Since the 1980s, working to save lives and improve health for the most vulnerable.
- In the past four years, Jhpiego has supported the Government of India to save the lives of an estimated 83,000 children and 9,900 women through improved contraceptive services. Averting an estimated 16.4 million unintended pregnancies and 10 million abortions saved an estimated US$549 million (INR 38.5 billion) in direct health care spending.1
- An independent evaluation of Jhpiego’s initiative in India to implement the World Health Organization’s Safe Childbirth Checklist (which addresses the major causes of maternal death, intrapartum-related stillbirths and neonatal deaths) showed an 11% decline in still births and very early neonatal deaths at the 100 health care facilities where it was implemented.
- Through its collaboration with the public and private sectors, Jhpiego helped ensure that competent health care workers provided high-quality childbirth services for more than 2.8 million deliveries across the country.
- As a result of Jhpiego’s work in India in 2018, 38 national and subnational policies, regulations, guidelines and strategies were approved. Also, Jhpiego-led advocacy resulted in more than US$49 million mobilized at the national level and more than US$6 million at subnational level.
1Estimates calculated using Impact 2 (Marie Stopes International) and data as of September 2018.
Our Work in India
Supporting Postpartum Family Planning Transition to the State Governments of Uttar Pradesh and Bihar, and Assessing Postabortion Comprehensive Family Planning Gaps
From 2010 to 2018, Jhpiego provided technical assistance to the state governments of Uttar Pradesh and Bihar to ensure that postpartum family planning (PPFP) services—specifically, postpartum intrauterine contraceptive devices (PPIUCD) services—are available and of high quality at the intervention facilities of the two states. Jhpiego and the Uttar Pradesh and Bihar governments and their respective state technical support units have identified areas that still need strengthening to ensure sustained PPFP/PPIUCD services at the health facilities and gradually expand these services to all delivery sites in these two states. With support from the Bill & Melinda Gates Foundation, Jhpiego is working with the state governments to transition oversight of service availability, workforce capacity and service quality to the agencies chosen by the respective states. To respond effectively to the unmet need in Uttar Pradesh and Bihar, Jhpiego is also leveraging its experience in strengthening postabortion family planning services in Odisha and Chhattisgarh, to evaluate the situation through a landscape assessment of postabortion family planning in Bihar and Uttar Pradesh.
Expanding Access to Intrauterine Contraceptive Device Services (Phase II)
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.
Strengthening Postpartum Family Planning and Quality of Family Planning Services in Bihar
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.
Advocating for Quality in Family Planning
Strong support from the Bill & Melinda Gates Foundation has made the rollout of the Quality in Family Planning program possible. Under this initiative, Jhpiego is developing, piloting and advocating for a simplified, contextualized, evidence-based and scalable quality assurance model in Dhanbad, Giridih and Ramgarh districts of Jharkhand that could effectively be scaled up by the Ministry of Health and Family Welfare. This quality assurance model incorporates strategies such as: financial provider incentives, planning and management of service delivery points, engagement with community stakeholders (through the support of Accredited Social Health Activists), improved supply of family planning commodities and training human resources for family planning services. Key stakeholders, especially government decision-makers and implementers, are being continuously engaged during the development and testing of the model as an ongoing policy engagement process.
Advance Family Planning Program
Under this program, funded by the Bill & Melinda Gates Foundation, Jhpiego is working with the Government of India to mainstream quality through the “SMART” advocacy approach in the states of Assam, Jharkhand, Maharashtra and Uttar Pradesh. The overall goal of the program is to successfully advocate for sanctioned increases in the focus states’ budgets for family planning services and quality within the states’ program implementation plans under the National Health Mission (an initiative undertaken by the Government of India to address the health needs of underserved rural areas). So far, the combined advocacy approach has leveraged government resources, resulting in several policy and financial quick wins.
Maternal and Child Survival Program
The U.S. Agency for International Development’s Bureau for Global Health’s flagship Maternal and Child Survival Program (MCSP) focuses on 25 high-priority countries with the ultimate goal of preventing child and maternal deaths. MCSP is introducing and supporting high-impact, sustainable reproductive, maternal, newborn and child health (RMNCH) interventions in partnership with ministries of health and other partners. In addition to contributing to high-level technical and policy dialogue at the global level, MCSP provides tailored technical assistance to help countries meet specific priorities and contextual needs of local, sustainable RMNCH programs. For more on MCSP in India, visit here: http://www.mcsprogram.org/where-we-work/india/.
Ensuring Quality and Informed Choice for Family Planning
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.
Dakshata: The Government of India’s Strategic Initiative for Quality Improvement in Labor Rooms
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 is funded by the Children’s Investment Fund Foundation (for Rajasthan, Andhra Pradesh, Maharashtra, Jharkhand, and national level support for new states) and the Norway India Partnership Initiative (for Madhya Pradesh, Odisha, Bihar and Jammu & Kashmir). 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.
Manyata: Sustaining Quality Assurance Accreditation for Maternal Health Care in India’s Private Sector
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.
Born Healthy: Addressing Maternal Infections to Improve Newborn Outcomes
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.
Norway India Partnership Initiative (Phase III)
The Norway India Partnership Initiative (NIPI) is an outcome of the joint statement of the Prime Ministers of India and Norway for achieving global health goals. NIPI’s vision is providing strategic, catalytic and innovative support to India’s health program, the National Health Mission. The approach of NIPI is to test innovations for a brief period and, if effective, scale them up through the National Health Mission and Indian health systems. The geographical focus of NIPI is the states of Bihar, Odisha, Madhya Pradesh, Rajasthan and Jammu & Kashmir, where NIPI is also working as the lead development partner under the reproductive, maternal, newborn, child and adolescent health strategy of the Government of India. As the implementing partner of NIPI’s Phase III, Jhpiego is working to take NIPI to scale in India, establishing an innovation hub on maternal, newborn and child health and taking the NIPI initiative to global scale through documentation and dissemination of best practices.
Defining an Operational Model for an Antenatal Care based Gestational Diabetes Mellitus Screening and Management
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.
Human Papillomavirus Vaccine Program in India
Under this initiative—funded by Gavi, the Vaccine Alliance—Jhpiego is providing support to a few states who have taken their own initiatives to introduce the human papillomavirus (HPV) vaccine, thereby contributing to the primary prevention of cervical cancer in the country. Primary areas of work include: developing a program-learning toolkit, including an investment case for HPV vaccine introduction based on global and national best practices; coordinating with all relevant stakeholders, including universal immunization partners at the national level for prevention of cervical cancer; and engaging with community stakeholders to understand and document their perspectives on HPV vaccines.
Improving Breast Health Care
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.
Strengthening Management and Leadership Capacity for Nursing
Jhpiego, in partnership with the U.S. Agency for International Development, is working to accelerate reproductive, maternal, newborn, child and adolescent health outcomes by improving the quality of pre-service education (PSE) for the nursing midwifery cadre in private sector institutions across the states of Bihar, Madhya Pradesh, Odisha, Delhi/NCR, Haryana and Jharkhand). Under this initiative, partnerships for leveraging private sector resources are being established towards inclusive and sustainable improvement in the quality of PSE. The Indian Nursing Council’s established educational and clinical standards are being used to strengthen PSE, and tried-and-tested information technology is being leveraged to build the capacity of faculty members and improve knowledge and skills of students in private nursing training institutions. In addition, an institutional mechanism for continuing professional development for faculty is also being created in private sector institutions.
Strengthening Nursing-Midwifery Cadre in Uttar Pradesh
Supported by the University of Manitoba, Jhpiego is synergizing the Uttar Pradesh technical support unit’s efforts towards improving reproductive, maternal, newborn, child and adolescent health services—resulting in improved health outcomes—by providing technical assistance to strengthen nursing-midwifery training institutions in the state. The program’s four objectives are to: 1) strengthen the quality of pre-service education in all public sector nursing institutions in Uttar Pradesh by implementing a standards-based approach; 2) demonstrate a feasible model of pre-service education strengthening for the private sector by implementing the standards-based quality improvement model in 13 private nursing institutions; 3) strengthen the capacity of the state nursing registration council and state nursing directorate in regulation, management and leadership of nursing cadre; and 4) assist in operationalization of Health and Wellness Center by creating a training ecosystem for production of mid-level health providers in the state.
Strengthening Nursing Midwifery Skills for Universal Health Coverage
With support from the World Bank, Jhpiego is working to assess and improve the skills and competencies of frontline health workers and their supervisors to enhance the effectiveness of primary health teams for providing high-quality, collaborative primary health care at the sub-block level in Madhya Pradesh. This includes development of a team-based training package for frontline health workers and their supervisors focusing on work planning and team dynamics, soft skills and noncommunicable diseases. The scope of the program also includes conducting a landscape analysis of capacity and performance of nurses and making recommendations on a contextually appropriate, cost-effective skills development strategy for nursing professionals in Punjab to address the state’s evolving public health challenges and demand for health care.
Improving Maternal and Newborn Health Outcomes through Technology Driven Interventions: Alliance for Saving Mothers and Newborn
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.
Expanding Family Planning Choices
This three-year project, funded by the Bill & Melinda Gates Foundation, seeks to uphold the quality of contraceptive implant services by working at the global and country levels. Globally, Jhpiego serves in a technical advisory role for the Implant Access Program’s Operations Group—a working group comprised of donor representatives that supports quality implant programs—to monitor, identify and collaboratively respond to priority issues. Jhpiego also provides short-term technical assistance to ensure that several countries with high implant use, including India, incorporate a quality implant removal component into overall implant strategy and implementation.
Performance Management and Action Project (PMA)
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.
From the Country Director’s Desk
With a slight nip in the air, and Diwali round the corner, it’s that time of the year, when friends and family gather to celebrate the festive season!
For us in public health, we know that each day is a joyous celebration when a child is born by choice, not chance; when children and adolescents make a healthy transition to adulthood; and, when health care reaches the remotest and most vulnerable homes.
This year, on September 25th, we brought together more than 200 colleagues – key policy makers and government officials, champions from the field, health care providers, bilateral and multilateral partners, donors, international and national NGOs, and thousands more who joined us online (#MCSPIndia) – to celebrate the legacy of USAID’s flagship Maternal and Child Survival Program (MCSP) in India, as we shared program learnings at its national dissemination meeting in New Delhi.