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India: Improving Maternal, Newborn, and Child Health

In 2010, the Bill & Melinda Gates Foundation launched the Family Health Initiative in Bihar, India (now named “Ananya,” a Sanskrit word meaning “unique” or “unlike others”). The goals of the Ananya program are to reduce maternal, neonatal, and child mortality; malnutrition; fertility; and morbidity from infectious diseases by developing and implementing innovative, integrated health solutions that involve both the public and private sectors. To achieve these goals, the foundation intends to address both supply- and demand-side barriers to improving maternal, newborn, and child health in Bihar. Through a set of six complementary grants, the program seeks to increase the uptake, coverage, and quality of family health interventions in the state. The program will be implemented in eight focal districts by 2012-2013 and scaled up to the rest of Bihar by 2015.

The foundation has contracted with Mathematica to lead the measurement, learning, and evaluation (MLE) component of the Ananya program. Mathematica is working closely with its lead evaluation partner in India, the Public Health Foundation of India (PHFI), in designing and executing the MLE plan. Mathematica is also partnering with Sambodhi Research and Communications, which leads the primary data collection effort and participates in other evaluation activities. COHESIVE-India is evaluating the grant that is designed to improve the availability and quality of care provided by the private sector for select infectious diseases.

The MLE plan for the Ananya program has three components:

1. Impact Analysis of the Ananya Program and of Select Innovative Solutions: The ultimate goal of the Ananya program is to improve family health outcomes in Bihar. Therefore, measuring changes in key outcomes over the course of the program and assessing the program’s contribution to these changes are central to our evaluation design. In particular, we will examine the effects of the overall package of interventions implemented by the grantees in the eight focal districts compared with changes in coverage in non-focal districts over a two-year period. We will also examine changes in key coverage and impact indicators across the state over a five-year period. In addition, we will use a randomized design to rigorously test the effectiveness of two highly innovative solutions in enhancing the quality of household interactions with frontline workers and in improving key coverage indicators. 
   
   
2. Process and Scale-Up Analysis: A rigorous implementation, or process, evaluation will provide a comprehensive picture of what interventions are being implemented, how they are being implemented, and key implementation successes and failures. With this information, the evaluation aims to inform program improvement and course correction by the foundation and grantees. This qualitative data will also assist in our interpretation of the impact analysis findings. A second focus of the process evaluation is scale-up, a critical piece of the Ananya initiative. Key assumptions in the program logic are that integrated solutions can be brought to scale and that delivery at scale of high-impact family health services and interventions will significantly reduce maternal, neonatal, and child mortality and morbidity. Therefore, measuring the extent to which scale-up occurred, understanding and documenting the scale-up process, and identifying the factors that facilitate and inhibit scale-up are all critical components of the MLE effort.
   
   
3. Cost and Cost-Effectiveness Analysis: Although evidence of effectiveness is critical to persuading development partners to adopt a new approach to family health, the costs of doing so will also influence replication and scale-up decisions. The goal of the cost analysis is to generate estimates of overall program costs, the costs of major program components, replication costs, and the key cost drivers. In addition, we will attempt to determine the cost-effectiveness of both the program and the value-added solutions, and how cost-effectiveness may have evolved over the course of the Ananya program.

Publications/Presentations

"AnanyaBaseline: Early Findings from Household Surveys" (April 2012)
"Measurement, Learning, and Evaluation for the Ananya Program (Family Health Initiative in Bihar)
Design Report" (October 2011)
"Measurement, Learning, and Evaluation Framework for the Bihar Initiative Revised Report" (April 2011)