This five-year project, funded by USAID, aims to transform, redesign and re-engineer primary health care (PHC) in India for provision of equitable, comprehensive and client-centered PHC that contributes to improved health outcomes for marginalized and vulnerable populations, including women and girls. NISHTHA supports creating a strong, responsive, accessible, sustainable and affordable PHC system that ensures effective delivery of reproductive, maternal, newborn, child and adolescent health services and integrates quality services for control of tuberculosis. NISHTHA is working to ensure availability of a skilled workforce, create sustainable training ecosystems and improve health care infrastructure and responsive health systems at the national level and across 12 states (Assam, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, Arunachal Pradesh, Manipur, Meghalaya, Mizoram, Nagaland, Sikkim and Tripura). Core areas of support include: 1) providing technical assistance for rollout of the Government of India’s flagship Ayushman Bharat Health and Wellness Center program, which aims to achieve universal health coverage in India; 2) creating an ecosystem for designing, incubating and testing innovative solutions; and 3) fostering strategic partnerships between the public and private sectors to strengthen comprehensive PHC and ensure effective delivery of maternal and child health, family planning and tuberculosis services and the School Health and Wellness program. Jhpiego is also establishing learning labs across the country, upgrading and operationalizing 30,050 health facilities into functional Health and Wellness Centers, and empowering 24,000 community health officers to lead PHC teams—thereby providing approximately 143 million people with access to high-quality, comprehensive PHC services.

In April 2020, USAID provided supplemental COVID-19 Emergency Response Funding to the NISHTHA project (see above) to provide technical assistance to strengthen the response towards the COVID-19 pandemic at the national level and across 13 intervention states (Assam, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, Arunachal Pradesh, Manipur, Meghalaya, Mizoram, Nagaland, Sikkim and Tripura). NISHTHA’s approach includes strengthening health system readiness and response capacity, protecting the health workforce, ensuring continuity of essential services, carrying out targeted risk communication for enhanced community level preparedness, and co-designing and deploying innovative solutions.

When the country was hit with an unprecedented second wave of the pandemic in April 2021, USAID provided additional funding to strengthen the availability of medical oxygen. With the Government of India, the project is addressing the most critical bottlenecks in the oxygen supply chain logistics. In addition, this second phase of the project focuses on building resilient primary health care systems that are well resourced, robust, responsive, client centered and better prepared to face future public health threats through the Government of India’s flagship Ayushman Bharat Health and Wellness Centers program.

With funding from Unilever, the NISHTHA project (see above) is working to expand the reach and impact of healthy hygiene behaviors among targeted communities for the improved health and wellbeing of nearly 132 million people in four states (Madhya Pradesh, Chhattisgarh, Jharkhand, and Nagaland). The project uses a multi-pronged approach to demonstrate community-level campaigns designed to promote healthy hygiene behaviors among targeted communities and enhance access to safe water and sanitation. In addition, the School Health and Wellness Program platform and Health and Wellness Centers under the Government of India’s flagship Ayushman Bharat program are being leveraged to improve knowledge, attitudes and practices among school children and within communities through delivery of specially curated content on water, sanitation and healthy hygiene behaviors.

With support from the Bill & Melinda Gates Foundation, Jhpiego is providing technical assistance to strengthen the delivery of comprehensive primary health care (PHC). To achieve this, Jhpiego is ensuring the availability of a skilled health workforce and creating sustainable training ecosystems, improved health care infrastructure and responsive health systems that will contribute to improved health outcomes in the state of Uttar Pradesh. The project supports the Government of Uttar Pradesh to: 1) strengthen and create robust health systems that accelerate transformation of 21,113 PHC facilities as Health and Wellness Centers; 2) integrate reproductive, maternal, newborn, child and adolescent health services within comprehensive PHC through Health and Wellness Centers to improve the quality of services for women, mothers and children; and 3) design and implement continuum of care models in a few geographies and co-design a robust and responsive PHC system in close collaboration with the Government of Uttar Pradesh and key partners to address public health emergencies.

Jhpiego, in coordination with the Bihar Technical Support Program, is supporting the Government of Bihar to establish a comprehensive primary health care system that is responsive to community health needs by establishing a network of 11,500 Health and Wellness Centers across the state. Jhpiego aims to support the state government to meet the Health and Wellness Centers targets by 2022 and ensure the quality of training of community health officers who will eventually be posted at the Health and Wellness Centers to lead primary health care teams. The focus of this project is on generating evidence and learnings and using the evidence to advocate for policies that strengthen comprehensive primary health care services.

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 State. The program is an attempt to devise an evidence-based ANC model with a special focus on 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 is also incorporating digital records for ANC services at maternal, newborn and child health care site sites through the Community Health Integrated Platform under the state-level “Nirogi Rajasthan” campaign to enable decision support for appropriate management and referral of high-risk pregnancies. While the program has initially been introduced in 125 facilities across 14 blocks of four districts of Rajasthan (Bundi, Dholpur, Karauli and Udaipur), it aims to achieve pan-country scalability by informing ANC guidelines for the country.

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. Among the surveys that PMA has carried out in India to date, a survey to assess the impact of COVID-19 on family health and economic conditions was the first of its kind.

Moving Integrated, Quality Maternal, Newborn and Child Health and Family Planning and Reproductive Health Services to Scale (MOMENTUM) is a suite of projects, funded by the U.S. Agency for International Development, that aims to accelerate reductions in maternal, newborn and child mortality and morbidity in high-burden countries by increasing host country commitment and capacity to provide high-quality, integrated health care. Each of the projects has a specific focus area; together they provide a comprehensive, flexible package of support for countries as they overcome context-specific health challenges towards sustainable development. The five-year, Jhpiego-led MOMENTUM Country and Global Leadership project focuses on: 1) providing targeted technical and capacity development assistance to our missions, partner countries and local organizations; and 2) contributing to global technical leadership and policy dialogue for improved maternal, newborn and child health, voluntary family planning and reproductive health outcomes. Jhpiego’s 12 sub-partners under this project are: Save the Children, Johns Hopkins University International Vaccine Access Center, The Manoff Group, Quicksand, Matchboxology, BAO Systems, Avenir Health, McKinsey and Company, PACT, Institute for Healthcare Improvement, Christian Connections for International Health and Ubora Quality Institute.

With partners Khushi Baby and Accenture Development Partnerships, Jhpiego is designing and prototyping a replicable, scalable digital platform across the continuum of care (from pregnancy to immediate postnatal period till discharge). This project, which seeks to demonstrate the feasibility of digital integration on overall service delivery across the continuum, is integrating and testing two apps—the Khushi Baby app (for the antenatal period) and the ASMAN app (for the intranatal period)—as a connected suite in a digital platform. This platform leverages data collected across the continuum for predictive analytics, initiation of risk stratification of pregnancies and preparation of the health system to provide targeted, coordinated care to those with a higher likelihood of complications. The intelligent continuum of care platform will be driven by two strategic and interlinked pillars: 1) improve and automate measurements across the continuum through integration of point-of-care diagnostic devices; and 2) ensure an integrated, longitudinal tracking platform for pregnant women (during the antenatal, intrapartum and postnatal periods) and newborns. This project is funded by the Bill & Melinda Gates Foundation.

Under this initiative, funded by the Bill & Melinda Gates Foundation, Jhpiego is facilitating and providing technical assistance to the Government of India to establish “Nurse Practitioners in Midwifery” (NPMs) and “Midwifery-Led Care Units” to transform maternal and newborn health care in India through provision of knowledgeable, skilled, compassionate and woman-centered care. This work includes: 1) establishing an educational framework at the national and state levels for production of skilled, competent and empowered NPMs by supporting three National Midwifery Training Institutes and four State Midwifery Training Institutes (three in Uttar Pradesh and one in Bihar); 2) leading the development of a standardized learning resource package for NPM educators and NPMs for use across all National and State Midwifery Training Institutes in the country; 3) providing technical inputs on the scope of practice for NPMs, examination guidelines for NPM educators and selection criteria for NPM educators and NPMs; 4) providing technical assistance to Uttar Pradesh and Bihar in the effective roll-out of midwifery services by facilitating the formation of a state-level roadmap for midwifery and state task force for midwifery and the establishment and operationalization of Midwifery-Led Care Units; and 5) facilitating the creation of a favorable policy and regulatory environment for NPMs in collaboration with the Ministry of Health, Indian Nursing Council and other stakeholders.

With funding from the Bill & Melinda Gates Foundation, Jhpiego is assisting the Government of Uttar Pradesh to operationalize Health and Wealth Centers for comprehensive primary health care. Project objectives are to: 1) enable the government to facilitate strengthened and robust health systems that accelerate transformation of 21,113 Health and Wealth Centers in the next three years; 2) integrate reproductive, maternal, newborn and child health, nutrition and adolescent health services within comprehensive primary health care services through Health and Wealth Centers, thereby improving quality of services for women, mothers and children; 3) provide technical support to design and implement continuum-of-care models in demonstration districts; and 4) co-design a robust and responsive primary health care system in close collaboration with the government and key partners to cater to public health emergencies.

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.

With funding from Merck, Jhpiego is supporting improving access to early detection, diagnosis and management for cervical cancer in Odisha State. Jhpiego is providing technical assistance to the state to develop an operational framework on cervical cancer care and implement the framework in phases in one district of Odisha. Activities include: developing training and learning resources for primary health care; building the capacity of providers to detect, diagnose and manage cervical cancer; raising community awareness of cervical cancer; strengthening referral pathways; establishing review mechanisms; and documenting program learnings. The ultimate goal of this initiative is to build a clear, long-term road map for comprehensive cervical cancer care in Odisha.

With technical support from Jhpiego, Laerdal Medical India Private Limited and Shree Guru Gobind Singh Tricentenary (SGT) University, the Indian Nursing Council established a state-of-the-art National Reference Simulation Centre at SGT University in 2018. The Centre’s vision is to become a global leader in simulation-based education, and its mission is to serve as a demonstration, reference and training center for introducing the use of simulation in regular nursing teaching as well as inter-professional training. Project objectives are to: 1) create a national reference, demonstration and resource center on simulation training which will be linked with nursing institutions across the country through a hub-and-spoke model; 2) create a pool of master simulation trainers by training faculty from nursing institutions across the country; 3) assist the Indian Nursing Council in generating evidence for replacing clinical hours with simulation-based learning and for integration of simulation in regular nursing educational curriculum; and 4) demonstrate and promote a model for inter-professional education through simulation-and team-based training.