Maternal|Child Health

Situación de las Prácticas de Alimentación y Nutrición Materna Infantil Estudio de Línea de Base

El Instituto de Investigación Nutricional realizó la línea de base en el ámbito del proyecto “Ventana de Oportunidad” de CARE Perú en las Regiones de Ayacucho y Apurímac en grupos de intervención del proyecto y grupos de control. Las encuestas fueron realizadas entre septiembre y noviembre de 2010 y fueron aplicadas a una muestra de madres de niños/as entre 0 y 2 años de edad seleccionados al azar en los distritos seleccionados para el proyecto. [153 pages] 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...

Measurement, Learning, and Evaluation for the Ananya Program (Family Health Initiative in Bihar)

In 2010, the Bill & Melinda Gates Foundation launched the Family Health Initiative in Bihar, India (now named “Ananya”, a Sanskrit word meaning “unique” or “unlike others”). The goals of the Ananya program (2010–2015) are to reduce maternal, newborn, and child mortality; malnutrition; fertility; and morbidity from infectious diseases by developing and implementing innovative and integrated health solutions that involve both the public and private sectors. More specifically, the program aims to expand the reach, coverage, and quality of (1) essential primary health and nutrition services for infants, children, and women of reproductive age; and (2) diagnostic and disease-control services for infectious diseases, including pneumonia, diarrhea, tuberculosis, and visceral leishmaniasis. [68 pages] Read More...

Using Supply- and Demand-Side Strategies to Improve Maternal and Child Health in Bihar, India

This report focuses on the findings from our process study of two early Ananya grants: (1) the Integrated Family Health Initiative (IFHI), led by CARE; and (2) Shaping Demand and Practices to Improve Family Health in Bihar (SDP), led by BBC Media Action. We focused on these two grants because their activities had begun earlier than other grants and had had time to take root. Next, we offer additional detail on the interventions, describe the data collection for the study, and summarize key findings. [120 pages] Read More...

Baseline Findings from the Ananya Evaluation

The Ananya program (ananya is a Sanskrit word meaning “unique” or “unlike others”) was created by the Bill & Melinda Gates Foundation (the foundation) to address some of the important family health challenges in Bihar, one of India’s most populous and poorest states. Ananya started as a five-year program (2011–2015) with the long-term goals of reducing maternal, newborn, and child mortality; fertility; and undernutrition rates in Bihar. To achieve these goals, the foundation is funding a synergistic set of complementary grants focused on improving the reach, coverage, and quality of family health services in two main areas: (1) essential reproductive, maternal, newborn, and child health services and (2) diagnosis and treatment of infectious diseases, including pneumonia, diarrhea, tuberculosis, and visceral leishmaniasis. Since its inception, the program has also expanded to include additional interventions that focus on improving sanitation in Bihar and on strengthening the system for health payments, including health-related incentives for households and incentives and payments for frontline health workers. [126 pages] Read More...

Midterm Performance Evaluation of the Bangladesh NGO Health Service Delivery Project (NHSDP)

This 159-page midterm performance evaluation of the Bangladesh Non-governmental Organizations (NGO) Health Service Delivery Project (NHSDP) examines the project’s progress toward meeting its goal and objectives. NHSDP is the United States Agency for International Development (USAID)/Bangladesh’s largest health initiative; this flagship project is the latest in a series of programs going back to at least 1998 that have sought to improve the ability of local NGOs to provide basic health services to the poor. NHSDP was designed in 2012, when USAID was implementing significant procurement reforms and emphasizing the need to work more directly with local organizations. In 2013, USAID received gift funds from the United Kingdom’s Department for International Development (DFID) to co-fund NHSDP, which expanded the scope considerably. The DFID supplementary fund has supported the current NHSDP activities and strengthened its focus on family planning (FP) and maternal health outcomes, with a specific focus on improved service delivery for the urban poor. Read More...

Improving Maternal and Infant Health in Bangladesh (IMIHB)

A 36 page evaluation of the IMIHB project which aimed to improve maternal, newborn and child health status of urban and peri-urban areas in Gazipur district of Bangladesh. The project centres around capacity building of the community health provision and support system; awareness generation in the community; and establishing referral and linkages between health facilities. Read More...

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