Research Projects/Studies Completed Year-2006-2007
End line Survey for ICDS III Project in Rajasthan
Agency: Government of Rajasthan
Project Team: Ch. Satish Kumar, Neetu Purohit, N.D. Sharma, Mittu
Muthu Varghese, Jai Singh Shekhawat, Pasha M, Bejoy A.P. and Balamurugan
Under the Monitoring & Evaluation Component of the ICDS-III project, periodic
external evaluations during different phases of the project including baseline,
end-line surveys, continuous social assessment and operations research were envisaged
to be undertaken by independent organizations to assess the changes brought about
by the project during the intervening period. Initially the Government of Rajasthan
conducted a Baseline survey in the project area to establish the benchmark indicators
for the project planning. After successful implementation of the project for two
years, DWCD took up concurrent social assessment to monitor the project progress
and community understanding to reconfirm or redefine their operational plan to understand
the impact of their implementation strategies. The project was to conduct end-line
surveys to assess the progress and achievement of the project as compared with the
The specific objectives were:
- To study the utilisation level of the ICDS services by lactating and expectant women
and the impact of the ICDS program in improving the childbearing core practices
like breast-feeding and colostrums intake
- To assess the extent of antenatal care of pregnant women, breastfeeding and weaning
- To assess growth monitoring, nutritional status and participation of the children
below 72 months in pre-school activities at Anganwadi centres
- To assess the knowledge of adolescent girls about family life education
- To assess participation of the community in ICDS programs like household care and
- To compare the results of the end-line survey with the base line results on
critical indicators to appraise the progress and achievement of the ICDS project
interventions using the baseline results in Rajasthan project areas. It was a cross
sectional descriptive study with the multistage sampling technique with the basic
unit as household. The survey covered about 257 project areas WB old, new and general
including the rural, tribal and urban areas. The total households covered by the
survey were 17427.
The Endline survey observed a reduction in the percentage of underweight and severely
malnourished children in the age group of 0-36 months from that in the Baseline
survey. The weight at birth of the children showed an increase from the Baseline
survey (16.7 percent) to Endline (29.1 percent). The practice of initiating breast-feeding
within 2 hours of birth increased rapidly from 9 percent to 38.5 percent in the
Endline. Colostrum feeding has increased from 20.7 percent to 45.1 percent in the
Endline. The percentage of children who are exclusively breast-fed also increased
from 4.7 in Baseline to 5.9 in Endline. About 78 percent of lactating mothers got
registered after confirmation of the pregnancy. Doses of two T.T were received by
around 90 percent of the lactating mothers.
The percentage of adolescent girls participating in the women's activities
conducted by AWW was 0.9 percent in the Baseline survey against 5.5 percent in the
Endline survey. The adolescent girls who got registered in the AWC were 3.5 percent
in the Baseline survey and 10.2 percent in the Endline survey. The regular growth
monitoring of children less than 3 years of age was 81.3 percent in the World Bank
Rapid District Baseline Survey for Pilot Projects for Population Stabilisation in
Tonk and Jhalawar
Agency: Government of Rajasthan
Project Team: Ch. Satish Kumar, Mittu Muthu Varghese, Jai
Singh Shekhawat and M. Arulappa
Rapid growth in population of Rajasthan has an enormous pressure on its natural
resources, which has invariably hampered all the attempts made by the GoR to improve
the quality of life of the people and also in the attainment of a sustainable development.
To develop people-friendly interventions and strategies, a declaration by State
Population Policy commended to energise the systems to reach replacement level of
fertility by 2016 via mobilizing all possible resources in all the sectors. The
GoR had planned a pilot project in two districts of Rajasthan for population stabilization.
Before initiating the interventions, it was inevitable to have the baseline status
of the districts on indicators relating to maternal and child health and family
planning to assess effectiveness of interventions.
The total population covered in the survey was 51832 in Tonk district and 45018
in Jhalawar district. Total 1255 women were interviewed from Tonk and 1152 women
from Jhalawar district. The percentage of boys married at age less than 21 years
was 59 per cent in Tonk and 67.1 per cent in Jhalawar. Girls married at age less
than 18 years old were 44.8 percent in Tonk and 55.3 percent in Jhalawar.
The fertility characteristics showed the mean number of children born to a mother
was 3 in both Tonk and Jhalawar. The 3rd birth order was found between 55-60 per
cent in either of Tonk and Jhalawar. The percentage of women using terminal method
was higher than those using spacing method. The percentage of terminal method users
was 38.7 in Tonk and 39.0 in Jhalawar, while that of spacing method users was 21.6
in Tonk and 14.6 in Jhalawar. The unmet need for limiting was 3 per cent in Tonk
and 17.7 per cent in Jhalawar. The unmet need for spacing method was high in Tonk,
while for limiting method was high in Jhalawar.
The 'maternal health care' was taken care of by 50 per cent of the respondents.
About 80 per cent of the women had undergone at least one antenatal check-up, about
60 per cent had consumed two doses of T.T. injection, and about 20 per cent consumed
adequate doses of IFA tablets. The institutional deliveries were comparatively less
than the home deliveries in both Tonk and Jhalawar.
Only 10 per cent of women practiced exclusive breastfeeding for 4 months in both
Tonk and Jhalawar. Besides this, only half of the mothers fed their children with
colostrums. The complete immunization of children accounted to 36.2 per cent in
Tonk and 26.8 per cent in Jhalawar. Only one fourth of the mothers visited health
facilities during the last 12 months of the survey. The overall satisfaction received
with the health services was 87 percent in Tonk and Jhalawar.
End-line Evaluation of Youth Education on Sexuality (YES) Project in Agra
District of UP
Agency: FPA India, Mumbai
Project Team: P.R. Sodani, Laxman Sharma
A project on Youth Education on Sexuality (YES) was implemented by the Family Planning
Association of India (FPA India), funded by the Community Fund, National Lottery
Charities Board (NLCB) through International Planned Parent Federation ' South Asia
Regional Office (IPPF-SARO). The project was implemented in 316 villages and five
towns of two sub-divisions, Kiroli and Kheragarh of Agra district in Uttar Pradesh,
from January 2001 to December 2005. The five-year project offered a unique opportunity
to young people to lead a happy, healthy and satisfying sexual life free of exploitation,
fear, guilt, misconceptions and diseases. The primary beneficiaries of the project
were young people (10-24 years), whereas secondary beneficiaries included parents,
teachers and community leaders.
The objectives of the YES were:
- To enlist support from the community to enable the youth to make voluntary and responsible
reproductive health choices.
- To increase the accessibility of services and correct information to the youth to
improve their sexual and reproductive health status and protect them from avoidable
reproductive health risks.
- To enable the youth to lead a sexual life free from exploitation, fear, shame, guilt
and misconceptions/ false beliefs about sexuality.
- To effect a reduction in adolescent pregnancy by 10 percentage points and an increase
in the girl's age at marriage by 3.2 years by the end of 2005.
The awareness of sexual and reproductive rights as well as of seeking services as
and when required was reasonably found among 8200 adolescents including females
in the annual reports. The end-line evaluation report reflected that males (72%)
and females (66%) were sensitive towards their sexual health needs. About 4400 expecting
mothers received ANC services and approximately 2500 mothers received PNC services
during project implementation. More than 12500 youths received information through
project efforts on implications of early marriage and early child bearing. Mean
age at marriage was found to be 20 years for the boys and 18 years for the girls
in the intervention area, against 19 for the boys and 17 for the girls in the control
Increase in contraceptive practices among 7300 couples reflected the advocacy
in women regarding unwanted pregnancies and untimely pregnancies, and improvement
in the quality of their lives. A majority of youth (71%) was aware of female sterilization
regarding permanent methods. Similarly, within the intervention area a majority
of 15-24 years youths (85%) had awareness of oral pills and condoms as a spacing
method compared to the youths of 10-14 years (60% - 69%).
The project was successfully implemented with the three key strategies for
achieving the overall goal, which was to enable young population to develop improved
sexual and reproductive health (SRH) status and to exercise their reproductive rights
and responsibilities. These strategies may be replicated in other areas for up-scaling
the SRH programme for better results with a wider coverage.
To collate health information on identified areas, data entry and upload the Documents
on WHO India Office
Agency: WHO India
Project Team: P.R. Sodani, Lata Suresh
The WR India office approached the institute for collating health information
on the following four identified areas: health expenditure, user charges, cost analysis,
decentralization and quality of care. The information on the identified areas was
collected from published and non-published material obtained from various sources.
Under this assignment, we collected information from about 250 articles. The material
search included empirical research studies, research studies based on primary and
secondary data, papers published in national and international journals, policy
papers, working papers, occasional papers from national and international institutions.
Apart from these, the search also included workshop and conference reports, and
technical reports. The sources of information collection included library search,
journal searches, web searches, institutions/organizations and contacting them.
The information was uploaded on the WHO India office application
Financial Resource Flow for Population and AIDS Activities (Phase I ' 56 Countries)
Agency: NIDI, Netherlands
Project Team: Anoop Khanna, Kshitij Sharma
The Resource Flows (RF) was a joint collaboration between UNFPA, UNAIDS, Netherlands
Interdisciplinary Demographic Institute (NIDI) and IIHMR. The aim of the RF project
was to develop and refine a system for the collection, monitoring, analysis and
dissemination of data on financial flows for population and AIDS activities at a
worldwide level. The project was established to monitor expenditures related to
population and AIDS and to advocate that adequate funds be mobilized to ensure that
ICPD and UNGASS promises were realized. The principal method of data collection
consisted of annual mail surveys to donors and developing countries. The project
had created a resource flow database of both donor and domestic resources that is
Developing Training Modules on Legal Norms in Reproductive Health
Project Team: N Ravichandran, S.G. Kabra, S.C. Gupta, Ajit
Kumar Jain, Manisha Chawla, Sunita Nigam
Training needs assessment had undertaken through the questionnaire method
and focus group discussions with health care and media personnel to assess their
existing knowledge on reproductive health, related laws and their perceived role.
Apart from this, inputs were taken from visits to the premier institutions in the
state and meetings with policy makers and programme managers.
A workshop was conducted to design appropriate curriculum and pedagogy for
training, which were pre-requisites for addressing the competency needs of health
care providers. A needs assessment as perceived and expressed by the health care
providers was undertaken vis-'-vis programme goals and objectives and interventions
thereof. Further, evaluation of the developed module by experts, pre-testing of
the module and participants' feedback was used to improve the programme design.
The module on 'Laws protecting women's rights relating to reproductive health' aimed
at empowering health care providers, media professionals and others working in the
area of reproductive health and gender with critical knowledge of reproductive rights,
essential medico-legal background and related laws impacting on the reproductive
health of women.
bjectives of the module:
- To understand women's health status affected by complex biological, social
and cultural factors
- To appreciate rights-based approach to reproductive health as a crucial aspect
of human rights
- To understand medial background of the laws related to reproductive health
- To enumerate various women's rights related to reproductive health
- To enumerate the various laws and other legal provisions related to reproductive
- To understand the obstacles in proper implementation and monitoring of the
laws relating to reproductive health
- To internalise their individual and collective roles in implementation and monitoring
of these laws and provisions
- To develop skills to effectively counsel women and others about women's rights.
Baseline Survey for Behaviour Change Communication Campaigns in Uttar Pradesh
Agency: Futures Group, New Delhi
Project Team: Neetu Purohit, Ch. Satish Kumar, Sanjay Rode, Mathew George, Ganesh
Rajput, Hemant Mishra, Swati S Roy, T. Sudhir Raj, Sanjay Tripathi, Pitambar P,
Arnab Mandal, Jayati Srivastava, Shweta Chooramani, Laxman Sharma, Swadhin Mandal
The survey was aimed initially at providing baseline indicators for initiating the
Behaviour Change Communication (BCC) campaign in Uttar Pradesh. Later on, these
indicators were used for evaluating the impact of Behaviour Change Interventions
on the target community. The main objectives of the survey was a) to provide information
regarding knowledge, attitude and practices with regard to reproductive health issues
like family planning, ante-natal, natal and post natal care and child care from
women in the reproductive age group and their spouses; b) to assess the role of
mothers-in-law in decision making for contraception use by sons and daughters-in-law,
her influence on child preference and her own history of contraceptive use and knowledge
on ante-natal care; c) to assess the knowledge, training status and attitude towards
clients among community level health providers like ANM, AWW and TBA.
This large-scale survey has covered 370 villages spread across 66 districts of Uttar
Pradesh. As a whole, 7,400 households had been selected for interviewing the target
respondents like women in the reproductive age group of 15-49 years, their spouses,
mothers-in-law of the currently married women present in the household. Among the
Community level health providers, a total of 600 ANMs, 600 AWWs and 600 TBAs were
being interviewed from the corresponding PHC catchments area of the selected rural
In order to provide client based and time specific communication interventions,
the survey collected information on the types of media exposure, timing of exposure
and suggestions for suitable timing for the campaign.
National Health Workforce Plan 2001-2010, Ministry of Health, Maldives
Agency: WHO, Maldives
Project Team: S.D.Gupta and Nutan Jain
The Ministry of Health, Maldives approached the WHO Maldives to provide technical
support to undertake review the NHWP 2001-2010, and appropriately revise the same.
As a result WHO Maldives entered in an APW with the Institute with the following
- Review and revise the existing NHWP 2001-2010
- Revise the criteria for prioritising training requirements of the health sector
- Identify possible institutional mechanism to implement the activities in the NHWP
and include list of possible training institutions and course details
The existing plan was reviewed by interviewing and holding the workshop with key
stakeholders at Male. Consequently, a revised workforce plan was developed considering
the norms for each level of Maldives health system ' Island to the Regional level;
and managerial positions at each of the department and the IGM hospital. The plan
had worked out replacement of expatriates with the nationals. It is recommended
that a national level training institute need to be established to address the training
needs of the in-service health workforce. Establishment of a medical college is
also recommended to produce medical professionals as a strategy to replace the expatriates.
To ensure the effectiveness of these divisions, it is necessary that each of them
develop a clear description of roles and responsibilities, hierarchy and reporting
relationship and span of control. For this each division prepare a task and skills
matrix, and type of health personnel needed to undertake the identified tasks.
National Family Health Survey- 3 (NFHS-3) for State of Rajasthan and Madhya Pradesh
Agency: IIPS, Mumbai
Project Team: Dhirendra Kumar, Santosh Kumar, N D Sharma, J.P. Singh, Hemant
Mishra, Santosh Kumar Sharma, Neeraj Mishra, Soma Mitra, Anil Jha, Rajesh Pareek
Ministry of Health and Family Welfare (MoHFW), Government of India (GoI) had
decided to conduct the third round of National Family Health Survey (NFHS-3) in
the year 2005-2006. The Government of India had designated the International Institute
for Population Sciences (IIPS), Mumbai as the nodal agency for coordinating the
project United States Agency for Interational Development (USAID) provided the funding
for NFHS-3 with supplementary funding from UNICEF for the nutrition component of
the survey. NFHS-3 also received a part of its funding from the Gates Foundation,
DFID and UNFPA. Macro International, USA provided technical assistance. The fieldwork
was carried out by different field organisation working in the areas of population,
health and family welfare. Institute of Health Management Research (IIHMR), Jaipur
had been assigned to conduct the fieldwork in the states of Rajasthan and Madhya
The overall objectives of NFHS porgramme were: a) to strengthen India's demographic
and health database by estimating reliable state-level and national-level indicators
of population, maternal and child health, HIV/AIDS, and nutrition; b) to facilitate
evidence-based decision making in population, health and nutrition; and c) to strengthen
the survey research capabilities of Indian institutions and to provide high quality
data to policy makers, family welfare and health programme managers, government
agencies, NGOs, international agencies, and researchers.
Specific Scope and Objectives of NFHS-3:
NFHS-3 provided the estimates of the levels of fertility, infant and child mortality,
and other family welfare and health indicators by background characteristics and
measure trends in family and welfare and health indicators over time at the national
and state levels.
NFHS-3 also provided information on several new and emerging issues including:
a) perinatal mortality, male involvement in family welfare, adolescent reproductive
health, high-risk sexual behaviour, family life education, safe injections, tuberculosis,
and malaria; b) family welfare and health conditions among slum and non-slum dwellers
from eight cities of Chennai, Delhi, Hyderabad, Kolkata, Meerut, Mumbai and Nagpur;
and c) HIV prevalence for adult women and men at the national level and for each
of the six high HIV prevalence states, namely Andhra Pradesh, Karnataka, Maharashtra,
Manipur, Nagaland, and Tamil Nadu.
Feasibility of a Hospital in Jaipur City
Agency: Divine Hospital, Kolkata
Project Team: Santosh Kumar and S.K. Puri
The promoters of the Divine Nursing Home, an 80-bedded hospital in Kolkata had decided
to start another unit of its hospital in the Jaipur city. The proposed place for
the health facility is at Bapunagar, Jaipur and it aimed at fulfilling the health
needs of people primarily residing in and around Bapunagar, Gopalpura, C-Scheme,
Jawahar Nagar etc.
IIHMR was entrusted for doing feasibility study and preparing the Project Report,
which enumerated the following:
- Environmental Scan
- Project Design ' Facilities Plan
- Techno-commercial Feasibility including Financial Projections for five years
Environmental scan was done using both primary and secondary data. General physicians,
senior consultants, hospital administrators, diagnostics facilities, healthcare
experts were interviewed to understand the supply side needs and issues. Household
Survey was also done using conveniences sampling to understand the customer perception
about present healthcare facilities in town, need of new hospital and expectations
from the new facility.
The health care provision in Jaipur is dominated by the private sector comprising
Charitable Trust Hospitals and Nursing Homes. According to the Rajasthan Patrika
(2005) Jaipur has nearly 24 government hospitals and 91 private hospitals. A rapid
survey about bed utilization observed that most of the hospitals are working at
more than 70% occupation rate, which clearly is an indication of scarcity of new
beds in the city.
Most of the consultants were just satisfied with the present status of patient
care and patient care facilities in hospitals in Jaipur city. The experts opined
that these hospitals lack comprehensive care units for cardiology, cosmetic surgery,
replacement surgery, open transplant, trauma care, and neurology.
It was found that among those households, who visited the hospitals in last
one year, nearly 19% visited SMS first, 18% had opted for general practitioners
and approximately 14% opted for SDMH. Among other preferred hospitals were Soni,
Janana, Tongia etc. Among those who visited the hospitals, only 30% were satisfied
by the services of respective hospitals and 13% were unsatisfied. A huge proportion,
57% of respondents said they were not aware of the satisfaction level.
In response to the expectations from a new hospital most of the households
opined that the hospital should offer quality treatment, correct and timely diagnose,
good infrastructure, affordable price, availability of qualified, punctual &
experienced doctors, cleanliness, patient friendly attitude of doctor, punctuality
and care from other staff, ethical practices, availability of all diagnostic services
under one roof, and last but not the least near by facility in the given order.
Following are the snapshots of hospitals in Jaipur:
- Jaipur lacks the state of the art super specialty hospitals, as most super
specialty services are part of general hospitals as thrust areas.
- Even though the cases of Neurology and Diabetes have increased tremendously,
most hospitals of Jaipur do not include these in their major thrust areas.
- Jaipur hospitals need comprehensive care units for cardiology, cosmetic surgery,
replacement surgery, open transplant, trauma care, neurology and diabetic care centre.
- Affordable quality care using good infrastructure, qualified and experienced doctors
are the most important expectation from the new hospitals. Promptness, patient friendliness
and ethical practices are other important aspects a new hospital should look for.