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Baseline Findings from the Ananya Evaluation · PDF file 2014-05-04 · Baseline...

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  • Baseline Findings from the Ananya Evaluation

    Final Report

    November 19, 2013

    Mathematica Policy Research: Anu Rangarajan Evan Borkum Swetha Sridharan Dana Rotz Mercy Manoranjini Seth Morgan

    Public Health Foundation of India: Lalit Dandona Rakhi Dandona Priyanka Chaman G. Anil Kumar

    ananya

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  • Contract Number: 4993/22539 (18)

    Mathematica Reference Number: 40195.100

    Submitted to: Bill & Melinda Gates Foundation 3rd Fl., Left Wing Capital Court Building, Olof Palme Marag Munirka, New Delhi, India 110 067 Project Officers: James Moore, Program Officer Katherine Hay, Senior Program Officer Usha Kiran Tarigopula, Senior Program Officer

    Submitted by: Mathematica Policy Research P.O. Box 2393 Princeton, NJ 08543-2393 Telephone: (609) 799-3535 Facsimile: (609) 799-0005 Project Director: Anu Rangarajan

    Baseline Findings from the Ananya Evaluation

    Final Report

    November 19, 2013

    Mathematica Policy Research: Anu Rangarajan Evan Borkum Swetha Sridharan Dana Rotz Mercy Manoranjini Seth Morgan

    Public Health Foundation of India: Lalit Dandona Rakhi Dandona Priyanka Chaman G. Anil Kumar

    ananya

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  • Ananya Baseline Report Mathematica Policy Research and Public Health Foundation of India

    iii

    ACKNOWLEDGMENTS

    This report would not have been possible without the support and collaboration of a broad range of individuals and organizations. At the Bill & Melinda Gates Foundation, we are indebted to our program officers, Usha Tarigopula, James Moore, and Katherine Hay for their excellent guidance, support, and responsiveness throughout. The contributions of our local data collection partner, Sambodhi Research and Communications, were key to the success of this effort. We would like to thank Kultar Singh, Aparna Seth, Chandan Singh, Manish Naithani, and Gurshabadjeet Singh for tirelessly piloting and revising multiple rounds of our survey instruments, providing a comprehensive and in-depth training to field investigators, and capably managing a complex data collection effort. Our close interactions with the Ananya partners, including CARE, BBC, WHP and, more recently, IFC and PCI, have also been critical in shaping our thinking and approach. We truly appreciate their willingness to engage closely with us and their generosity with their time, advice, and feedback throughout the process.

    The contributions of several Mathematica staff were integral to this effort. We would like to thank Seth Morgan, Bethany Simard, Carol Razafindrakoto, Mason DeCamillis, and Matthew Jacobus for their hard work on countless data programming tasks and their close attention to detail while working under pressing deadlines. We are also grateful to Stacy Dale for her support in the analysis, Emilie Bagby for her assistance with the baseline survey instruments, and Peter Schochet for helping us think through questions related to evaluation design. Kimberly Smith and Nancy Murray participated in the crucial work of developing the building blocks of this report, the measurement, learning, and evaluation framework and design. Kim also provided in-depth comments on an early draft of this report. John Kennedy skillfully edited the report and Jennifer Baskwell assisted with formatting, uncomplainingly processing several round of edits to the text and graphics.

    Finally, we would like to thank the households and health workers who participated in this study. Their patience with us as we administered the surveys, and their willingness to share their experiences, are what finally made this study possible.

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  • Ananya Baseline Report Mathematica Policy Research and Public Health Foundation of India

    v

    CONTENTS

    EXECUTIVE SUMMARY ........................................................................................................... xi

    I INTRODUCTION ........................................................................................................ 1

    A. The Public Health System in Bihar ....................................................................... 2

    B. The Ananya Grant Portfolio .................................................................................. 5

    C. Overview of Ananya MLE Design ....................................................................... 10

    D. Road Map for the Report .................................................................................... 12

    II OVERVIEW OF BASELINE DATA COLLECTION .................................................... 13

    A. Goals of the Baseline Data Collection ................................................................ 13

    B. Sampling and Fielding Approach ....................................................................... 14

    C. Survey Design and Content ............................................................................... 17

    III FINDINGS FROM THE HOUSEHOLD SURVEY ...................................................... 23

    A. Sample Characteristics ...................................................................................... 23

    B. Mortality Rates ................................................................................................... 25

    C. Antenatal Care and Preventive Practices ........................................................... 26

    D. Delivery .............................................................................................................. 29

    E. Newborn Care .................................................................................................... 33

    F. Nutrition ............................................................................................................. 36

    G. Immunization ..................................................................................................... 40

    H. Family Planning ................................................................................................. 41

    I. Other Baseline Findings ..................................................................................... 43

    J. Conclusion ......................................................................................................... 47

    IV FINDINGS FROM FRONTLINE WORKER SURVEYS ............................................. 49

    A. Background Characteristics ............................................................................... 49

    B. Training .............................................................................................................. 51

    C. Knowledge of Maternal and Child Health Topics ................................................ 54

  • Ananya Baseline Report Mathematica Policy Research and Public Health Foundation of India

    vi

    D. Attendance at Deliveries and Home Visits.......................................................... 58

    E. Incentive Payments ............................................................................................ 62

    F. Summary ........................................................................................................... 64

    V FINDINGS FROM FACILITY- AND PROVIDER-LEVEL SURVEYS .......................... 65

    A. Infrastructure ...................................................................................................... 65

    B. Sanitation and Hygiene Practices ...................................................................... 67

    C. Staffing and Management .................................................................................. 70

    D. Maternal and Delivery Care Services ................................................................. 74

    E. Family Planning ................................................................................................. 80

    F. Recordkeeping ................................................................................................... 81

    G. Summary ........................................................................................................... 83

    VI CONCLUSION AND NEXT STEPS .......................................................................... 85

    REFERENCES ......................................................................................................................... 87

    APPENDIX A ............................................................................................................................ 89

  • Ananya Baseline Report Mathematica Policy Research and Public Health Foundation of India

    vii

    TABLES

    I.1 Summary of the Current Portfolio of Ananya Implementing Grants ............................. 7

    II.1 Sample Sizes and Response Rates for the Baseline Surveys ................................... 16

    II.2 Domains and Illustrative Indicators for the Household Survey ................................... 18

    II.3 Domains and Illustrative Indicators for the Frontline Worker Surveys ........................ 19

    II.4 Domains and Illustrative Indicators for the Facility and Provider Surveys .................. 20

    III.1 Statewide Mortality Rates ............................................................

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