Impact of the Ananya program on reproductive, maternal, newborn and child health and nutrition in Bihar, India: early results from a quasi-experimental study

The Government of Bihar (GoB) in India, the Bill and Melinda Gates Foundation and several non-governmental organisations launched the program aimed to support the GoB to improve reproductive, maternal, newborn and child health and nutrition (RMNCHN) statewide. Here we summarise changes in indicators...

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Vydáno v:Journal of global health Ročník 10; číslo 2; s. 021002
Hlavní autoři: Darmstadt, Gary L, Weng, Yingjie, Pepper, Kevin T, Ward, Victoria C, Mehta, Kala M, Borkum, Evan, Bentley, Jason, Raheel, Hina, Rangarajan, Anu, Bhattacharya, Debarshi, Tarigopula, Usha Kiran, Nanda, Priya, Sridharan, Swetha, Rotz, Dana, Carmichael, Suzan L, Abdalla, Safa, Munar, Wolfgang
Médium: Journal Article
Jazyk:angličtina
Vydáno: Scotland Edinburgh University Global Health Society 01.12.2020
International Society of Global Health
Témata:
Child
Child Health - statistics & numerical data
Childrens health
Communication
Female
Global health
Grants
Health care
Health facilities
Health promotion
Health Promotion - organization & administration
Health services
Humans
India
Infant Health - statistics & numerical data
Infant mortality
Infant, Newborn
Initiatives
Maternal Health - statistics & numerical data
Newborn babies
Nutrition
Nutritional Status
Performance management
Pilot Projects
Pregnancy
Program Evaluation
Public health
Quasi-experimental methods
Reproductive Health - statistics & numerical data
Research Theme 6: Learning from Ananya Programme in Bihar
Self help
Skills
India
Bihar India
ISSN:2047-2978, 2047-2986, 2047-2986
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Shrnutí:The Government of Bihar (GoB) in India, the Bill and Melinda Gates Foundation and several non-governmental organisations launched the program aimed to support the GoB to improve reproductive, maternal, newborn and child health and nutrition (RMNCHN) statewide. Here we summarise changes in indicators attained during the initial two-year pilot phase (2012-2013) of implementation in eight focus districts of approximately 28 million population, aimed to inform subsequent scale-up. The quasi-experimental impact evaluation included statewide household surveys at two time points during the pilot phase: January-April 2012 ("baseline") including an initial cohort of beneficiaries and January-April 2014 ("midline") with a new cohort. The two arms were: 1) eight intervention districts, and 2) a comparison arm comprised of the remaining 30 districts in Bihar where interventions were not implemented. We analysed changes in indicators across the RMNCHN continuum of care from baseline to midline in intervention and comparison districts using a difference-in-difference analysis. Indicators in the two arms were similar at baseline. Overall, 40% of indicators (20 of 51) changed significantly from baseline to midline in the comparison districts unrelated to ; two-thirds (n = 13) of secular indicator changes were in a direction expected to promote health. Statistically significant impact attributable to the program was found for 10% (five of 51) of RMNCHN indicators. Positive impacts were most prominent for mother's behaviours in contraceptive utilisation. The program had limited impact in improving health-related outcomes during the first two-year period covered by this evaluation. The program's theories of change and action were not powered to observe statistically significant differences in RMNCHN indicators within two years, but rather aimed to help inform program improvements and scale-up. Evaluation of large-scale programs such as using theory-informed, equity-sensitive (including gender), mixed-methods approaches can help elucidate causality and better explain pathways through which supply- and demand-side interventions contribute to changes in behaviour among the actors involved in the production of population-level health outcomes. Evidence from Bihar indicates that deep structural constraints in health system organisation and delivery of interventions pose substantial limitations on behaviour change among health care providers and beneficiaries. ClinicalTrials.gov number NCT02726230.
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ISSN:2047-2978
2047-2986
2047-2986
DOI:10.7189/jogh.10.021002