Improving primary health care delivery in Bihar, India: Learning from piloting and statewide scale-up of Ananya

Darmstadt, Gary L.; Pepper, Kevin T; Ward, Victoria; Srikantiah, Sridhar; Mahapatra, Tanmay; Tarigopula, Usha Kiran; Bhattacharya, Debarshi; Irani, Laili; Schooley, Janine; Chaudhuri, Indrajit; Dutt, Priyanka; Sastry, Padmapriya; Mitra, Radharani; Chamberlain, Sara; Monaghan, Sophia; Nanda, Priya; Atmavilas, Yamini; Saggurti, Niranjan; Borkum, Evan; Rangarajan, Anu; Mehta, Kala M.; Abdalla, Safa; Wilhelm, Jess; Weng, Yingjie; Carmichael, Suzan L.; Raheel, Hina; Bentley, Jason; Munar, Wolfgang; Creanga, Andreea A.; Trehan, S. P.; Walker, Dilys; Shah, Hemant

doi:10.7189/jogh.10.0201001

Cited by 14 publications

(16 citation statements)

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“…Further, they were collected cross-sectionally when multiple other interventions were being implemented as a part of the Ananya programme in the same geospatial areas. 14 31 While the study design allows for the assumption that women would have had an equal chance of having been exposed to other initiatives, it cannot be ruled out that women who attended FLW-facilitated discussions may be more likely to also attend other educational events, such as radio programmes and street theatre. Further, it is difficult to differentiate whether the benefits for women who were exposed to the tools were due to the content of the tools or simply the confounding effect of having been exposed to an FLW, thus making it difficult to attribute impact to specific interventions.…”

Section: Discussionmentioning

confidence: 99%

“…New tools and interventions were designed and piloted by grantees, with subsequent provision of technical support to the GoB to facilitate statewide scale-up of those found to be successful. 14 In order to achieve impact at scale, a grant entitled ‘Shaping Demand and Practices’ was awarded in 2011 to the organisation BBC Media Action to develop a large-scale, multiplatform suite of interventions across the eight innovation districts, reaching 28 million people, with plans to scale up effective interventions across all 38 districts of Bihar in 2014. 15 In this study, we evaluate the impacts of a package of mHealth and paper-based job aids for use by FLWs in group settings, to assess whether they improved health-related knowledge, subsequent interpersonal discussion and behaviours among beneficiary women.…”

Section: Methodsmentioning

confidence: 99%

“…Similar to other interventions of the Ananya programme, 14 BBC Media Action initially piloted its tools during 2014 and 2015, starting in the eight focus districts and expanding to an additional seven districts for the paper-based tools. In order to reach beneficiaries statewide, implementation would be reliant on the transfer of ownership and implementation to the GoB to scale up effective interventions to the rest of the 38 districts alongside the supply-side interventions of CARE India.…”

Section: Methodsmentioning

confidence: 99%

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Implementing health communication tools at scale: mobile audio messaging and paper-based job aids for front-line workers providing community health education to mothers in Bihar, India

et al. 2021

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IntroductionAs part of an investment by the Bill & Melinda Gates Foundation to support the Government of Bihar to improve reproductive, maternal, newborn and child health and nutrition (RMNCHN) statewide, BBC Media Action implemented multiple communication tools to support front-line worker (FLW) outreach. We analyse the impacts of a package of mHealth audio messaging and paper-based job aids used by FLWs during government-sponsored village health, sanitation and nutrition days (VHSNDs) on knowledge and practices of childbearing women across the RMNCHN continuum of care.MethodsData from two surveys collected between July and September 2016 were analysed using logistic regression to compare health-related knowledge and behaviours between women who had been exposed at VHSNDs to the mHealth GupShup Potli (GSP) audio recordings or interpersonal communication (IPC) tools versus those who were unexposed.ResultsExposure to GSP recordings (n=2608) was associated with improved knowledge across all continuum-of-care domains, as well as improved health-related behaviours in some domains. The odds of having taken iron-folic acid (IFA) tablets were significantly higher in exposed women (OR 1.5, 95% CI 1.1 to 2.2), as was contraceptive use (OR 2.0, 95% CI 1.2 to 3.2). There were no differences in birth preparedness or complementary feeding practices between groups. Exposure to IPC paper-based tools (n=2002) was associated with a twofold increased odds of IFA consumption (OR 2.3, 95% CI 1.7 to 3.2) and contraceptive use (OR 1.8, 95% CI 1.2 to 2.8). Women exposed to both tools were generally at least twice as likely to subsequently discuss the messages with others.ConclusionBBC Media Action’s mHealth audio messaging job aids and paper-based IPC tools were associated with improved knowledge and practices of women who were exposed to them across multiple domains, suggesting their important potential for improving health outcomes for beneficiaries at scale in low-resource settings.Trial registration numberNCT02726230.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Implementing health communication tools at scale: mobile audio messaging and paper-based job aids for front-line workers providing community health education to mothers in Bihar, India

et al. 2021

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“…We initially expected a potentially nonlinear association. We assumed that indicators may have lower levels at the beginning due to pervasive structural barriers against improvement, impeding progress in areas with lower baseline levels during Ananya scale-up [ 10 ]. On the other hand, indicators with relatively high levels at the beginning of scale-up may have already fulfilled their capacity to benefit and therefore may not respond to further programme inputs.…”

Section: Discussionmentioning

confidence: 99%

Improving the precision of maternal, newborn, and child health impact through geospatial analysis of the association of contextual and programmatic factors with health trends in Bihar, India

et al. 2022

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Background There is a scarcity of research that comprehensively examines programme impact from a context-specific perspective. We aimed to determine the conditions under which the Bihar Technical Support Programme led to more favourable outcomes for maternal and child health in Bihar. Methods We obtained block-level data on maternal and child health indicators during the state-wide scale-up of the pilot Ananya programme and data on health facility readiness, along with geographical and sociodemographic variables. We examined the associations of these factors with increases in the levels of indicators using multilevel logistic regression, and the associations with rates of change in the indicators using Bayesian Hierarchical modelling. Results Frontline worker (FLW) visits between 2014-2017 were more likely to increase in blocks with better night lighting (odds ratio (OR) = 1.23, 95% confidence interval (CI) = 1.01-1.51). Birth preparedness increased in blocks with increasing FLW visits (OR = 3.43, 95% CI = 1.15-10.21), while dry cord care practice increased in blocks where satisfaction with FLW visits was increasing (OR = 1.52, 95% CI = 1.10-2.11). Age-appropriate frequency of complementary feeding increased in blocks with higher development index (OR = 1.55, 95% CI = 1.16-2.06) and a higher percentage of scheduled caste or tribe (OR = 3.21, 95% CI = 1.13-9.09). An increase in most outcomes was more likely in areas with lower baseline levels. Conclusions Contextual factors (eg, night lighting and development) not targeted by the programme and FLW visits were associated with favourable programme outcomes. Intervention design, including intervention selection for a particular geography, should be modified to fit the local context in the short term. Expanding collaborations beyond the health sector to influence modifiable contextual factors in the long term can result in a higher magnitude and more sustainable impact. Registration ClinicalTrials.gov: NCT02726230.

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“…At the global level, a series of programs have been designed to improve sanitation and hygiene with a focus on the needs of rural residents, women, girls, and school students. These programs focus on latrine construction, sanitation science and technology, communityled health education, and policy advocacy (Tumwine et al, 2003;Fewtrell et al, 2005;Banke et al, 2006;Strunz et al, 2014;Du et al, 2019;Patel et al, 2019;Rheinländer et al, 2019;Als et al, 2020;Darmstadt et al, 2020;Morse et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

Health Benefits of Improved Latrine in Rural China

Shang

Li²,

Wang³

et al. 2022

Front. Environ. Sci.

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Proper sanitation facilities promote health because they allow people to dispose of their waste appropriately. Since the founding of the People’s Republic of China, the Chinese government has been committed to improving water and sanitation. The coverage of sanitary latrines in rural China reached more than 70.0% in 2022. Using published literature, open data, and national statistics, this study evaluated the health effects of improved latrines in China. A search strategy aimed at collecting all latrine improvement-related community intervention research in China from 1990 to 2021 was designed and implemented. Incidences of three diseases—schistosomiasis, diarrheal disease, and soil-transmitted helminths (STH)—were used as indicators of health benefits. The relationship between adjusted relative risk (RR) and coverage of sanitary latrines in the study area was examined using a log-linear model. Overall, 411 incidences of the three diseases before and after community intervention were extracted from 74 qualified articles. The results demonstrated the importance of promoting access to sanitary latrines in disease prevention and control in China. The overall estimates revealed mean reductions of 60% for diarrhea risk, 42% for schistosomiasis risk, and 65% for STH risk compared to no intervention. In addition, increasing sanitary latrine coverage was negatively correlated with RR in China, indicating that populations with high sanitary latrine coverage were less likely to be affected with water, sanitation, and hygiene-related diseases.

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Improving primary health care delivery in Bihar, India: Learning from piloting and statewide scale-up of Ananya

Cited by 14 publications

References 38 publications

Implementing health communication tools at scale: mobile audio messaging and paper-based job aids for front-line workers providing community health education to mothers in Bihar, India

Implementing health communication tools at scale: mobile audio messaging and paper-based job aids for front-line workers providing community health education to mothers in Bihar, India

Improving the precision of maternal, newborn, and child health impact through geospatial analysis of the association of contextual and programmatic factors with health trends in Bihar, India

Health Benefits of Improved Latrine in Rural China

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