Completed Projects 2018-19 Details

Title: Engendering Evidence-Based Policy for Young People’s Sexual and Reproductive Health in India

Agency: Palladium

Team: Sunita Nigam

This research aimed to provide evidence related to the effectiveness of existing policies and programs for young people’s SRH in India, and further inform policy and practice so that the country is able to realize the gains from the demographic dividend over the next decade. Towards this aim, this research proposed to study the policy framework, implementation machinery, service delivery mechanisms, and knowledge, attitudes and practices related to SRH among the population aged 10-24 in India.

Objective/s of the Project:

How effective was the policy framework, budgetary allocations and implementation machinery for young people’s SRH?
How effective were the service delivery mechanisms, such as infrastructure, supplies, delivery of young people’s SRH programs by health workers, access, and SRH programs in schools?
How effectively were the roles of the private and voluntary sectors integrated with the above two?
What were the KAP related to various aspects of SRH, such as knowledge of menstruation, pregnancy, contraception, STIs and HIV; attitudes of adolescents and youth towards contraception, abstinence, perceived vulnerability to STIs/HIV/pregnancy, and gender role stereotypes; and practices related to safe sex, seeking SRH information and services, treatment of STIs, vaccination of HPV vaccine, HIV testing, substance abuse, supportive parenting, psychosocial support, prevention of gender-related violence, pregnancy, antenatal care, and delivery, among the 10-24 age population?
hat gender differences existed in program implementation, knowledge, attitudes and practices?
What evidence could be provided to policymakers and stakeholders to enable design and delivery of policy interventions related to young people’s SRH with particular focus on gender equity?

Title: Construction of drinking water schemes at 20 villages of Chamauli and Pouri-Hans Jal Dhara

Agency: The Hans Foundation

Team: Goutam Sadhu, Parvinder Sharma, Abhishek Srivastava

The overall goal of the project was to meet out the demand and gap of potable water & improve the health of status to the targeted population of 20 villages of Chamauli and Pouri Districts of Uttarakhand. The objectives of the project were –

Provide safe drinking water & reliable water supply to the masses by implementing/construction of a different type of water supply schemes
Construction of low-cost sanitation facilities
Increase Health impact through new water supply and complementary sanitation measures
Achieve acceptance of the project through substantial involvement of the community and especially of women in the local planning, implementation, and maintenance of the water supply and sanitation facilities
Safeguard the sustainability of project benefits and facilities through the formation of CBOs
Create co-operation between the rural consumers and Department

The Project was implemented phase-wise in a following manner:

Phase 1: Preparation of village water security plan including a detailed project report (DPR).
Phase 2: Construction of proposed Water Supply Schemes/Construction of technical
Phase 3: Community Participation (sensitization & mobilization) for planning, implementation, O&M of the schemes.

Title: Financial Resource Flows for Family Planning (FP Project-2016)

Agency: UNFPA and NIDI

Team: Anoop Khanna, Divya Vyas, Ajay Sharma

The ‘Financial Resource Flows for Family Planning’ (FP) was executed by the Netherlands Interdisciplinary Demographic Institute (NIDI) in collaboration with the United Nations Population Fund (UNFPA). IIHMR played the role of outsourcing partners for data collection, processing, analysis and providing technical support to data collectors. The objective of the project, known as the FP project, was to monitor the public as well as private sector financial flows for family planning in developing countries.

The backbone of the “FP project” is the Family Planning 2020 (FP 2020) initiative, which is a global partnership that supports the rights of women and girls to decide freely, and for themselves, whether, when and how many children they want to have. The goal of FP 2020 is to enable 120 million more women and girls to use contraceptives by 2020. To estimate the additional resources needed for reaching this goal, there is a need to know how much is being currently spent on FP and the allocation of such resources. The “FP project” aims to estimate expenditures on FP within a country, and targets public and private sectors as well as NGOs.

Under "FP-Project 2016" the detailed financial information for family planning activities for the year 2016 was being collected during the F.Y. 2017-2018. A global sample of 69 FP2020 and GPRHCS (Global Program to Enhance Reproductive Health Commodity Security) supported countries that were covered in the FP-2016 survey. The UNFPA country offices were the focal point for carrying out the survey, generally in collaboration with government partners. Each UNFPA country office was responsible to collect data for its own country covering all the relevant Govt. organizations, NGOs, Insurance Companies and Corporations. IIHMR provided technical support to data collectors throughout the survey period. Country offices had to submit the filled-in questionnaires and reports within a time limit. The data collected through this global survey was processed through FP-Database in the cloud. The detailed financial information on family planning captured through this project represented the global scenario of family planning aids and spending and used for the purpose of advocacy and policymaking in order to support Family Planning goals.

Title: A study on Evidence based and Actionable Dietary advice to pregnant and lactating women (P&LW) in Rajasthan

Agency: CIFF, LONDON (Children's Investment Fund Foundation)

Team: Goutam Sadhu, Ranjan Prusty, Sunita Nigam, Rajeev Dhakad, Abhishek Kumar, Ashish Bandhu, Vijay Kumar Mishra

The study offered an important opportunity to rethink our approach to taking action on nutrition issues- push to rethink more concretely about the social determinants of health as well as the complex political, social, and ecological system that influence an individual’s nutritional status, to formulate evidence-based and actionable dietary advice for pregnant and lactating women in Rajasthan, In Rajasthan, CIFF’s plan was to test a Conditional Cash Transfer (CCT) model, Compared to the current approach 'Take home ration (THR) under ICDS. P&LW was given a certain amount of month every month (approx. 250-350 Rs) so that they can improve their diet/nutrition levels, CIFF believed that dietary advice needs to be sufficiently specific and importantly actionable. It was not good enough to say eat a balanced diet or eat more protein. The food choices suggested must be available, affordable, and culturally appropriate. A parallel research programme to understand target women’s motivations were also being developed.

The study objectives were following. 1. Determine what pregnant and lactating women eat during these periods and other details of eating habits – occasions, size of different meals etc. How is this different from their usual diet (when not pregnant or lactating)? Identify gaps in their diets compared to the recommendations offered by WHO and Indian Council of Medical Research (ICMR), and 3. Identify realistic and specific dietary advice/recommendations to address nutrient gaps using locally available foods and food products that are acceptable and affordable.

This study was conducted in three districts of Rajasthan namely Baran, Udaipur, Barmer district. We selected respondents of pregnant, lactating women and non-pregnant & non-lactating women from 30 villages/cluster across 5 blocks of each district. A cluster sampling design was used for the current study. In each of the cluster, 4 women each from the 6 groups namely; Non-pregnant & Non-lactating, Pregnant 0-5 months, Pregnant ≥6 months, Lactating women with <6 months’ child, Lactating women with 6-11 months’ child and Lactating women with 12-23 months’ child were interviewed. Quantitative data were tabulated and analyzed using SPSS and excel. and 24hr recall was calculated in Opti food software.

Title: Vulnerability Assessment in the Indian Sundarbans

Agency: Norwegian University of Life Sciences, Norway

Team: Upasona Ghosh, Arnab Mandal, Sabyasachi Mandal

The project assessed the significance of various aspects of vulnerability for the people in the Indian Sundarbans living under the changing climatic situation. A combination of household surveys and participatory rural appraisal techniques was used. It also aimed to explain how the vulnerability of the Sundarbans’ people is perceived by the experts, policymakers and by the community itself. The project followed the Intergovernmental Panel on Climate Change (IPCC) to assess the aspects of vulnerability in terms of three dimensions: exposure, sensitivity, and adaptation. Exposure, defined as the natural hazards to which different communities are exposed, is sometimes excluded from assessments. The objective, in such cases, was to examine vulnerability (sensitivity and adaptation) at a given level of natural hazards. Exposure was excluded from our study since people in a single community were generally exposed in equal measure to natural hazards. The metrics of the hazard itself – for example, a flood – do not vary across the community. What varies is how sensitive each household is to this hazard in terms of its effects, and how it adapts to these effects through mitigation and response. The project was expected to come up with rigorous scientific empirical data on vulnerability assessment in extremely micro-level settings and contributed well to future research of similar nature. The findings were expected to lead to a greater understanding of how the vulnerability is experienced in small communities. Such an understanding helped policymakers and program implementers to design appropriate measures for disaster preparedness in small communities.

Title: Participatory Action Research on Interventions to Support Deaf Young People in West Bengal and Karnataka

Agency: Deaf Child Worldwide (DCW), UK

Team: Manasee Mishra, Usha Manjunath

The purpose of the action research project was to design, implement and test a set of interventions for deaf young people in a sample of the DCW project sites in India. The action research project took into consideration the policy and socio-cultural contexts (including issues of gender equity). The process of designing the set of interventions, implementing and testing it, was to be carried out in a participatory manner, with deaf young people being active participants throughout the process.

Such participatory action research benefitted them in immediate and long-term contexts. Deaf young people were empowered during their engagement in the process. Activities such as reflections of life experiences, articulation of aspirations, interaction with peers, or the enabling environment created through the action research intervention positively affected them as the action research project was underway.

The long-term benefits of the action research project were that, it would offer a set of interventions that was designed, implemented and tested for its effectiveness. Future programming of DCW for deaf young people in India and other countries across the world was actively informed by the set of interventions tested in the action research project.

Title: Interventions to increase immunization coverage among children

Agency: CHUM (Centre Hospitalier De L’Universite De Montreal)

Team: Alok Mathur

The study aimed to evaluate the impact, cost-effectiveness, scalability and sustainability of participatory, community-based knowledge transfer and education (KTE) interventions to improve coverage of basic vaccines among children less than 24 months from undeserved communities in India. It was hypothesized that participatory, community-based KTE interventions could increase vaccination coverage in hard-to-reach populations. Trial design: Cluster-randomized, stratified, superiority trial with two parallel groups and a 1:1 allocation ratio to investigate the effectiveness of participatory, community-based KTE interventions versus usual care on the primary endpoint of receipt of third dose of pentavalent (Hemophilus Influenza Type B, diphtheria-tetanus-pertussis (DTP), and Hepatitis B) (PENTA 3) vaccine among children 12-23 months. The aim of this pilot study was to assess study processes and feasibility and aid in refining methods for the larger study.

Title: Research Program Consortium on Health System Economics & Financing

Agency: Johns Hopkins Bloomberg School of Public Health, USA

Team: Manasee Mishra, Debjani Barman, Upasona Ghosh, Arnab Mandal, Rittika Brahmachari, Sivaji Bose, Baisakhi Mandal

The improvement in the situation in low and middle-income countries is critical to the development goals that the world community has set for itself. Evidence informed policy and practice is vital to bringing about such change. The Future Health Systems (FHS) project was a multi-country research consortium supported by DFID, UK. The consortium started in 2006. It was led by Johns Hopkins Bloomberg School of Public Health, USA. IIHMR was the India based partner. The project was broad in its scope. It sought to generate evidence that can contribute to effective and equitable health systems. It had an active component for promoting the uptake of the research findings among relevant stakeholders. It had successfully highlighted various issues including the informal healthcare market, the vulnerability due to climatic shocks and inequity in access to healthcare. The Indian Sundarbans has been the study site for many studies conducted for this project. Child health in the Indian Sundarbans was a focus of the project.

FHS was in its extension phase. There was consolidation of the learnings of the earlier years during this phase. Generation of various knowledge products (e.g. journal articles, blogs, research briefs) and promotion of the learnings with stakeholders was accelerated. The endeavor in the extension phase was to show how issues observed in the Indian Sundarbans were common to other disadvantaged areas in India and abroad.

Title: Climate Change, Uncertainty and Transformation

Agency: Norwegian University of Life Sciences, Norway

Team: Upasona Ghosh, Manasee Mishra, Shibaji Bose (Consultant), Sabyasachi Mandal (Research Assistant)

The study used qualitative methodology to explore how different actors from above (e.g. policy makers), middle (e.g. media) and below (e.g. local communities) conceptualize climate change related uncertainties in the Sundarbans in West Bengal. It explored how and to what extent climatic uncertainties were impacting the major drivers in the lives of the ‘below’ of Sundarbans, and how people were living with such uncertainties. Further, it explored whether and to what extent climatic uncertainties were leading towards transformation in the socio- ecological system of the Sundarbans. The study was expected to contribute to an understanding of the following in the Sundarbans in West Bengal: contextual and social changes due to the changing climate; coping and adaptation mechanisms of the people of the Sundarbans due to climatic threats; policy paradigms and implementation with specific reference to changing climate; and future alternative pathways for sustainable development for the people of the Sundarbans.

Title: Linkages of Parallel Health Providers and Impact on Health System: A Social Network Analysis from Indian Sundarbans

Agency: IIHMR In-House Research Grant

Team: Rittika Brahmachari, Sabyasachi Mandal (Research Assistant)

Social network theory informed the study. Using qualitative methodology, the study explored the following: the presence and functioning of the network of rural medical practitioners with health system actors in the Sundarbans in West Bengal; the extent of influence of the healthcare market on the rural medical practitioners and vice versa; and how to make use of these networks for effective service delivery for the people of the Sundarbans in West Bengal. The study found three types of significant linkages in the social network of rural medical practitioners: formal healthcare actors, private healthcare market actors, and community-based actors. The network comprised of strong and weak social ties that act as safety nets for rural medical practitioners. The resilience of these groups of community based informal healthcare providers had the potential to complement the formal healthcare providers, both in normal times and during climate shocks. The strengthening of weak ties with formal healthcare providers could lead to building resilient and responsive health systems.

Completed Projects 2018-19 Details

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