India

With support from the Johns Hopkins University, Jhpiego is providing technical assistance to the Government of Uttar Pradesh and Jharkhand to improve access to high-quality breast health care for women in India. For this program, the cornerstones of Jhpiego’s evidence-based strategy include a strong learning agenda among providers and communities, and demonstration of a well-functioning early detection system at the primary health care level that links to timely referral to a designated tertiary care hospital.

This program, supported by a philanthropic investment from an anonymous donor, aims at dramatically expanding access to long-term and reversible contraceptive (LARC) methods to women at the sub-district level in the two states of Odisha and Chhattisgarh. While focusing on ensuring quality of care, the program works to establish and strengthen services to provide both the postpartum and the interval (general) intrauterine contraceptive device (IUCD), as well as postabortion family planning and family planning counseling. The goal of Phase II of this program is to ensure sustained contraceptive prevalence rates in the states of Odisha and Chhattisgarh at its 388 program facilities (187 Phase I facilities plus 201 new facilities), with an emphasis on ensuring that LARCs such as IUCDs are part of the expanded contraceptive choices offered.

Funded by the David and Lucile Packard Foundation, Jhpiego provides strategic technical assistance to the Government of Bihar for facilitating the implementation of a comprehensive, multi-year implementation strategy for postpartum family planning (PPFP), along with scaling up some components of the strategy in five focus districts (Muzaffarpur, Gaya, Saran, Bhagalpur and Madhubani). In addition, this initiative seeks to demonstrate a feasible, efficient and effective programmatic model to strengthen provision of high-quality family planning services in the same five districts. The PPFP services include the Lactational Amenorrhea Method, postpartum intrauterine contraceptive devices and postpartum sterilization. In addition to expanding access to PPFP services, the program piloted the introduction of progestin-only pills in public sector health facilities in Gaya district. The program’s long-term goal is to address unmet need for modern contraceptive methods, in particular during the postpartum period, thereby empowering women and couples in India to fulfill their reproductive health wishes.

Funded by a philanthropic investment from an anonymous donor, this program focuses on ensuring that women in India are fully supported to select the family planning method that best suits their needs. To this end, Jhpiego has successfully piloted an innovative model to support the Government of Jharkhand in implementing a range of policies, capacity-building approaches, and managerial/operational processes and tools. Under this program, Jhpiego plans to implement the lessons learned from the state of Jharkhand in select districts of Maharashtra and Assam. Jhpiego will convene and actively engage government family planning champions as “thought partners” and messengers to propel statewide scale-up of a quality improvement model in Maharashtra and Assam through data-driven advocacy at district and state levels. Jhpiego will also assist in the rollout of reformed incentive mechanisms to ensure that success is defined not only by the number of new acceptors, but also by the assurance that each woman has received the best available method to meet her needs.

Jhpiego has been the lead technical partner in developing Dakshata, the Government of India’s strategic initiative aimed at strengthening the quality of care during and immediately after childbirth through competent, skilled and confident providers. This initiative has been funded by various organizations, including the Children’s Investment Fund Foundation. The Dakshata program uses the World Health Organization’s Safe Childbirth Checklist as a framework for improving the skills of health care workers, prioritizing resource availability, improving compliance to safe care practices and improving use of data for action.

Based on the success of a previous program that leveraged private enterprise to improve maternal, newborn health and family planning in India, MSD for Mothers (as Merck for Mothers is known in India) is supporting Jhpiego to implement Manyata, a program targeting private-sector health care facilities in Uttar Pradesh, Jharkhand and Maharashtra. Under this program, Jhpiego works closely with partners to develop and validate a viable and investable business model for a quality assurance mechanism, while laying the groundwork for sustainable quality improvement efforts in the maternal health care private sector in India.

Funded by the Children’s Investment Fund Foundation, the Born Healthy program is testing a proof of concept to transform the way antenatal care (ANC) is provided in Rajasthan. The program is an attempt to devise an evidence-based ANC model with a special focus on the identification and management of maternal infections as well as strengthening targeted supplementation of iron and calcium during pregnancy. Jhpiego is testing a model of improved ANC—called group antenatal care—that also uses technology in the form of point-of-care diagnostics to make testing and treatment of key high-risk maternal conditions efficient, cost-effective and readily available. Strengthening identification and tracking of high-risk pregnancies is also a key focus area. The program has initially been introduced in 125 facilities across 14 blocks of four districts of the state of Rajasthan (Bundi, Dholpur, Karauli and Udaipur). The program aims to achieve a pan-country scalability through informing the ANC guidelines for the country.

Funded by an educational grant from Novo Nordisk, Jhpiego, in collaboration with the Government of India and the Government of Madhya Pradesh, implemented a two-year demonstration project (2015–2017) in Hoshangabad district of Madhya Pradesh to operationalize an antenatal care (ANC) based service delivery model for gestational diabetes mellitus (GDM) screening and management, as envisioned in the national GDM guidelines. Now, through additional support from World Diabetes Foundation, Jhpiego is providing support to the national government to scale up the intervention at the national level and continue its work in Madhya Pradesh. Additional assistance in Hoshangabad district will also expand to Betul district, essentially to make these districts as model sites for GDM implementation for Madhya Pradesh and for the nation.

The Alliance for Saving Mothers and Newborns (ĀSMĀN) is a major health care technology-driven initiative that is being funded by the Reliance Foundation, U.S. Agency for International Development, Tata Trusts, MSD for Mothers (as Merck for Mothers is known in India) and the Bill & Melinda Gates Foundation. The ASMAN program is being implemented in the states of Madhya Pradesh and Rajasthan to help create innovative, facility-based interventions that enable provision of high-quality care during and immediately after childbirth.

This four-year project, funded by the Bill & Melinda Gates Foundation, builds on the PMA2020 project, which used innovative mobile technology to support low-cost, rapid-turnaround surveys monitoring key health and development indicators. PMA is enhancing this survey platform to generate high-quality data and ensure that governments, donors, managers and advocates use this data to make decisions regarding family planning programs. In addition to scaling up the survey platform for more widespread use, this project supports expanding it to include additional technical areas. Co-led by Jhpiego and the Bill & Melinda Gates Institute for Population and Reproductive Health, this project is operational in several African and Asian countries, including India.

With funding from UNICEF, Jhpiego is conducting an eight-month assessment of home-based newborn care (HBNC) in 15 high-priority districts of the “SAMPURNA” strategy in the state of Odisha. The assessment focuses on service delivery, health workforce, governance, health information system and availability of medical products in order to identify strengths and performance gaps pertaining to the HBNC program. In addition to pinpointing enablers and bottlenecks, the assessment is also examining the perceptions of providers and beneficiaries—all of which will inform rollout strategies of future programs and interventions. Results will inform a high-level committee constituted by the state government of Odisha on reducing neonatal mortality in the state. Based on findings, the committee will develop recommendations to be implemented through the government of Odisha with support from UNICEF.