, immunization and family planning, as highlighted in Figure 1, 2, 3 and 4, indicate that there are substantial gaps in achieving related MDG goals 4 and 5.

Despite recent gains and commitments from the Government of Bihar (GoB) and active leadership of key stakeholders to improve health infrastructure and outcomes, deep-rooted problems limit the government’s ability to affect lasting change. Persistent barriers include poor quality and availability of frontline and primary health center level services and staff, limited access to services by neglected and marginalized populations, lack of accurate data, lack of effective program management, weak training systems, absence of supervision in health facilities, poor functional integration of interventions, inadequate public health infrastructures, and an underdeveloped and unregulated private sector.

With support from the Bill and Melinda Gates Foundation, the Integrated Family Health Initiative (IFHI) program seeks to support the GoB to improve family health outcomes statewide as well as build their leadership and ownership towards these services. Ultimately this is to accelerate the progress toward MDG 4 to reduce child mortality and MDG 5 to improve maternal health. [12 pages] Read More...

Evaluation of the Information and Communication Technology (ICT) Continuum of Care Services (CCS) Intervention in Bihar

The Information and Communication Technology (ICT) Continuum of Care Services (CCS) intervention was conceptualized and implemented by CARE as part of the Ananya program in Bihar.1 The intervention involves the provision of ICT-enabled mobile-phone-based tools for frontline workers (FLWs) that aim to increase the coverage and quality of services that FLWs provide, enhance their communication with beneficiaries, and facilitate supervision (Box 1 summarizes the features of the ICT-CCS tool). [123 pages] Read More...

Measurement, Learning, and Evaluation Framework for the Bihar Initiative

The Family Health Initiative in Bihar, India (referred to in this report as the “Bihar Initiative”) is one of the foundation’s flagship programs. It represents a new approach to investing in global health, with the goal of yielding greater impacts on health outcomes and mortality, and accelerating progress toward Millennium Development Goals 4 and 5. In particular, the Bihar Initiative takes an integrated approach to improving reproductive, maternal, neonatal, and child health by leveraging and bundling services and delivery mechanisms from several of the foundation’s Global Health Strategies to improve uptake and coverage across the continuum of family health care. These strategies include Maternal, Neonatal, and Child Health; Family Planning; Nutrition; Vaccine Delivery; Tuberculosis; Enteric and Diarrheal Diseases; Pneumonia; and Neglected and Other Infectious Diseases. [60 pages] Read More...

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