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Three Decades of Excellence inHealth Management and Research

29th STATE OF INSTITUTE REPORT29th STATE OF INSTITUTE REPORT

2014

Institute of Health Management Research, Jaipur

2014

WHO Collaborating Centre

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Institute of Health Management Research, Jaipur

29th STATE OF INSTITUTE REPORT

29th STATE OF INSTITUTE REPORT

2014

2014

Three Decades of Excellence inHealth Management and Research

WHO Collaborating Centre

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C o n t e n t s

C o n t e n t s The Institute 4Our Mission 4 Thrust Areas 4Capabilities 4

From the Trustee Secretary's Desk 5From the Director's Desk 6Global Networking 8Campuses of IIHMR 11

Research 14Research Projects and Studies Completed 14Ongoing Projects and Studies 24Research

Educational Program s 38me

Training Programmes 45Management Development Programmes (MDPs) 45MDPs Schedule for 2014-15 50

Conferences & Workshops Organized 52

Conferences/Seminars/Workshopes & Attended 58

Publications 61

Team IIHMR 64Management Board 64Governing Board 65Board of Management 66

Academic Council 67Faculty 69Research Scholars 85

Administration 85 Academics 86Finance and Accounts 86Dr. D.A. Henderson Library & Documentation Centre 86I.T. Department 87Project Offices 88

Gender Health Resource Centre (GHRC) 91

Key Resource Centre (KRC) for Drinking Water & Sanitation 91

IDA Assisted ICDS Programme 92

Synergy - IIHMR Alumni 94

Hem K. Bhargava A.L. Shah Anil Kumar NBRajkumar Pathak

Editorial BoardHem K. Bhargava A.L. Shah Anil Kumar NBRajkumar Pathak

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IIHMR is an institution dedicated to improvement in standards of health through better management of health care and related

programs. It seeks to accomplish this through management research, training, consultation, and institutional networking in anationalandglobal perspective.

Our Mission

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The Institute

IIHMR is engaged in policy issues, program planning andmanagement and capacity building mainly in the health sector. It undertakes research, training and consulting activities in thefollowing areas:

PrimaryHealth Care

HealthandHospitalManagement

PharmaceuticalManagement & Rural Management

Populationand Reproductive Health andEvaluation

HealthEconomics andFinance

NGOManagementandNetworking

Program Management

Management Research, Educationand Training

Designand ConductManagement Training forHealth Sector

Networkingand InstitutionalCapacityDevelopment

Project Management

Operations Research andEvaluation

Economicand FinancialAnalysis

SurveyResearch

SocialAssessment

QualityAssurance

HealthSector Reforms

Program Evaluation

Thrust Areas

Capabilities

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I am happy to bring before ourprofessional colleagues, friends andwell-wishers, thephenomenal strides IIHMR hasmadeduring 2013-14. We have been able to develop and establish our campuses in Delhi and Bangalore to promote research, education and training inmanagement in the health sector. This year, IIHMR Jaipur has achieved the University status as IIHMR University by an Act of theGovernment in February 2014. The IIHMR University will primarily be a research and post-graduate education University. We believethat with this breakthrough, IIHMR will script a new chapter in the history of management research education and training in the healthsector and other related areas suchas health economics and finance, population and reproductive health, public health, primary healthcareandhealthcare developmentin thecountry andin SouthEast AsiaRegion.

We are pleased to inform that the collaboration with the Johns Hopkins University to offer Masters of Public Health (MPH) program inIndiahascometo fruition andthe MPHprogramcould belaunchedthisyear for countriesin theSAARC Region.

Another significant development, which is worth mentioning, is thestart of PhD program in hospital and hospital management and alliedfields. The response among the professionals and the students to the PhD program was immense at the national and international levels.However,wewere constrained toenroll onlylimitednumberof students.

The Post-graduateProgram in Hospital and HealthManagement,now, MBAHospitaland Health Management,has retained its first rank as

a high qualityeducation program in thecountry. We have done exceedingly well in research and management training programs during theyear.

All this possible because of the incessant and untiring efforts of faculty and research staff and strong support of the support staff. I wish wemaintainthis spirit and makethe IIHMRUniversityas a world-classinstitution of learning.

M.L. Mehta

From the Trustee Secretary's Desk

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The year 2013-14has been the year of transformation of IIHMR. This year, the IIHMRhas achievedthree significantmilestones. First andthe foremost being that IIHMR, Jaipur has been accorded status of a University, to be known as The IIHMR University, by IIHMR University Act 2014 enacted on February 6, 2014. IIHMR University has a unique status as primarily a research university healthmanagement and allied areas. The IIHMR University is a Postgraduate Education university that would offer master and doctoral leveleducation and training. This distinction granted to IIHMR is hard and sustained work of the faculty and research staff producing researchstudies, capacity building and education in management in the health sector in India and globally. This could happen with a phenomenalcontribution of the faculty and research staff, and an excellent support of IIHMR Management, Administration and Finance, IT and

Library personnelover thelast threedecades

IIHMR University will continue to carry the legacy of IIHMR and its Mission. It would offer masters degree programs in health andhospital management, pharmaceutical management, rural management, human resource management for health, health care logistics andsupply management, health economics, finance and health insurance, health information technology, health communication and behaviorchange,other health sector relatedareas.

The Second milestone accomplished is the launch of Master of Public Health (MPH) Program with the Johns Hopkins University Schoolof Public Health, USA, the global leaders in public health education and training. The program has developed keeping in view the public

health needs in the countries in the South East Asia Region. The students will receive the Johns Degree which would have the samecredentials.The 80 credit program is taught by the faculty of the IIHMR University andJohns Hopkins University School of Public Healthmainlyat theIIHMR Jaipur Campus. Thestudentswill attendcourses in thewinter termat theBaltimore campusof JohnsHopkinsSchoolof PublicHealth.

The Third milestone is the beginning of PhD Program, This is the first ever doctoral program in health and hospital management andrelated areas of health policy and program management. The PhD Program will enable IIHMR to fulfill its mission to build researchcapacity in the health sector and develop competent researchers in the country. The response to the PhD program has been immenseamong thehealth professionals.Thefirst cohort of PhD scholars has rolledthis year.We aresure that our PhDProgram will establishnew standardsof researchandbuild researchcapacity in thecountry.

From the Director's Desk

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The Institute continues to strive for excellence and achieving its mission of improving standards of health of the people through highquality management research,educationandcapacity developmentof the health professionalsat the national and international level. It hasemerged globally as a unique model of an autonomous non-profit and self financed organization that is focused on a social sector such asthe health, through researchandeducation. We takepride in introducing a newdiscipline of health management worldwide andpromoting researchandhuman resourcedevelopmentin health policy analysisandprogram management, wayback in1984.

The Institute has conductedseveral short and long term research studies that havehigh impact and relevanceon health policy and programstrategies. TheInstitutehas beengivenresponsibility of conducting NationalFamilyandHealth Survey– 4 in theStatesof Madhya Pradesh(E),Uttarakhand and Chhattisgarh. UNFPA assisted operational research project on implementationof Health Information Management in the state of Bihar made a significant improvement in quality and effectiveness of HMIS, particularly, for NRHM. Fortification of milk and oil with Vitamin A and D in Rajasthan has shown new opportunity for reducing micronutrient deficiencies. Under the foodfortification project, supportedby GAIN, about 1.7million litersof milk is fortifiedin cooperation with RSDFC andsuppliedthroughout the state. Fortification of wheat flour with iron folic acid and B12 has been a major breakthrough in urban and rural areas. ResearchProgram Consortium, funded by DFID, continues to explore research questions and generate evidence for improvement in effectiveness

and efficiency of health systems. IIHMR joined in the path breaking initiative of improving health of urban poor in partnership with thePopulationFoundationof India withthe support of USAID.

Capacity building in management in the health sector, especially national, state and district level managers, program managers of projectsfunded by development agencies in the country, through Management Development Programs (MDP), continued to be a major focus of the Institute. The Professional DevelopmentCourse, a 10-week training program, supportedby the MoHFW/NIHFW, WHOFellowshipprogram for ministerial staff of MoHFW, and Leadership and Strategic Management Program for health professionals of SAARCcountries have made a significant contribution in capacity building in management, public health and health program management.International program for Rational Use of Essential Medicines with focus on TB, HIV and Malaria has become popular, especially incountriesin theAfrican Region.The Instituteshas alsoidentifiednewareas of capacitybuildingineffective health sector management.

The PostgraduateProgram in Hospital and HealthManagement (PGDHM)continuesto enjoyNo.1 Rank in the country. The program hasset high standards of management education in the health sector. The demand for our students in the hospital and health program ingovernment and private sector has phenomenally increased. The students' placement is consistently perfect since the inception of theprogram in 1996. We take pride in creating a critical mass of young professional managers in the health sector and transforming management of health systems and hospitals in the country. We believe they would be the future leaders in professional management of hospitals, health organizationsandpharmaceutical industry.

As IIHMR University, the Institute has entered in a distinguished league of education and research institutions. As a University, we plan tointroducenew academicandresearchprograms.

We have our dreams to become a global institution of learning and scholarship in management education, research and capacity developmentin thehealthsector. We have high hopesfora brightfutureandscripting a newchapter in thesuccessstoryof IIHMR.

S.D. GuptaMD, PhD (Johns Hopkins), FAMS

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Global Networking

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The Institute has been instrumental in setting up collaboration and networking globally with various national and internationalorganizations anduniversities to promote publichealtheducationin thehealthsector. We take pride in having technical tie-ups with theseprestigious institutionsand organizations.

IIHMR is a WHO Collaborating Centre for District Health System Based on Primary Health Care for itsexcellence in health managementresearch, trainingandeducational programs.As thecollaboratingcentreof WHOSEARO, the Instituteworks in theareasof organization andmanagement of thehealth system,strengthening the district health system, quality management in health care, operations research, andhealth sector reforms. The Institute operates as a resource centre; organizes intra - and inter-country training programs; and collaborates with W.H.O. in monitoring and evaluation and provides expertise inhealth systemmanagementandresearch.

South-East Asia Public Health Education Institution Network (SEAPHEIN) has been created by the WHO South-East Asia Regional Office to promote collaboration and sharing of information andknowledge among the member countries in the Region in pursuit of strengthening public healtheducation and training. IIHMR is a founding and an active partner of the network and has signedagreements forcollaborationwithvarious institutions in SEARcountries to promote capacity buildinginpublic health,management andjoint collaborative research.

To promote public health education in India, India Public Health Education Institution Network (IndiaPHEIN) has been developed and promoted under the stewardship of WHO-SEARO. TheInstitute hosts the Secretariat of IndiaPHEIN and playing a leading role in establishing the network tostrengthen publichealth educationin India.

IIHMRand NIHFWhaveagreed to promote cooperation in education, training andresearch. Theareasof co-operation include joint training; research; visits by and exchange of scholars, teachers and otherstaff; exchange of students for long and short term programs; exchange of research materials (reports,information, published papers etc.); andsharingof information throughvideo conferencing.

The Afghan Public Health Institute (APHI), Ministry of Public Health, Afghanistan and IIHMR Jaipurhave agreed to work together to promote management education, research and training in the healthsector inAfghanistan.

ACTD is a registered non-profit, non-political and non-governmental organization working for thedevelopment and transformation of the civil society in Afghanistan. ACTD was established in 2007 by agroup of Afghan professionals to offer research, training and consultancy services in order to developpractically applicable knowledge. IIHMR has signed a MoU with ACTD to strengthen research, training,andconsultancy services inhealth management areasin Afghanistan.

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To establish and strengthen the capacity of the NGOs and the employees of the Government of Afghanistan, IIHMRhas signed an agreement with IbnSinaAfghanistanand workingtogether to providetraining in important health management areas, such as health policy planning and management, healthcare financing, policy for HIV/AIDS, project planning, implementation monitoring and evaluation,quality assuranceand hospitalmanagement inAfghanistan.

The IIHMR and the SAARC Tuberculosis and HIV/AIDS Centre (STAC) have technical tie-up forconducting training in the SAARC countries. The Institute has been instrumental in providing technicalsupport to theSTAC several trainingsonLeadership& StrategicManagement inSAARC region.

IIHMR and Gulf Medical University (GMU), Ajman, UAE have agreed to launch various academicprograms and short-term courses in healthcare management and other related areas in UAE. GMU isrecognized as a standard bearer of excellence in medical education in the Gulf region delivering high

quality medical educationand training to professionalsfrom54 nations.The twoorganizationswill jointly developvarious educationcoursesin HospitalAdministrationand HealthcareManagement.

The collaborative arrangement with the SUPBIOTECH, Paris is aimed at the exchange of faculty andstudents and development of special programs and internships. The collaboration calls for research anddegreeprogramsand conferences andworkshops tobe offeredand conductedjointly.

IIHMR and the University of Chester have signed a MoU for cooperation to enhance academic andresearch opportunities for the staff and students and also to develop cultural linkages between both the

institutions in thefieldof publichealth.

To establish educational affiliation between the two organizations, the Institute has signed aMemorandum of Understanding with B.P. Koirala Institute of Health Sciences (BPKIHS), Nepal. Themajor areas of agreement include advice and consultancy on structural, academic, policy and proceduralmatters related to the establishment of a new School of Public Health, partnership to support thedevelopment of School of Public Health, support in curriculum development in public health, exchangeof faculty and training of faculty and staff in public health, participation and support in teaching training activities, student exchange, collaborationin research activities, collaboration in serviceand public healthpolicy activitiesetc.

Mahidol University, Thailand – The Institute has technical collaboration with Mahidol University, Thailand and Padjadjaran University, Gadjah Mada University and Hasanuddin University, Indonesia tojointly develop academic and educational activities, such as student exchange programs, faculty exchangeprograms, technicalcooperationand collaborationin researchprojects.

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Campuses of IIHMR

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• IIHMR University, Jaipur • IIHMR Delhi • IIHMR Bangalore • IIHMR Kolkata

Indian Institute of Health Management Research (IIHMR) was established with a fundamental purpose of creating new knowledge anddevelopingalternate modes of improving healthcare to management research,educationand training in India andotherparts of the world.

The Institute has significantlycontributedto the areas of health researchmanagement in the country and in South-EastAsia Region. It hasestablished a new paradigm of management of capacity development among healthcare professionals at the national, state and district levels in the areas of leadership, strategic management, and quality assurance in health care. The Institute works as a WHO Collaborating Centre for District Health Systems Based on Primary Healthcare since last one and a half decades. The Ministry of Health and Family

Welfare, Government of India, has designated the Institute as ‘Institute of Excellence’ for its contribution to capacity development programs in the health sector. The Post-graduate program in Hospital and Health Management, Pharmaceutical Management and RuralManagement are theunique programsof IIHMR.

Under the Society of Indian Institute of Health Management Research, the IIHMR group has created four campuses all over India. TheIIHMR,Jaipur hasnowbecametheIIHMR University. TheIIHMR Universitywillbe thefirstof itskindResearch University in theStateof Rajasthanwith an exclusive focus on management research, educationand training in thehealth andrelated sectors. Theprimary focusof theUniversity is onResearchand Post-graduateEducation.

With the establishment of IIHMR, Jaipur as the IIHMR University, the AICTE approved Post-graduate Courses offered at the Institute will be offeredas MBAprograms in the related disciplines. Besides these MBAprograms, the University introduceddoctoralprograms. Inthis endeavour, the University introduced the first Ph.D. in Hospital and Health Management in February 2014. The IIHMR, Delhi andBangalorecampuseswilloffer thecoursesat itspresent statusas AICTE approvedpost-graduateprograms.

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An Exclusive Health Research and Postgraduate University

IIHMR Jaipur has now become the IIHMR University. The IIHMR University is a specialized Research University in management research, postgraduate education and training exclusively in the health sector. The University aims to generate new knowledge andtechnologies to provide evidence and inputs for developing effective policies and health interventions and strategies. The origin of theIIHMR University has its roots in pioneering and significant contributionof Instituteof Health Management Research (IIHMR), Jaipur inthe last three decades to policy and program management research, and capacity development in health and hospital management in IndiaandSouth-East Asia, whichhas enabled it to attainthe statusof a university. TheIIHMRUniversity hasa mission to improve thestandardsof health through better management of health care and related programs through management research, education, training andinstitutionalnetworking in a nationalandglobal perspectivein thehealth sector.

Over the last 30 years, IIHMR, working as a WHO Collaborating Centre for District Health Systems and designated as an Institute of Excellence by the Ministry of Health and Family Welfare, has played a major role in promoting and conducting health policy and programmanagement research. The Institute has been instrumental in a paradigm shift in the management of health care and hospitals in India. Acritical mass of professionally trained health and hospital managers has been produced by IIHMR. For its contribution to management education, it has gained several Leadership Awards. In addition, IIHMR has become a major destination for training and capacity development in leadership and strategic management, hospital management, disaster management, quality management, project management, health management information systems,and health economics andfinance.

Organization Structure and Culture The IIHMR University has a unique organization culture that enshrines core values and ethos of autonomy, accountability, openness andtransparency. Theinterdisciplinary teamsof the faculty andresearchstaff constitute an enablingenvironmentfor learning andprofessionalgrowth and development. The faculty is multidisciplinary that represents public health, management, economics, statistics, demography,social andbehavioral sciences,rural developmentand pharmaceuticals.

The IIHMR University comprises of the following four main institutions/schools which work in coordination, sharing academicexperience andlearning:

• Institute of HealthManagementResearch

• Institute of Socialand Behavioral Sciences

• School of PharmaceuticalManagement

• Schoolof RuralManagement

Collaborating Institutions and Universities

World Health Organization; SEAPHEIN; Johns Hopkins University, USA; Chester University, UK; Mahidol University, Thailand;SAARC TBInstitute;The UNION;AfghanPublic Health Institute, Kabul; BP KoiralaInstituteof Public Health, Nepal.

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IIHMR has completed three successful decades of research in the healthcare sector. Throughout these years, the Institute has conductedmore than 500 research projects and studies at the national and international levels. These have high relevance to health policies andprograms. The Institute has extensively worked on assignments/consultancies for studies and projects funded by various bilateralagencies, the Government of India and State Governments. The areas of research/studies included during these decades were HealthSystem, Human Resource and Training, Family Welfare, Maternal and Child Health, Medical Education, Health Management InformationSystem, Evaluations, Education and Communication, Information Technology Survey, Project Implementation Plan, Health Economicsand Financing, Drugs, Strategy Planning, HIV/AIDS, Nutrition, Communication Behaviour, National Health Policy, Health Insurance,Quality Assurance,OperationsResearch, Reproductive Health, andGender Health.

The Institutecontinuesits efforts in expandingits focuson research in policyand program management in the health sector. The following are thestudies/research projectscompletedand ongoingduring theyear2013-14.

Research Projects Studies CompletedandMonitoring and Evaluation: Technical Assistance for Strengthening Health of the Rural Poor (METASHARP)

Agency : MoPH,Afghanistan

Team : S.D. Gupta,L.P. Singh,AnubhavAgarwal, RajpalSinghYadav, Suhail IsmailSheikh,B GowthamGhosh

METASHARP project was a contract between the Ministry of Public Health (MOPH), Islamic Republic of Afghanistan and the JohnsHopkins School of Public Health (JHSPH), USA. IIHMR provided technical support to the Provincial Health Offices and MOPH toenable them to play a greater role in data analysis and monitoring and evaluation activities under National Health Services Performance

Assessment (NHSPA) of all types of health facilities in Afghanistan.The first roundof NHSPA started in 2004and wascompletedin 2009-10.

The Ministry of Public Health (MoPH) of the Islamic Republic of Afghanistan, with technical assistance from the Johns HopkinsUniversity Bloomberg School of Public Health (JHSPH) and the Indian Institute of Health Management Research (IIHMR), has used theBalanced Scorecard (BSC) to measure the performance of Afghanistan’s provinces in the delivery of the BasicPackage of Health Services(BPHS), and to provide policymakers, health managers and the public with evidenceconcerning areas of strength and weakness. The BSC

was used by the MoPH to clarify its vision and strategies, and to manage change through a set of indicators that reflected the policies and

strategiesof theMoPH. The BPHS BSC was revised substantially in 2011 to reflect the changingpoliciesand conditionsin the country. The 2012-13BSC was basedon the data collected from 725 randomly selected BPHS health facilities in 34 provinces across the country, and involved observations of 6,930 patient-provider interactions andpatient exit interviews, along with2,403 health workerinterviews. The indicators andmethodsusedfor estimation in2012-13BSCwere thesameas thoseused in2011-12BSC.

The revision was carried out through a participatory process that was led by the MoPH and with active involvement of various otherstakeholders in the Afghan health sector including the non-governmental organization (NGO) implementing partners, donors, health

worker association representatives, and other stakeholders, including a MoPH led BSC Technical Working Group. The Third Party

Evaluation team from the Johns Hopkins Bloomberg School of Public Health (JHSPH) and Indian Institute of Health Management Research(IIHMR) facilitatedthe process.

Research

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Strengthening of HMIS in Bihar

Agency : UNFPA

Team : Santosh Kumar, S.P. Chattopadhyay, Tukaram Khandade, Akhil Agrawal, Bimlesh Sinha,Vikash Singh, Vishal Singh,Ganesh Rajpoot,Aash Mohammad

To improve the quality of HMIS data in terms of timeliness, completeness and correctness and its utilization in planning and decision-making at every health facility level in Bihar, IIHMR Jaipur undertook a project titled “ ” with theStrengthening of HMIS in Biharsupport of UNFPA. TheProject wasimplementedfrom October2009 toMarch2014.

The Specific objectives of the project were:

• to train health functionaries at different levels of facilities and to oversee the quality of the data generated at different levels (HSC,PHC, District,andState);

• tobuild analyticalcapacityof themiddle level managers to use thedata inplanning, monitoring, evaluation anddecisionmaking;

• toestablisha systemof feedbackand suggestmeasures forimprovement at differentlevels;• in order to to make the project efforts sustainable, to transfer the skills and learning by the project and its protocols to government

officials.

To change the HMIS of Bihar was not a short-term task. Adequate infrastructure and trained staff in the area were vital aspects of strengthening the HMIS. User participation from the inception of ideas of such systems, their initiation, design, development andimplementation were also required in order to develop gradual changes in the user ’s understanding and to enable IT to become a normal

wayof doing things.Such changesneeded to be carried out incrementally, enablingusers to learn from previouschanges and to incorporatenew changes that emerge over time. Thus, the actors needed to create an environment that enabled in-house and external generation and

sharing of knowledge within the sustainability strategy framework. Efforts to bring the above-mentioned change at all management levelsarenow beginningto take root. As a result, support to thesystemby highermanagementnow will play a significant supportive role andwillbea crucialpivotin the roll-outof thesystemand continued andeffective utilization of generateddata/information.

Finally, HMIS was not onlyabout technology, butwas also important tosupport it with socialand political commitment tomakingit a gamechanger – a sustainable,reliable andeffectivetoolin healthsystem information managementin thestatein theyearsto come.

Evaluation of Demand Side Interventions for Revitalization of Post-Partum Family Planning in Bihar

Agency : JHPIEGO, USA Team : VinodKumar,VivekLal, GowthamGhosh DanishAhmad,DineshChandra,MohammedSharif B ,

JHPIEGO had worked to strengthen Post-Partum Family Planning/Post-Partum Intrauterine Contraceptive Device (PPFP/PPIUCD)services as a part of Government of India ’s program for the introduction of PPIUCD services in the country. IIHMR was assigned toconduct an independent baseline and end-line assessment in Bihar in the districts of Begusarai and Darbhanga for both supply-side anddemand-sideinterventions.

With the objective of assessing the knowledge and attitude of service providers, community based workers and the awareness of post-partum family planning among post-partum women, the baseline and end-line evaluation was done by IIHMR during 2011and 2013

respectively. The reporthas beensubmitted to JHPIEGO.

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Utilization of Emergency Contraceptive Pills among Rural and Urban Women in Rajasthan: A Study of Psycho-social Determinants

Agency : ICMR

Team : Neetu Purohit,ShilpiMishra,RakhiMathur,PriyankaBakhshi,SoniaLuna, Lalit MohanNayak,VrindaMehra

Emergency contraceptive pill (ECP) is a back-up birth control method that is used within days of unprotected sex or in the event of aknown contraceptive failure. It is not intended for use as a regular contraceptive method. The broad objective of this study was tounderstand the pattern of use of emergency contraceptive pill and associated psycho-social determinants among rural and urban womenof Rajasthan. The specific objectives of the study were to assess the level of awareness and knowledge of the women about emergency contraceptive pill; to find out the utilization pattern of these pills and perceived immediate and prolonged health effects; to discover thefacilitating and hindering factors influencing their availability, accessibility, acceptability and affordability, and the role of mass media indissemination of information and knowledge. A cross-sectional study was conducted in urban and rural areas of Jaipur district. Bothmarried and unmarried women were interviewed. While married women (N- 978) were contacted through household survey, unmarried

women(N-228) werecontactedat eating joints and shoppingmalls.It was found that more than 95 percent of the respondents were aware of contraceptive methods like OCP, IUCD, and female and malesterilization. About 45 percent of the married women were aware of ECP; this proportion increased to 87 percent for unmarried women.Close to three-fourths married respondents were not aware of circumstances in which ECP is to be used. Around six percent of respondents reported the use of ECP (8%in urban areas and5% in rural areas). Theusers of ECPhad gained knowledge of ECPthrough TV (46.8%) or fromtheir husbands(29.8%). In case of unmarried women, a majorityof them (82%) recognizedECP by their brandnames. Television advertisements (96%) were the main source of information about ECP while friends and newspapers were the source of information for 58 percent and 48 percent of the respondents respectively. Around 63 percent of these women used ECP as a regularmethod of contraception. About 69 percent of married respondents admitted that the availability of ECP had benefitted women and 88percent reported that due to its availability they no longer had to live under fear of pregnancy. About 71 percent of the women suggestedthatawareness generationon sideeffectswould curbirrationaluse of ECP.

Pilot for 7 Gram Panchayats on Community Managed Water Supply System in Tonk

Agency : UNICEF, PHED, Government of Rajasthan

Team : GauthamSadhu,ArindamDas,ParvinderKumarSharma, Suresh Siwal

The project intended to develop a workable model in seven Gram Panchayats of Tonk district involving the Village Water and SanitationCommittee(VWSC) to manage andmonitordrinkingwater supply schemes. Also, the project aimed to strengthen the capacitiespertaining towaterand sanitation to themembersof theVWSCs inthesevillagesso that they couldmanage theirwatersupplyschemes ina sustainablemanner.The projectwassupportedby UNICEFandPHED, Governmentof Rajasthan.

The major activitiesof the projectwere:1) baselinesurvey to assess KAP of the community pertaining to water and sanitation, the status of water supply, and the demand for improved services with regard to drinking water supply; 2) sensitizing and creating awareness among implementers like government functionaries, PRIs, representatives of VWSCs and the community; 3) planning and designing of variouscommunity participation strategies related to drinking water supply schemes; 4) training and capacity building of the community informulation, implementation and maintenance of the schemes; 5) supporting the execution of community managed works and servicesrelated to drinkingwater supply schemes; 6) post execution activities likehanding over the responsibilityof operationand maintenance of theseschemesto thecommunity.

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Strengthening Hospital Operations at Kothari Hospital, Bikaner

Agency : KothariHospital,Bikaner

Team : SantoshKumar,VijayPratap Raghuvanshi

Kothari Hospital and Research Center is a 130-bedded hospital located in Bikaner district. IIHMR was involved in strengthening theexisting processes and bringing professionalism in the day-to-day management of the hospital and thus preparing the hospital for NABH. The objectives of the study were to developstandard operatingprocedure(SOP) to determine equipmentrequirementsas per NABH /JCIstandardsandto providebriefingto thekeyhospitalstaff. Themethodologies of theprojectwere:

1. Going round the hospital and discussing with the staff in different areas and with hospital management to understand the existing processesand theproblemsfaced andthefuture plans

2. Developingthe infrastructural requirements andSOPas pernewdemands

3. Providing onsite support in implementingchangesthrough monthlymeetingsat thehospitalsite.

Social Mobilizing and Marketing: Positioning Food Fortification

Agency : GAIN-PMU, IIHMR

Team : Neetu Purohit,SeemaMehta, PriyankaBakhshi,RakhiMathur and SoniaLuna

Malnutrition is common in India; onein every threechildren is malnourished.Foodfortification is a practicaland inexpensivealternative todealwiththe problemof micronutrientdeficiency. Food fortification is theadditionof keyvitaminsandminerals to staple foods to addressnutritional gap. Food fortification project has already launched fortified wheat flour, oil and milk through open market channel inRajasthan. Thestudy was aimed at understanding thebehaviour of consumersandidentifyingselling andresistance aspects from thepoint of view of consumers and retailers towards buying grocery products. It was found that about two-thirds of the respondents were buying wheat grains. Packed flour was being bought by about one-fourth of the respondents. In case of oil, a large segment of the respondents(84.7%) bought packed oil. Onlyabout 18percentof theconsumers were awareof fortifiedfoods,out of which29 percent belongedto theupper class. A majority of the respondents who hadheardof fortified foods didnot knowwhat it meant.Of thosewho were aware, about five percent hadusedfortifiedproducts. Further, in thestudy, the retailer’s practicesof selling groceryproductswerealso explored to know the factors which contributed to increased selling of grocery products. According to the retailers, the reason for the brands which wereselling was established brand name (46.2%), reasonable pricing (27.5%) and advertisement of the product through various mediums(13.8%).

Review of HMIS of Mother Child Tracking System (MCTS) and Women & Child Development (WCD) inRajasthan, Odisha and Bihar

Agency : Save theChildren

Team : Santosh Kumar, Rajeev Kamal Kumar, Veena Nair Sarkar, Kanika Pawar, Kalpa Sharma, Suman, Saheli Manish Kumar,Lalchand,RajpalYadav

Save the Children (BalRaksha Bharat) is implementing Strengthening Maternal, Newborn, ChildHealth and Nutrition (MNCHN) project in three states, namely Rajasthan, Odisha and Bihar. The main purpose of this project was “to contribute to strengthening evidence-based

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MNCHN interventions, services andpractices”in theintervention area.As part of thesaidintervention, IIHMR hasbeenassignedthe task to review the HMIS (Health Management Information System) of Mother Child Tracking System (MCTS) and Women & ChildDevelopment (WCD). Theoutcomeof thestudywasused todevelop HMIS inorderto strengthen programs inthe abovestates.

Concurrent Monitoring of Food Fortification Project (IPS) in Rajasthan

Agency : GAIN-PMU, IIHMR

Team : TanjulSaxena, Sunita Nigam, GunjanMishra , ShirishHarshe

In order to address the problem of micronutrient deficiency in the state, Institute of Health Management Research (IIHMR) Jaipur hassigneda Grant Agreement (GA) as Executive Agency (EA) to implement theproject on Food Fortification – IntegratedProgramStrategy in Rajasthan with the Global Alliance for Improved Nutrition (GAIN), Geneva. The Program Management Unit (PMU) requiredconducting concurrent monitoring of the project encompassing all three project components i.e. production and distribution, legislation

and quality control, and social marketing and communication. The concurrent evaluation was designed in such a manner that the project gets benefitted from external monitoring including suggestions for improving the implementation mechanism, and also to improve theoverall functionality of theproject. Themonitoring was done from February 2013 till April 2013 andthe report was submitted to PMUinMay2013.

Follow-up Study on Technical Appraisals of Producers (Flour and Oil) for Enhancing Partnership in FoodFortification Project (IPS)

Agency : Project MonitoringUnit – Global AllianceforImprovedNutrition

Team : Suresh Joshi,AnoopKhanna,N.D. Sharma, Lalit MohanNayak,Suresh Siwal

The main purpose of the study was to followthe producers (flour mills and oil mills) coveredunder the categories of Technical Assessment to explore the creation of new partnerships and making the existing partnerships more operational in terms of fortified production andsupply. The objectives of the study were to understand the factors which had influenced the mill owners for joining the program and tostudy the factors which had restrained the millers to join the food fortification project. The study was commissioned by PMU-GAIN on‘Scoping Assessment for Fortification through Identified Manufactures, and Flour Mills and Oil Producers in Rajasthan ’. In the study, atotal of 112 mills (95 wheat flour and 17 oil mills) were visited and mill owners/ managers of the mills in 17 districts of Rajasthan wereinterviewed. Thestudy found that 40 mills were willing to participate in the food fortificationproject. A majority of the wheat flour mill

owners needed continuous training on the food fortification project. They also expressed the need of a test kit or tie-up with any locallaboratory for regularly testing premix and finished product. IEC activities to generate awareness of the importance of fortified foodsamong consumers through advertisements in local channels with fortified brand names of wheat flour and oil producers were alsoindentified as major issues. Thestudy findings also presented thescopefor research in publicnutrition as well as food fortification servicesintheState.

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Client Exit Interview Survey in Rajasthan, 2013

Agency : Marie Stopes International

Team : LaxmanSharma, DanishAhmad,Lal handSharmac

Marie Stopes International (MSI) has been delivering family planning and safe abortion services in India. Marie Stopes India (a subsidiary of MSI) provides high quality family planning and safe abortion services in National Rural Health Mission’s high-focused states. Thespecific objectives of the Exit Survey Research were: to assess the extent of service utilization by the clients; to assess the extent of client satisfaction and quality of care provided by the MSI; to assess the client profile in order to get the percent of the clients under the BPLcategory; to assessthe existing marketingstrategies; andto suggestnecessary modifications required.

The Survey wasconductedin three differentstates i.e. Rajasthan,MadhyaPradeshand Uttar Pradesh.

Facility Survey in Rajasthan - DLHS-4:

Agency : Ministry of Health and FamilyWelfare,Government of Indiaand InternationalInstitute for Population Sciences,Mumbai

Team : LaxmanSharma, ArindamDas,DanishAhmad,MohammadSharif, Kailash Prajapati.

The Ministry of Health and FamilyWelfare, Government of India, assigned Institute of Health Management Research, Jaipur (IIHMR) tocarryout theFacilitySurvey under theDistrictLevel Household andFacility Survey (DLHS-4). Theoverall objective of the survey was toassess the performance with regard to the implementation of various programs under NRHM at the district level. The specific objectives

were: to estimate or assess the availability of critical inputs in public health care establishments through facility survey; to ascertain theextentof utilization of facilities forproviding theRCH services; andto assess servicequality using appropriate outcome indicators at eachlevel i.e.Sub-healthCentres,Primary Health Centres,CommunityHealth Centres,Sub-divisional Hospitalsand DistrictHospitals.

A total of 2212 health facilities (SHC,PHC,CHC,SDHand DH) werecoveredthroughout the state.

District Level Household Survey (DLHS) Round 4 in Punjab and Chandigarh

Agency : Ministry of Health and FamilyWelfare,Government of Indiaand InternationalInstitute for Population Sciences, Mumbai

Team : J.P. Singh, Arindam Das, Vinod Kumar SV, Pradeep K chhawa, Gowtham Ghosh, Prafull Kumar, Mukesh Gehlot,Singh a BKailash Prajapati

Specificobjectives of theSurvey: To estimateor assess:

• Antenatalcare andimmunizationcoverage.

• Extent of safedeliveryandcoverageof JSY.

• Contraceptive prevalence andunmet needfor familyplanning.

• Awareness of RTI/STIand HIV/AIDS

• Assessment of thequality of RCHservices

• Contributionof public-private sectors to RCHservices

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• Availabilityof RCHservicesnearest to theselectedPSUs

• To know the level of aneamia, blood sugar, BP and anthropometric parameters through the Clinical, Anthropometric and Bio-Chemical (CAB)test andmeasurements.

• Availabilityof critical inputs inpublic health careestablishments throughfacilitysurvey

Instituteof HealthManagementResearch, Jaipur (IIHMR) was assigned to carryout theDistrict Level Household Survey (DLHS)Round4 inPunjab andChandigarhby theMoHFW inwhich IIPS, Mumbaiwas thenodal agency. Inaddition, itwas theresponsibilityof IIHMRtocarry out the survey for the government health facilities for the aforementioned states. The survey was conducted in all 21 districts(including Chandigarh). In all, 1300 Primary Sampling Units (PSUs) and 1360 health facilities were covered in this survey. Overall, 35016households were surveyed in which 32875 eligible women were interviewed. During the survey, the respondent ’s weight, height, bloodsugar, blood pressure and hemoglobin were also measured as health was an important component in DLHS-4. More than 1,47,000 bloodsamples were sent to PGI, Chandigarh (partner institute for Punjab and Chandigarh under DLHS-4) to test hemoglobin. The overallobjective of thesurvey was to assess theperformance with regard to theimplementation of various programs under NRHM at thedistrict

level.

Piloting Mobile-based MCTS HMIS at Village Level in Bihar

Agency : Dimagi (USAID)

Team : SantoshKumar,RajeevKamal Kumar,S.P. Chatt , AkhilAgarwal, TukaramKhanda eopadhyay d

Healthsystem in Indiastrives for timelyand quality data forproper planning,monitoringand evaluation. Ina paper based recording systemit takes 15 days fordata collection (at thesub-center), data updation (at theprimaryhealth center) andthen data transfer (to MoHFW Web

Portal MCTS), whichseverelyaffects theservices deliveryof maternal andchild health inourcountry. To improve the timeliness of data collection, updation and reporting, a pilot project was commissioned in Kanti block of Muzzafarpurdistrict of Bihar in January 2013. Under this project, 10 ANMs who were capable of handling mobile phones were given android basedmobile phones loadedwitha softwarewhich was identical to thegovernment ‘s records. In-built servicereminders, due listsandcounseling

videos were also loaded in each phone. Using the phones the data were sent to a central database system using both offline and onlinemethods. IIHMR and Dimagi International imparted rigorous one-week training to all the ANMs. During ground level implementation,

ANMs wereobservedand weregivenon-fieldsupport for six months.

An analysis of the data showed that timeliness of reporting had improved with almost no time lag between data collection and data

reporting. Using the mobile based reporting, various validation rules and data checks improved correctness and completeness of the data.Most of the ANMs were happy that computerized data collection had reduced their involvement in preparing the monthly reports as allreports could begeneratedautomatically.

Future Health System’s Young Researchers’ Grants

Agency : DFID, UK ohnsHopkinsUniversity andJ

Team : UpasonaGhosh,LalithaSwathiVadrevu, DivyaK Bhati

Joining a tough competition, three junior researchers from IIHMR had individually won small research grants from the FHS consortium

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head office at theBloomberg School of PublicHealth, theJohns Hopkins University in 2013. Theprimary objective of these three grants was to develop research capacity of young researchers from the partner institutions of the FHS consortium. The following were theresearchers andtheirresearchtopic:

Upasona Ghosh: Effect of women ’s social network on mother and child health in women-headed households: a case study of Indian

Sundarbans.Lalitha Swati Vardevu: Assessingtheneedfor psycho-socialcare forchildrenin theSundarbans.

DivyaK Bhati: Realityof girl childhealthrights inthe arid zonesof Rajasthan

The research activities of each of the above grants have been completed and the research products including a brief report and apublishable paper foreachgrant areunder preparation forwider dissemination.

End- line valuation of the rojectentitled PARIVARTAN : A FamilyWelfareand PopulationDevelopmentProjectE P ‘ ’

Agency : Population Foundation of India

Team : ShilpiMishra Sharma, AnoopKhanna,Pradeep SinghKachhawa,Mohammed Sharif,LalchandSharma

An end-line evaluation of “PARIVARTAN ”: A Family Welfare and Population Development Project jointly resourced by J K Tyre andPopulation Foundation of India (PFI) was carriedout to documentgood practices, success and learning from theproject. Theproject wasbeing implemented in 60 villages in Rajsamand Block, District Rajsamand, Rajasthan, covering a population of 41,000. The goal of theproject was tobuildcapacity, generateandprovidebasichealthcare to theruralpopulationin theselected area tobridgethe gapbetweentheneed andaccess toRCHservices.

The approach for the end-line evaluation was entirely qualitative in nature. The study involved interaction with the primary stakeholders: women beneficiaries of the project and key members of the community, village level monitors (VLM) and secondary stakeholders: key projectofficials of theimplementingand fundingagency; communitystakeholders; andat the institutional level, PRIs, ANMs, GNMs,malenurses, anganwadi workers (AWW), and school teachers. In-depth interviews with various level stakeholders including women in thereproductive age group (15-49 years) and FGDs with the community were instructed to gather the relevant information. Case studies of projectbeneficiarieswere alsodocumented.Theevaluation hadbeencompletedandthefinal reportwas submittedto PFI,New Delhi.

National Healthcare Survey

Agency : GlobalAdvisorAssociatedServices Pvt. Ltd. Team : Santosh Kumar, S Chatt , Dhirendra Kumar, Kalpa Sharma, Tukaram Khanda e, K. Sreenath Reddy,.P. opadhyay d

Manoj Kumar Gupta, Veena. R,Lalchand Sharma

Disease burden estimations basedon sound epidemiological researchprovide the foundation forpublic policy. In theabsence of anysinglereporting system, theestimates of thediseases are primarilydrawn frompublic hospitals’statistics,which leaves out those who preferto goto any kind of private hospitals or prefer to ignore their treatment. In view of this, it was conceptualized to carry out a quick referenceestimate of diseases’ burden both in urban and rural India. The survey was supported by Global Advisory & Associated Services Pvt. Ltd,Disease Management Association of India, Continua Health Alliance, USA, and HIMSS Asia Pacific India Chapter. Institute of Health

Management Research ipur, was assigned to develop a survey design, field work,and data management. Thepurpose of thestudywas to, Ja

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understand the disease load and disease distribution in urban and rural areas of India in order to identify causes of ill health that can beaddressedthroughbetter planningand program management.

This was an explorative study based on primary data collected from the households in different parts of India. Considering the size of thecountry, India wasdividedinto twelvezones,and fromeach zoneone statewas selected.

Rapid Assessment of Promotion of Fortification of Wheat Flour through small millers in the Sarada andSalumber blocks of Udaipur district

Agency : Project MonitoringUnit – Global AllianceforImprovedNutrition

Team : GoutamSadhu,TanjulSaxena, PrafulKumarBarla, AudreyPareira,Kailash Prajapat andLal handSharmai c

The study was commissioned to rapidly assess the pilot project by Global Alliance for Improved Nutrition (GAIN) for “Use of Fortified Atta by Community Using Small Chakki for Flour Fortification in Tribal Blocks of Udaipur District ”. The objective of the study was to

assess the present knowledge among rural families (including general population, pregnantand lactating women)on foodfortification andtheirattitudeand behaviortowards regular useof fortifiedatta.

The study also aimed to assess the knowledge, attitudes and practices of the fortification of atta done at small chakkis (flour mills) in the villages of the flour producedfromwheatbroughtbyfamilies forgrinding.

The survey used structured questionnaires to interview two categories of respondents i.e. the community (general population, pregnant andlactatingwomen)and chakki owners. Focus Group Discussions and interviewswere alsoconductedto capture thequalitative results of thepilot project.

Capacity Building Preparation of IWRM Plan and Facilitation of Plan through Panchayati Raj System

Agency : SWRPD, Government of Rajasthan

Team : MonikaChaudhary, PrincePurohit

The objectives of the project were to build the capacity of the VWHSC members and other community members to prepare GP levelIWRM planand facilitatethem for theimplementation of IWRMplan throughPRI/waterusergroups.

A Study on the Effect of Consumer Participation on Price Sensitivity of Fortified Products Agency : Project MonitoringUnit – Global AllianceforImprovedNutrition

Team : MonikaChaudhary, Md. Shahnawaz, DivyaVyas,Sandeep Narula

The objective of the study was to understand the impact of the non-economic factors which could have an influence on the purchasedecision of the consumer in order to find out whether these non-economic factors were powerful enough to negate the impact of economicfactorsand reduce price sensitivity of fortifiedproducts.

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Mentoring for Maternal Health Young Champion

Agency : Institute of InternationalEducation(IIE)

Team : Nutan P Jain

The Maternal Health Young Champions(MHYC)program with fundingfrom the Harvard Schoolof Public Health (HSPH) was designedto support young leaders who were passionate about lowering maternal mortality through new and innovative practices that helped save women’s lives. To reduce maternal mortality and morbidityover the long-term, emerging public health leaders needed to be equipped withtheskills,commitment, andvision to respond fully tomultiple causesand consequencesof this threat. In2013,out of a cohortof 10young peopleselected to receive this prestigious fellowship to support their developmentas a leader in the field of maternal healthin thecountry andglobally, one of them was hosted by theInstitute.TheMHYCconducted a studyon “Accessibility to Maternal HealthCare in a PahariaandSanthal Village inJharkhand” to answer thefollowingresearchquestions:

• How and why do socio-cultural contexts lead to financial and geographical inaccessibility to care during pregnancy and skilled birthattendance among vulnerable tribal populationsviz.Santhalsand Pahariasin Sundarpahari Block, Jharkhand?

• Is the lack of access stemming from a cultural reluctance of the tribes or from the system which has not reached out to thesecommunities?

• Howdo thewomenof thetwocommunities copewith theseaccess-relatedbarriers?

• How and to what extent do the government programs and schemes related to provision of care during pregnancy and skilled birthattendance address theinaccessibilityconcernsof thepopulations?

Independent Monitoring Activities for Bihar School-based Deworming in 2014

Agency : DtWI,NewDelhi

Team : SantoshKumar,S.P. Chattopadhyay, TukaramKhandade, AkhilAgrawal, BimleshSinha,Vishal Singh, alchandL Sharma

Deworm the World Initiative (DtWI) prides itself in its evidence-based approach to policy implementation and evaluation. Theorganization conducts independent monitoring of process andcoverage evaluation foreachround of deworming in every state in which it operates. IIHMR team supported the DtWI in organizing a survey in 33 districts of Bihar as per the terms of reference. To ensure thequality of field work and related activities under the project, the following methods were considered by the IIHMR team on Deworming Day, Mop-UpDay andValidationDay inBihar:

1. During training/inductionof monitorsandsupervisorson thequestionnaire,pre-andpost-tests were givenas perDtWIguidelines2. On the Deworming Day and Mop-Up Day, filled questionnaires and schedules were checked by the supervisor on the ground level

(school) and sample basis. A few students were re-interviewed by the supervisor to understand the aberration of the responses,if any.

3. During theCoverage Validationdays, themonitors weresupportedby thesupervisorsto complete theprocessin allrespects.

The projectwas completedas per the TORand the deliverables weresubmittedto DtWIwithinthe time frame.

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Market Survey for Seth Anandram Jaipuria Eye Hospital, Nawalgarh

Agency : JaipuriaHospital

Team : SantoshKumar,Kalpa Sharma, LalchandSharma

Seth Anandram Jaipuria Eye Hospital was established in 1942 at Nawalgarh, Rajasthan. It provides comprehensive care ranging overpreventive services, anticipatory guidance, assessment of well-being, treatment of illnesses covering minor to most complicated and lifethreatening ones to all age groups. The objectives of the study were to assess the community ’s perception of the Hospital, to assess thereasons for less utilization of services available at theHospital by thecommunity, andto assess theservices andfacilities provided byotherhealth careproviders anddiagnosticcenters.

The study wascarried out in 53 villages of Jhunjhunuand Sikar districts of Rajasthan.

Ongoing Research Projects Studiesand Technical Support for Improved Delivery of Comprehensive Package of Health Services to the Urban Poor

Agency : USAIDIndia,Delhi

Team : Goutam Sadhu,Rajendran Thambi, Ambey Srivastava, Himani Tiwari, B.L. Tailor and Madhur Mathur (Rajasthan);Sanjoy Samaddar,RakeshKumar,HemantKumar Mishra andYagyeshShriwastava(Chhattisgarh)

Health of the Urban Poor (HUP) program is being implemented by Institute of Health Management Research, Jaipur in two empoweredactiongroup(EAG) statesi.e. Rajasthanand Chhattisgarh. Theprogram aims at improving thehealth statusof theurbanpoorby 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, states and citiesfor effective implementation of the National Urban Health Mission (NUHM); 2) to expand partnerships in urban health engaging thecommercial sector in public private partnership activities; 3) to promote the convergence of different Government of India urban healthand development efforts; and 4) to strengthen urban planning initiatives by the state through evidence-based city-level demonstration andlearning efforts.

IIHMR launched HUP program on 27th September 2010. HUP Rajasthan and Chhattisgarh have been involved with the respective stategovernments as key technicalassistance agencies foreffective planningand roll outof NUHM.HUP teams aresupporting thestates in theadoption of the five HUP approaches that are aligned with the NUHM framework, viz. a) Mahila Arogya Samiti (MAS), b) Urban HealthandNutritionDay (UHND),c) CityHealth Planning,d) Ward / CityCoordinationCommittee,e) Health ManagementInformationSystem(HMIS), f) Mahila Aroghya Samiti, g) Health Management Information System, h) Ward Coordination Committee, and i) Water andSanitation in Urban Areas. The unit has prepared a training module for frontline workers on WASH. It facilitates data collection throughdailydiary systemand strengthens HMISand initiatesmulti stakeholder convergenceconsultation.HUP Rajasthanand Chhattisgarh teamsare also supporting the respective states in the development of integrated city and state health plans under NUHM and institutionalizing aknowledge repositoryonurbanhealthat thestatelevel.

HUP has also established itself as a leader in implementing select models and approaches to urban health that are in line with the NUHMFramework forImplementation. HUP ’s technical assistance to theGovernment of Indiaon theNationalUrban HealthMission resulted in

theunion cabinet of ministersapproving theNationalUrban Health Mission (NUHM) onMay1,2013.

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Integrated Programme Strategy in Rajasthan - Food Fortification Project

Agency : GlobalAlliance for Improved Nutrition(GAIN),NewDelhi

Team : RahulSharma, Suresh Joshi,R.S.Rathore,RajeevBaghel,SudeepSharma, RanjeetaRani,RajkapoorRaghav

The project aims to reduce the prevalenceof micronutrient deficiencies in the State of Rajasthan by making available fortified wheat flour,oil, milk and soyadal 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 otherpublic funded programs, such as the Integrated Child and Development Scheme and Mid-Day Meal. The core project components are:production anddistribution,social marketingand communication, legislation andquality control,and monitoringandevaluation. 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 hassucceededin makinglargescaleflourmillsto produce fortifiedwheat flour, threemajormilk dairies inRajasthan, namelySarasDairy, LotusDairy 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 Limited 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 dalanalogue with the project support for Mid-Day Meal preparation covering over a million school children in Rajasthan. Various socialmarketing and communication approaches have been implemented to create the awareness to use fortified food in the community. Specialefforts arebeing madeto involve print andelectronic media to promotetheconsumptionof fortifiedfood.

A small scale operation research project has been undertakenwhich is called “Village LevelWheat Flour FortificationProject ” in two tribalblocks of Udaipur district, namely Slumber 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 sustainedinterestamong grinders andcost implicationof small scalefortificationinitiative.

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

Agency : DFID, UK/Johns HopkinsUniversity

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

The Future Health System (FHS) research project in India was initiated by IIHMRin 2006 as a part of a ResearchProgram Consortium ledby 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 knowledgebase on whichan appropriate strategy for a more equitable health system wouldbe developed. In India, the FHS research is implementedby IIHMR with the primary focus on the health care delivery system in theIndianpartof theSundarbans. Themainfocus of this researchis togenerateknowledge onthe barriers todeliveryandaccessof healthcareservices for children and find out the ways by which they can be made more effective in the Sundarbans. It tries to understand themultidimensional nature of the crisis in health care access in the Sundarbans to plan effective service delivery mechanism. The generationof knowledge primarilyrelates to thewhat, where, andhowof an effective servicedelivery system.

The research is currently in its second phase (2011-16). During the year, several studies were conductedon sample households, health careproviders, and various institutions in one block of the Sundarbans (PatharPratima). Based on the survey results, the first SundarbansHealthWatch Report onchildhealthissues andtheir solutions was published anddisseminated. ThesecondHealth Watch Report is under

process andwillcomeout inJune, 2014.

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Migration, Poverty and Access to Health Care: A Multi-Centric Study on People’s Access and Health System’sResponsiveness in Fast Growing Smaller Cities

Agency : ICMR

Team : AnoopKhanna,Alok Mathur,SoibamNepola,ShatabadiBagchi

The objectives of this multi-centricstudy funded by Indian Council of Medical Research,New Delhi are to assess the migrants’healthcareaccess in the vulnerability context of migration and livelihood insecurity and to understand the factors (individual/community/system-level) affecting themigrants’access to healthcareservices in fastgrowing smaller cities. Extensive formativeresearchdata (both qualitativeand quantitative) has been collected from 27 identified slums of Jaipur. Based on the formative research information, key points wereidentified for developing intervention strategy, like awareness level of ANC, location of health facility, identity cards to migrants to availfacilities, frequency of visit of health workers, attitude of health care providers etc. A yearlong supportive intervention was made inidentified slum clusters of Jaipur. For intervention, a two-pronged approach was used: one was to improve as well as sensitize servicedelivery 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 ongoing phase of theproject is to measure theimpact of theoverallinterventionthroughsystematicscientific evaluation.

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

Agency : Karolinska Institutet, Sweden

Team : Barun Kanjilal, Neetu Singh,ManuGupta

The project is coordinatedby Karolinska Institutet in Sweden, involving twelvepartners across Europe and Asia, includingIIHMR. These

four-yearprojects(2011-2015)are funded by theEuropeanCommission ’s 7thFrameworkProgram. TheARCADEprojectuses innovativeeducational technologies to strengthenhealthresearchacross Asia.Focusing onpost-graduate,doctoral andpost-doctoral training,partnerinstitutions are developing cutting-edge online courses, blended 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 hasproduced a self-learning module on “Climate, Society and Health” for prospective PH.D students in developing countries. The next module is on“Behaviour Change andCommunicationfor Health Researchers ” that will beused as a resourcematerialfor thePhDstudentsof IIHMR University.

Financial Resource Flows for Population Activities- RF 2012 Agency : UNFPA and NIDI

Team : AnoopKhanna,ManuGupta,Ajay Sharma

The Financial Resource Flows project is a joint collaboration of United Nations Population Fund (UNFPA) and the NetherlandsInterdisciplinary 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 inCairo in 1994 and the Declaration of Commitment adopted at the United Nations Special Session on HIV/AIDS 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

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the Project. In every financial year the data is collected through a mailed survey for the previous financial year. Various UNFPA country offices are provided withsurvey instrumentsspeciallydesignedfor thatparticularyear. Eachcountry office is responsible to collect data forits own country covering the relevant NGOs and government organizations. IIHMR provides full technical support to data collectorsduring the course of the survey. Country offices submit the filled-in questionnaires and reports within a time limit. The data submitted toIIHMR is thencleanedandfedin theweb-based RF-Database.TheRF-Database canbe simultaneouslyaccessedby all theauthorizedusersglobally. The latest round of the project was RF-2012 under whichthe data was collected in F.Y. 2013-14 for F.Y. 2011-12. A sampleof 40countries from three regions was coveredin this round.Annually, a report of thesurvey results is submitted to NIDI by IIHMR at theendof the subsequent round. Evaluation Report of each round of the survey is presented by IIHMR every year during the evaluation meet organizedat IIHMR, NIDI orUNFPA HQoffice inNew York.

Developing Competency Framework for Mainstreaming Gender Responsive Healthcare Services

Agency : ICMR

Team : Nutan P Jain,VidyaBhushanTripathi, SnigdhaPareek,MatadinSharma The objectives of the project are to assess health care providers ’ and managers’ understanding/perspective of gender equality and equity with a focus on adolescent health care services in Rajasthan; and to develop competency framework for providing gender-responsiveservices by various levels of health care providers (men and women) including quality characteristics, standard operating procedures, andindicators especially for adolescent reproductive health services using structure, processes and outcome framework of quality. As a first step, a matrix wasdeveloped to understandthe roles andresponsibilities of health functionaries, andgender gapswereidentified to developtools for data collection. To finalize theframework on gendercompetencies, theDelphi techniquewas used with a total of nine experts. Asituational analysis of the studywas conducted in six districts, namely Banswara, Udaipur, Ajmer, Jodhpur, Bharatpurand Sri Ganganagar.

Consisting of a total of 83 lady medical officers the team interviewed 23 respondents and an equal number of male medical officers wereinterviewed. In addition,465ANMsanddistrict level officials (CMHO, PMO, RCHO, DPM,PCPNDT Coordinator)werealso the part of thestudy. Thedataanalysisis inprogress.

Study of LAC Region for Financial Resource Flows for Population Activities

Agency : UNFPA and NIDI

Team : AnoopKhanna,ManuGupta,Ajay Sharma

IIHMR wascontracted by theNetherlands Interdisciplinary Demographic Institute (NIDI) to conduct theFinancialResource Flows fromPopulationActivities separatelyin theLatinAmericanand Caribbeancountriesfor the round of financialyear 2012. “RF-LACProject ” isa part of the Financial Resource Flows project which is a joint collaboration of United Nations Population Fund (UNFPA) and theNetherlands Interdisciplinary Demographic Institute(NIDI).The Resource Flows (RF)project monitorsprogress achievedby donors anddeveloping countries in implementing the financial resource targets agreed upon at the International Conference on Population andDevelopment inCairo in1994 andthe Declarationof Commitment adopted at theUnited Nations Special Session onHIV/AIDS in2001.

The RF project collects data and subsequently reports on international population assistance and domestic expenditures for populationactivities in developing countries. A total sample of 39 countries was covered from the LAC countries in this round of the survey. TheUNFPA country offices of the sampled countries were provided with the survey instruments specially designed and translated in the

regional language.IIHMRis responsible toprovidefulltechnical support to theofficesfordatacollection.

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Healthand NutritionSurveyin Rajasthan

Agency : GlobalAlliance for Improved Nutrition(GAIN),Geneva

Team : PR Sodani,ND Sharma, Sunita Nigam, Lalit MohanNayak,Suresh Siwal,PriyankaBakshi,RakhiMathur,SoniaLuna

As part of an effort to accelerate plans to collect coveragedata in priority countries to measure consumptionof adequately fortified foods,the Global Alliance for Improved Nutrition (GAIN) assigned IIHMR to conduct a coverage survey in the State of Rajasthan, India toassessstaple food intakes among womenof reproductiveage (WRA) andyoung children.

The objectives of this household survey based on spatial three method (S3M) were to assess and determine whether women of reproductive age andchildren aged 0-24 months consume thefoods; to determine theadequacyof fortification; andto assess thecoverageof 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 252PSUsall over Rajasthan.

National Key Resource Centre for Drinking Water and Sanitation

Agency : MoDW&S,GoI

Team : GoutamSadhu,TanjulSaxena, ParvinderKumar

IIHMR hasbeenidentified bytheMinistry of DrinkingWater andSanitation, Government of India, as theKeyResource Centre (KRC) for

Sanitation in Rajasthan. The main objectives are: to build capacities of the government officials, PRI representatives, and otherstakeholders (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 thePanchayatiRajandRural DevelopmentDepartment, Departmentof Healthand FW, PHED, andother departments relevant to promoting

waterand sanitationin the state.

In the current phase of the project, training programs are conducted in cascade mode, developing a District Resource Group (DRG) foreach district through TOTs. District Water and Sanitation Mission Members (DWSM) are also involved in DRG. The DRGs will furtherimpart training tothe PRIs andVWHSC members andNGOs.

Development of Training Material for Public Health Management for District Level Managers, WHO SEARO

Agency : WHOSEARO

Team : S.D. Gupta,VinodKumar,AnoopKhanna,Suresh Joshi,Nutan P Jain,AnilKumarNB

PublicHealthin the21stCentury is facedwith imminentchallenges tohealth. Thefactorsresponsiblefor this are:

a) the increasing disease burden of non-communicable and chronic diseases, reemergence of traditional infectious diseases, andemergenceof newinfections;

b) the risinginequity inaccess toprimary healthcare;

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c) thenegative impactof rapidglobalizationand market economies onhealth care; and

d) thelowefficiencyandeffectivenessof healthsystems.

The countries in the region are undergoing epidemiological and demographic transition. Most of them are facing an unfinishedagenda of double burden of diseases,and theconsequenceof theageingof populations.

To address these challenges, WHO has emphasized revitalization of primary health care and translation of its values and approaches indevelopingandstrengtheninghealth systems.Thedistrict health managers are importantfunctionaries in today ’s healthsystems. They needto be equipped with the competencies and skills in new public health 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. Thus, there is a need todevelop a training program to develop these competencies in the district health managers. WHO SEARO had entrusted IIHMR withdeveloping a training curriculum and material aimed at strengthening management of public health at district level in developing countries

witha focusonemerging infectiousdiseases.A draft trainingmodulehas beenprepared byIIHMRand submittedto WHOSEARO.

Technical Assistance for IDAassisted ICDS Systems Strengthening and Nutrition ImprovementProject (ISSNIP)

Agency : Ministry of Womenand ChildDevelopment, Government of India

Team : S.D. Gupta, Anoop Khanna, Vinod Kumar SV, Pradeep Singh Kachhawa, Ashutosh Sharma, Vivek Shukla,ShivKumarAcharya

The Ministry of Women and Child Development (MWCD) has initiated several measures to direct a strong focus on child nutrition anddevelopment. Conceptualizing the International Development Association (IDA) supported Integrated Child Development Services(ICDS), StrengtheningNutritionImprovement Project (ISSNIP) is oneof its unique initiatives thatcomplements the Government ’s larger

effortsand is aligned with thekey decisions made by theCouncil to support 200 high burdendistricts in thecountry. Of these,ISSNIP willbe implemented in 162 high burden districts in eight states. The Institute has been a consortium partner with PricewaterhouseCoopersPrivateLtd(PwC)and Childin Need Institute(CINI) toworkas theTechnical Agency(TA) for ISSNIP. TheTA hasa structure comprising of the Central TA team, consisting of the Project Director, Team Leader, Deputy Team Leader, Advisors and the five TechnicalProgramme Coordinators (TPCs) leading each of the technical task areas. At the State level, State Team Leaders (STLs) are engaged inleading thestate level activities. TheTechnicalAssistance Agencyhas been providingsupport, guidance andassistance in achievingthe key objectives of Phase 1 of the ISSNIP with interventions designed across the four key components: Institutional and systemsi)strengthening Community mobilization and behaviour change communication (BCC) Piloting convergent nutrition actions; ii) ; iii) ;iv) 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 andcapacitiesat thenationalandstatelevels.

Assessing the quality of Civil Registration System

Agency : The Institute for Social and EconomicChange (ISEC)

Team : Nutan P Jain,RahulSharma, Vidya BhushanTripathi, SnigdhaPareek,MatadinSharma

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 aims at facilitating updating exercise of National Population Register

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(NPR). It involves interviews with the CRS functionaries (Registrar, ANM, ASHA, AWW and Panchayat members. Apart from these,information is being collected from government hospitals, community health centers and private hospitals (with 50+ beds and with lessthan50 beds).

Training and Capacity Building of the Mid-Day Meal Program Frontline Functionaries in SustainablePromotion of Fortified Food with Hygiene Practices

Agency : Project MonitoringUnit – Global AllianceforImprovedNutrition

Team : GoutamSadhu,TanjulSaxena, ShirishHarshe,MohammadSharif

In order to address the problem of micronutrient deficiency in the state, Institute of Health Management Research (IIHMR) Jaipur hassigneda Grant Agreement (GA) as Executive Agency (EA) to implement theproject on Food Fortification – IntegratedProgramStrategy 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 representativeand two cook-cum-helpers from each block of all the districts of Rajasthan, regarding food and nutrition, health, hygiene, cooking andstorage techniques. In this regard, the PMU, after receiving the proposal for organizing the training, appointed IIHMR, Jaipur forundertaking the project titled “Training and Capacity Building of the Mid-Day Meal Programme Frontline Functionaries in SustainablePromotion of Fortified Food and Hygiene Practices ” implemented through 16 two-day capacity building programmes. rom GAIN ’sFperspective, a training program covering the mid-day meal scheme of frontline functionaries was conceived for objectives of sustainablepromotion of fortified food, along withthe promotion of safe practicesof hygiene, impartingawareness of differenttechniques of storageandprecautionary measureswhile preparingthe mid-daymeal,which willultimately impact thehigher goalsof addressingthe malnutritionproblemamongchildren.

Training of Trainers (ToT) of the Mid-Day Meal (MDM) functionaries of Rajasthan on sustainable promotion of hygiene and foodfortification was a two-daytrainingprogram, held in 16 batches at IIHMR, Jaipur inassociation with Project Management Unit-GAIN andthe Directorate of Mid-Day Meal Scheme, Rajasthan. A total of 710 participants, comprising of two cook-cum-helpers and the block educationofficeror his/her representative from each block,were nominated for the training programme. These participants, in turn, gavetrainingto all thecook-cum-helpersof theirrespectiveblocks afterreceiving training. The trainingprogrammecovered differentaspectsof hygiene, nutrition, cooking and storage techniques and food fortification, which are necessary for the MDM food handlers and cooks fordeliveringnutritiousand healthyfood to theschoolchildrenin Rajasthan.

Stress, Anxiety and Depression among Adolescents Attending Coaching Institute-Kota Coaching Hub Agency : ICMR

Team : AlokMathur,Deepti Shukla,GunjanMishra, Aditi Vyas

IHMR, Jaipur has recently completed a study on adolescents titled “Impact of Internet Use on Behavior, Wellbeing and Development of Urban Adolescents in Rajasthan”. Whilecollecting andanalyzing thedata it hascome to fore that psychologically unpleasant states such asstress, anxiety and depression certainly affect the wellbeing and development of adolescents. This paved the way to the conception of thought to study theabove-mentioned factors on theadolescentswho areat thevergeof makingtheircareer. Since theInstitute is working currently on adolescents involving limited psychological aspect, it is proposed to carryouta study solelyfocused on this subject so that theprevalence of psychological problems among students preparing for competitive exams could be assessed and appropriate corrective

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measures be taken. Kota is renowned for its coaching institutions. Hence the study will be carried out in Kota District of Rajasthan. Theinstitutes preparing students in the fields of engineering and medicine have been identified and listed on the basis of the strength of thestudents enrolled. There are over 30 coaching institutes for engineering and medical aspirants. The institutes to be covered in study will bechosen after physical verification as per the strength of the students, their availability and time schedule. The study will cover a sample of 800students. The topfourengineering institutesandfourmedical institutesof Kota withvaryingfeestructures willbe identified randomly.

As manyas 100students will be selected from each institute on the basis of a simple randomsamplingmethod.The study will be conductedon the basis of quantitative data only. The tool to be used to measure three negative emotional states is DASS (Depression, Anxiety andStressScale) forthispurpose.The durationof thestudyis of 14months.The funding agencyis ICMR NewDelhi.,

Research Projects Studies IIHMR Kolkataand – ,Improving Reproductive and Sexual Health of Young People by Increasing age at marriage in Bangladesh,

Nepal and India Agency : MAMTA-Health Institute for MotherandChild, NewDelhi

Team : Manasee Mishra, Nutan Jain, Arindam Das, Vidya Bhushan Tripathi, Saheli Manish Kumar, Suman Chakraborty, Veena Nair Sarkar

The study was an end-line assessment of an implementation project to increase age at marriage and delay of the first pregnancy in selectedareas of India, Bangladesh and Nepal. The project was a five-year, European Union funded one that adopted a multipronged package of interventions aimed at bringing about positive changes at the individual, community and societal levels in the three countries. MAMTA-Health Institute for Mother and Child, New Delhi was the lead agency responsible for the overall coordination of the project being

implemented in partnership with government and nongovernmental players in 18 sites in India, Nepal and Bangladesh. The end-lineassessment adopted five international assessment criteria viz., Relevance, Efficiency, Effectiveness, Outcome and Sustainability. It alsoadopteda mixed methodof approach usingboth qualitativeandquantitativemethodsfora comprehensiveunderstandingof the project.

Process Effectiveness of ‘Kolkata Urban Comprehensive Eye Care Project ’

Agency : Sightsavers, North East Area Office

Team : Manasee Mishra, Amlan Datta, Arijita Dutta (Consultant), Saheli Manish Kumar, Suman Chakraborty,

Veena Nair Sarkar,RebeccaSen Choudhury (Consultant)‘Kolkata Urban Comprehensive Eye Care Project ’ is a civil society initiative led by Sightsavers. Financial support for the project wasreceived from StandardChartered Bank. Theproject sought to eliminate avoidable blindness in theslum population residing in thearea of Kolkata Municipal Corporation. It is a five-year initiative (2010-2015).The project worked in partnership with government and nongovernment players. Approximately 1.49 million people living in the urban slums of Kolkata constituted its target population. The study ‘Process Effectiveness of Kolkata Urban Comprehensive Eye Care Project ’ sought to understand the relevance and progress of majorproject activities, including project communication. The review identified successes, constraints and challenges faced in theimplementation of project strategies highlighting the scope for improvement therein. It also identified elements and c