Summary

The paper documents efforts initiated in building capacity of law enforcers and NGOs for effective implementation of tobacco control laws in the state of Bihar, and provides a multi-strategy model for tobacco control interventions for replication. The framework recognizes six steps to strengthen tobacco control efforts at subnational level, viz. needs assessment, capacity building of multisectoral stakeholders, formation of inter-departmental administrative committees, advocacy (upstream and downstream), monitoring and reporting mechanism for assessing enforcement of the Indian tobacco control law, and media engagement.

Outcomes/Observations

Provider/managerial outcomes: Capacity building and training of law enforcers and NGO personnel from the state on various provisions of COTPA and WHO-FCTC. Within 2 years after the first meeting of the State Tobacco Control Coordination Committee (STCCC), 7 capacity building workshops were held. A total of 196 law enforcers were sensitized on tobacco control laws and policies.

Summary

This randomized controlled trial assessed the efficacy and cost-effectiveness of Counselling for Alcohol Problems (CAP), a brief psychological treatment delivered by lay counselors to patients with harmful drinking attending routine primary health-care settings. Primary outcomes were remission and mean daily alcohol consumed in the past 14 days, at 3 months. Secondary outcomes included effects of drinking, disability score, days unable to work, suicide attempts, intimate partner violence, and resource use and costs of illness. Analyses were on an intention-to-treat basis.

Outcomes/Observations

Health and wellbeing outcomes (Individual level): AUDIT score of less than 8 and mean daily alcohol consumption in the past 14 days immediately preceding the 3 month outcome assessment.

Summary

The aim of this study was to evaluate the effects of telemedicine on patients and medical specialists. This pilot study was conducted in two phases in a nodal Telemedicine Specialty Centre (TSC) in Apollo Hospital, Hyderabad. The first phase had a separate questionnaire for medical specialists from different branches of medicine. The second phase had questions for patients from the North-Eastern states of India. A cross‑sectional study was conducted among 122 participants on satisfaction in quality of service, cost‑effectiveness and problems encountered in healthcare provided by telemedicine.

Outcomes/Observations

Provider/managerial outcomes: All doctors were satisfied with the treatment given through TSC. Most doctors responded that they got desirable results on the diagnosis of the patient and an increase in patient’s inflow. Health and wellbeing outcomes (Individual level): 80% of patients were satisfied with treatment quality. Almost all participants found telemedicine cost‑effective and time convenient

Summary

This study conducted a stepped-wedge cluster-randomized trial in 15 primary health centers (PHCs) in the state of Haryana in India to test the effectiveness of a multipronged quality management strategy. The 21-month duration of the study was divided into seven periods of 3 months each. The primary outcomes included the number of women approaching the PHCs for childbirth and 12 essential practices related to childbirth. Outcomes were adjusted with a random effect for the cluster (PHC) and a fixed effect for ‘months of intervention’.

Outcomes/Observations

Provider/managerial outcomes: A multipronged quality management strategy enhanced the utilization of services and modestly improved key practices around the time of childbirth in PHCs.

Organizational outcomes: 22% increase in the number of women approaching PHCs for childbirth during the intervention period.

Health and wellbeing outcomes (Individual level): No difference in maternal or neonatal mortality rates or stillbirths between the two periods.

Summary

The study aimed to evaluate the sustained effectiveness and the cost- effectiveness of the Healthy Activity Programme (HAP) over 12 months and to assess behavioural activation. The HAP is a contextually adapted brief psychological treatment based on behavioural activation that focuses on increasing patient activation levels in pleasurable or mastery activities, and comprises the following strategies: psychoeducation, behavioural assessment, activity monitoring, activity structuring and scheduling, activation of social networks, and problem solving

Outcomes/Observations

Health and wellbeing outcomes (Individual level): HAP participants maintained the gains they showed at the end of treatment through the 12-month period, with lower symptom severity scores than participants who received EUC (Enhanced usual care) alone and higher rates of remission; these effects were partly mediated by increased levels of behavioural activation reported at 3 months.

Summary

This study examines the role of community health workers in retaining women in the maternity care continuum. It uses the example of the Accredited Social Health Activist (ASHA) programme in India to assess the association between individual and cluster-level exposure to ASHA and four key components along the continuum of care. To understand which services experience a maximum dropout, a linear probability model was used to calculate the weighted percentages of using each service and a multinomial logistic regression model was adjusted for dropout.

Outcomes/Observations

Provider/managerial outcomes: ASHA services had significantly higher reported use of ANC-1 and SBA. ANC-4 and PNC were the two services that were most frequently missed. No significant differences in the use of services across the different levels of exposure intensity.

Unintended outcomes: Exposure to ASHA is strongly associated with the service initiation and continuation along the maternity continuum, but not completion of service utilization along the continuum.

Summary

The objective is to capture the programme impacts on health outcomes across different medical events and on economic outcomes that are slightly structural in nature. The study evaluates the impact of India’s Yeshasvini Community-Based Health Insurance (http://sahakara.kar.gov.in/Yashasivini.html) programme. Randomly selected 4109 households in rural Karnataka were interviewed using a structured questionnaire. The paper evaluates the programme’s impacts using propensity score matching (PSM) methods. A comprehensive set of indicators was developed and the quality of matching was tested.

Outcomes/Observations

Health and wellbeing outcomes(Population level): Programme has increased health-care use among insured households. Treatment outcomes are also positive but vary across socio-economic groups and the type of medical event. Social outcomes: Clear evidence of a shift away from the use of government facilities to private facilities. There is strong evidence that CBHI provides substantial financial protection.

Summary

The objective is to determine the coverage, utilisation and feasibility of the mental health service scheme being implemented in PHCs. Paper also aims to develop a set of indicators for routine monitoring of mental health services for Sehore district of Madhya Pradesh, India. By using a sequential exploratory mixed methods design, key mental health indicators measuring service delivery and system performance were developed for the context of Madhya Pradesh, India. The research design involved a situation analysis, and conducting a prioritisation exercise and consultation workshops with key stakeholders.

Outcomes/Observations

Organisational outcomes: Local experts take part in the prioritisation and planning in the development of indicators for routine monitoring of mental health services in primary health care. The study generated, prioritised and selected nine mental health indicators that can be used to examine whether people with mental illnesses are effectively covered by the public mental health services.

Summary

The paper assesses the acceptability, feasibility, perceived costs and sustainability of implementing indicators relating to integrated mental health service coverage in six South Asian and Sub-Saharan African countries. A qualitative study using semi-structured key informant interviews was conducted. The ‘Performance of Routine Information Systems’ framework served as the basis for a coding framework covering three main categories related to the performance of new tools introduced to collect data on mental health indicators: (1) technical; (2) organisation; and (3) behavioural determinants.

Outcomes/Observations

Provider/managerial outcomes: Implementation strategies such as training courses and supervision were reported to be essential. Organisational outcomes: Simplicity of the forms, motivation, competence of health workers, and perceived use of mental health indicators, were reported as facilitators for better implementation outcomes. Various new indicators developed were reported to have contributed to mental health service improvement.

Summary

This study aims to evaluate the use of key mental health indicators in seven health care facilities in Sehore District, Madhya Pradesh, India. The study employed a mixed methods approach, including a qualitative study with health workers, HMIS staff, project coordinators and supervisors, a review of case records, and a structured questionnaire with health workers. The performance, user-friendliness, appropriateness, perceived utility and sustainability of the use of new mental health indicators was assessed.

Outcomes/Observations

Provider/managerial outcomes: Simplicity of the forms, as well as technical support from the project team, contributed to the acceptability and feasibility of implementation.

Organizational outcomes: Most practitioners reported that nurses are competent enough to lead data collection tasks within mental health programmes. Staff shortages and other priorities made it difficult for nurses to complete registers and conduct counseling sessions.

Unintended outcomes: Staff perception of the burden due to new forms increased over time.

Summary

The study objective was to determine the prevalence of perceived visual impairment, rate of follow-up post-referral, distribution of ocular morbidity, visual impairment, proportion of appropriate referrals and to compare results of this intervention with those of existing services. In this cross-sectional study, patients screened and referred to primary eye care services from September 2014 to March 2015 underwent comprehensive ocular examination by an optometrist and ophthalmologist. They piloted a model wherein CHWs administered a modified WHO questionnaire for identifying perceived visual disability.

Outcomes/Observations

Provider/managerial outcomes: There was 39.6% increase in patients seeking eye care services at the rural peripheral eye clinics before and after the project.

Health and wellbeing outcomes(Population-level): Most common pathology was refractive errors in rural population and cataract among the tribal population. Most common cause of visual impairment was cataracts in both populations.

Summary

The Noolpuzha Primary Health Center's success is the restult of a brillant show of leadership, headed by Dr. Dahar Muhammed. The primary health center's focus was solely on providing for it's community and that vision manifested in multiple innovations within the center. This included digitalized records that allowed providers to be more understanding of the patient's background, history, and needs before they stepped into the room, a community garden to rectify nutritional deficiencies and a sense of community ownership. Many tribal women held jobs in the Family Health Center. They performed tasks such as making brown paper bags for medicine and growing different foods in the community park. These connections were created and fostered by Dr. Dahar who utilized every ounce of funding he could manage from the local panchayat, national grants, and other funds usually stored for village infrastructures. He became a medium of integration between the health system and the community by connecting health needs to livelihoods, village infrastructure, and other determinants of health to the primary health center itself.

Summary

The goal of this study was to examine if school health programmes improved outcomes in rural Indian primary schools and could be implemented by community people who had received training. This was a mixed-methods, stepped-wedge, cluster-controlled study of schools pragmatically assigned to receive a multi-component, comprehensive school health program delivered by lay field workers. The program is structured around 3 interrelated components: health education, primary health services, and a healthy school environment.

Outcomes/Observations

Health and wellbeing outcomes (Individual level): Reduction in the diarrheal incidence of low-cost private school students receiving the intervention. Higher health-knowledge acquisition in intervention schools

Summary

CMC Vellore, a premier institution for medical education in India, launched a "Refer less resolve more initiative" course by distance mode to train 250,000 doctors to become multi-competent Family Physicians. The program focuses on ethics, rational prescribing, consultation skills, application of family medicine principles, and practical demonstration of compassionate, cost-effective, and high-quality care. 942 private practitioners and 177 government doctors have been enrolled.

Outcomes/Observations

Provider/Managerial Outcomes: The course inspired GPs to study the latest knowledge in the field of clinical medicine, using optimization techniques to reach proper diagnoses, writing rational prescriptions, incorporating ethical principles, confidently handling patients, and shifting gears from "commercial" to "care" focus. Overall, there was change in three major spheres: professional, ethical and values, and patient care culture.

Summary

The study evaluated a service delivery approach to provide early detection facilities at home by trained Community Health Workers (CHWs) for commons non-communicable diseases (NCDs) in a rural setting. The feasibility and efficacy of the model were assessed. The training was designed to ensure that both information and skills were developed. The CHWs made home visits to record participants' height, weight, blood pressure, and random blood sugar levels and educate them about healthy lifestyles and symptoms of common cancers.

Outcomes/Observations

Health and Wellbeing Outcomes (Individual Level): The CHWs screened men and women from 20 villages within 6 months which resulted in High BP and sugar detection in 32.6% and 7.5% participants respectively. The risk of hypertension was significantly higher among the overweight population compared to those having normal weight.

Summary

This study aimed to evaluate the MANAS trial's integration into primary care, the challenges to adherence, and to discuss the experiences of integrating the MANAS intervention into primary care. The study was a cluster-randomized trial conducted in two consecutive phases, first with PHCs and then with GPs. Patients were screened for common mental disorders by a layperson who was called the Health assistant (HA) using the 12 items General Health Questionnaire (GHQ-12) with a 5/6 cut-off score.

Outcomes/Observations

Provider/Managerial Outcomes: Most PHC doctors (12/20) and GPs (8/11) were diagnosing CMD before the program and emphasized that screening and categorization of CMD as mild or moderate/severe helped sharpen their diagnostic abilities.

Health and Wellbeing Outcomes (Individual Level): Majority of the responders found screening beneficial as it allowed them to talk about their health and problems

Summary

The study examined the effect of report cards on the coverage of maternal and neonatal health care in Uttar Pradesh and aimed to understand the effectiveness of this approach through a factorial, cluster-randomized controlled trial. The intervention, developed over 4 months, involved providing village-level information on the coverage of maternal and neonatal health services to health providers only, communities only, or both. In the community group, targets were community leaders and beneficiaries. The intervention included intense piloting in two villages.

Outcomes/Observations

In the study, the outcome was concluded by a theory of change on how report cards work to improve coverage by maternal health services. The findings also suggested that both mechanisms failed to increase service coverage, which has broader implications for related policies in India and other countries.

Summary

The PRogramme for Effective Mental health Interventions in Under-resourced health systeMs (PREMIUM) program examines the agreement between expert, self, and peer therapy quality ratings of individual treatment sessions for harmful and severe depressive disorders. The study was conducted by lay therapists in primary care over ten months. It aimed to describe the development, inter-rater reliability, and internal consistency of therapy quality scales for each treatment. Training of Lay therapists comprised a three-week workshop focused on general counseling skills and the two manualized treatments.

Outcomes/Observations

Provider/Managerial Outcomes: On average, each lay therapist had 3.79 of their treatment sessions rated in Stage 1, 4.07 in Stage 2 and 5.45 in Stage 3. Lay therapists' perceptions of peer-led supervision identified positive themes including bolstering self-esteem and an emphasis on equality.

Summary

The objective was to study the implementation process of Community-Based Monitoring (CBM) in PHCs by the guidelines of the Government of India. This study compares the implementation of community-based monitoring (CBM) in 45 primary health centers (PHCs) in Maharashtra with the same number of randomly selected PHCs not implementing CBM from the same districts. Information was collected by teams from Community Medicine Departments by visiting selected PHCs. The establishment of monitoring committees and training of medical officers (MOs) were completed, but only 36.36% were trained and 43.18% received the facility report card.

Outcomes/Observations

Provider/Managerial Outcomes: Only 36.36% of MOs were trained. 90.90% of MOs said Jansunwai increased community awareness and broke down barriers between people and PHC staff. Organizational Outcomes: The pattern of availability of the drugs was similar in both groups. The percentage of institutional deliveries and women receiving Janani Suraksha Yojana benefits among home deliveries was more in the non-CBM PHCs.

Summary

The study objective was to strengthen the national capacity of diabetes care and provide effective and affordable modes of diabetes management in semi-urban and rural areas through training programmes for physicians. The impact of training was assessed by pre and post-training knowledge scores. Physicians from 6 states (Tamil Nadu, Kerala, Andhra Pradesh, Karnataka, Orissa, Gujarat) and a few from other states with service of ≥33 years were trained in diabetes care in 5-day workshops between March 2004 to December 2006.

Outcomes/Observations

Provider/Managerial Outcomes: A total of 3023 (male 2311:female 712) were trained in 3 years. At the baseline, knowledge on diagnosis and complications was low. Scores improved by 16-17% on treatment, complications and pathophysiology. The majority of doctors felt that patient education and counselling had to be incorporated into their clinical practice.

Summary

The Kishori Panchayat (KP) Adolescents for Health Action model's primary objectives are to (1) study adolescents females (12–18 years old) of KP and non–KP knowledge and views of life skills, and (2) identify KP features and associated contextual elements that influenced the result. Adolescent girls (12–19 years old) from rural regions were the focus of KP's major mobilization and empowerment efforts. They are also expected to share the knowledge they learn via KP with their friends and the community.

Outcomes/Observations

Health and Wellbeing Outcomes (Individual Level): KP girls were more aware of knowledge and perceptions regarding life skills and their application which mainly focused on counselling of antenatal/postnatal care, childcare, immunization, home visits, street plays, rallies, and preparing health education materials.

Summary

In this study National Rural Health Mission's key objectives are assessed on the different levels of the village, block and district, the role of ASHA effectively utilized, reduction in IMR and MMR, novel strategies for reducing neonatal and maternal deaths, impacting outcome rates. The vision of the Mission consists of the following main elements: revitalize local health traditions and mainstream Ayurveda, Yoga, Unani, Sidha and Homeopathic treatments.

Outcomes/Observations

Provider/Managerial Outcomes: Only 21% of ANMs are involved in the selection of ASHAs. Almost 93% ANMs received the NRHM un-tied grant of Rs.10,000/year. Organizational Outcomes: The availability in all CHCs was satisfactory although telephone facilities did not exist in 29% CHCs, all-weather approach roads in 21%, functional vehicles in 14%, medical stores in 7% and regular supply of medicines in 26%

Summary

This study sought to determine whether mobile health (mHealth) device assessments used as clinical decision support tools at the point of care can reduce the time to treatment and improve long-term outcomes among patients with rheumatic and structural heart disease (SHD). A single-site, randomized trial was conducted at the Sri Satya Sai Institute of High Medical Sciences in Bangalore. Each mHealth clinic was equipped with wireless mHealth devices that were selected to assess functional and structural abnormalities at the point of care.

Outcomes/Observations

Provider/Managerial Outcomes: Point-of-care mHealth devices can be used as clinical decision support tools.

Health and Wellbeing Outcomes (Individual Level): Compared to standard care, an initial diagnostic strategy with mHealth was associated with a shorter referral time for valvular interventions and a lower probability of hospitalization or death.

Summary

The study was conducted to assess the effectiveness of Yoga, Pranayama, and Sudarshan Kriya in the community-based management of diabetes mellitus. The primary outcome variable was Hemoglobin A1c (HbA1c) Test for Diabetes (Hb1Ac) and secondary outcome variables were systolic blood pressure (SBP) and adherence to medication, and changes in lifestyle

Outcomes/Observations

Health and Wellbeing Outcomes: No difference was found in the proportion of people with HBA1c under control between the two groups. In addition, the mean SBP did not differ between the two groups following the intervention.

Summary

The study's objective was to design a tool to increase the coverage, quality and coordination of the services provided to Maternal health sub-centers (FLWs) in the Saharsa district of Bihar. It also aims to enhance communications with beneficiaries and facilitate their supervision. The ICT-CCS (the Information Communication Technology Continuum of Care Service Tool) design consisted of numerous mobile phone-based job aids aimed to improve key RMNCH-related behaviours and outcomes. ICTCCS was implemented in the Saharsa district, with cluster randomization at the health sub-center level.

Outcomes/Observations

Provider/ Managerial Outcomes: Job confidence was higher among FLWs from intervention vs control but only significant for ASHAs. Reports of antenatal visits were greater in the intervention.

Health and Wellbeing Outcomes (Individual Level): Intervention resulted in a significant increase in practices of skin-to-skin care and frequency of breastfeeding immediately after delivery. The use of any modern contraception method was higher compared to baseline.

Summary

The aim of the study is to identify the published mHealth/telemedicine initiatives in India in the context of the health system building blocks and potential for health systems strengthening; presents the disease area, type of telecommunication devices used, and target users of the innovation; actions required for ensuring an effective role of mHealth interventions. This article gives a gist of mHealth innovations in India and how the implementation needs to be improved, accessed by communities.

Outcomes/Observations

Provider/managerial outcomes: Telemedicine's importance in improving healthcare services through medical consultations and communication between healthcare providers. Health and wellbeing outcomes (Population-level): Evidence surrounding mHealth in India demonstrates a progression from anecdotal telemedicine user stories to primary research articles that provide evidence of effectiveness in reaching health goals.

Summary

The article's objective is to systematically appraise the literature to assess the effectiveness, cost-effectiveness and barriers to task-shifting for the management and prevention of NCDs in LMICs. There is a need to develop an alternative workforce that is structured around the community and consumer needs. A NPHW (Non Physician Health care worker) was defined as a lay healthcare worker with no formal medical training or nurses.

Outcomes/Observations

Organisational outcomes: Trained NPHWs can successfully screen community members for various NCDs. The use of NPHWs in the care of patients with mental health issues was shown to be cost-effective. Patient outcomes: Trained NPHWs could control patients with NCDs using treatment protocols without the involvement of physicians. Health and wellbeing outcomes (Population-level): There was improvement seen in maternal and child health care programs. Task-shifting has proved to be a viable and cost-effective option for the management of HIV-AIDS in Sub-Saharan Africa.

Summary

The objective of this study is to create a process for scaling up exclusive breastfeeding based on lessons learned from programmes/projects that have been implemented and assessed in various developing countries. At a community level, administering only breastmilk and no other liquids or foods for the first 6 months of life provides significant benefits to the infant and the mother as it protects infants against many common childhood diseases.

Outcomes/Observations

Provider/managerial outcomes: Breastfeeding interventions have the potential to save 13% of all under-5 fatalities in developing countries, making them the most important preventative approach for saving children's lives. Organisational outcomes: Training of health workers and community service providers to counsel women on safety options after HIV to continue exclusive breastfeeding and also the benefits of exclusive breastfeeding

Summary

The objective of this paper is to present the seven innovative models of psychiatric care and rehabilitation centers. At the community level, various culturally appropriate and clinically effective models of excellence have been developing in Asia.

Outcomes/Observations

Provider/managerial outcomes: Overseas psychiatrists are encouraged to do voluntary work in developing and underdeveloped countries in order to build local capacity Patient outcomes: The community people suffering from mental or psychiatric issues take help from such models and improve their mental illness. Health and wellbeing outcomes (Population level): The article presents models of excellence that provide great benefit to the people who suffer from psychiatric illness without incurring great expense. Social outcomes: This article has models which are trying to approach the ongoing stigma and ignorance about psychiatric illnesses

Summary

The article focuses narrowly on the additional allocation of primary healthcare expenditures and explores the idea by examining the impact of central level primary healthcare expenditure, on individual state level contributions to primary healthcare expenditure within 16 Indian states between 2005 and 2013.

Outcomes/Observations

The article gives an analysis on the increases in central level primary healthcare expenditure to states have an inverse relationship with primary healthcare expenditures by the state level.In wealthier states, lower additionality was found as states diverted expenditures away from primary healthcare as central expenditures increased. In poorer states, evidence for this substitution was not conclusive.

Summary

This paper reviews mobile and portable dental services implemented in some developed and developing countries. It discusses their utility, applicability, and feasibility in oral healthcare delivery for a developing country like India having a vastly underserved population. With key articles retrieved mostly from MEDLINE, the databases were searched for publications from 1900 to the present (2013) using terms such as Mobile dental services, Portable dental services, and Mobile and portable dental services.

Outcomes/Observations

Provider/managerial outcomes: State health services in developing countries offer medical and dental services to the masses through CHC, PHCs, and school-based dental camps. Health and wellbeing outcomes (Population-level): The mobile and portable dental services may solve the disparity in dentist population ratio between urban and rural areas, lack of access for basic dental services in rural areas, lack of organized dental care for the underprivileged.

Summary

This review synthesised evidence on effectiveness of CHW delivered NCD primary prevention interventions in low and middle-income countries (LMICs). This article reviews the trials that utilised community health workers for primary prevention/ early detection strategy in the management of NCDs in LMICs between years 2000 and 2015; focused on community-based randomised controlled trials and cluster randomised trials without any publication language limitation.

Outcomes/Observations

Provider/managerial outcomes: The Primary Care Physician visits were higher in CHW relative to the usual care group. Patient outcomes: Improved diabetes self-care activities, 5% weight loss, and 1% reduction in HbA1c level Health and wellbeing outcomes (Population-level): One of the trials reported statistically significant improvement in the quality of life of patients with diabetes after CHW led intervention.

Summary

This paper systematically reviews the efficacy of alcohol brief intervention in middle-income countries. The review included randomized controlled trials (RCTs) of face-to-face brief motivational interventions aimed at reducing heavy alcohol use that were conducted in middle-income countries.

Outcomes/Observations

Provider/managerial outcomes: In most cases, the content of the brief intervention was delivered by trained nurses in almost all the trials. Patient outcomes: Five trials reported statistically significant reductions in self-reported alcohol consumption based on the changes in scores of research tools in the treatment groups as compared to the control group at 3�24-month follow-up.

Summary

The nutrition activities were aimed at increased food production, initiating supplementary feeding, nutritional surveys and prevention of food adulteration activities. Major nutrition supplementation programmes in India includes: (i) Integrated Child Development Services Scheme (ICDS); (ii) Mid-day meal Programmes; (iii) Special Nutrition Programmes; (iv) Wheat Based Nutrition Programmes; (v) Applied Nutrition Programmes; (vi) Balwadi Nutrition Programmes; (vii) National Nutritional Anaemia Prophylaxis Programme; (viii) National Programme for Prevention of Blindness due to Vitamin A Deficiency, and (ix) National Goitre Control Programme.

Outcomes/Observations

The evaluation of programmes (wherever conducted) revealed that most programmes require strengthening or have several deficiencies or that programme could not achieve the desired results. In some programmes improvement in nutrition of benfeciaries was also recorded.

Summary

Invest for Wellness (i4We, Swasti’s flagship program is a system innovation in primary healthcare combining health and wealth interventions, and focusing on well-being for the most poor and marginalized communities. The i4We model is currently delivered in four settings: urban, rural, factories, and sex workers’ collectives and is self-sustaining program owned and run by Community Institutions and Collectives. Every member of i4We experiences and is entitled to benefits ranging from free screening, treatment, care, health education and advice, financial inclusion - tackling the issue of out of pocket expenses that pushes them further into poverty otherwise, while simultaneously creating savings for the members and earnings for the community institution that can be invested back into the program. The i4We team on ground is formed by community members and individuals who are from implementation science. The team is backstopped by a range of multi-sectoral practitioners and partners.

Summary

To demonstrate cost-outcome methods in the evaluation of mental health care programmes in low-income countries, four rural populations were screened for psychiatric morbidity and individuals with a diagnosed common mental disorder were assessed on symptoms, disability, quality of life, and resource use.

Outcomes/Observations

Health and wellbeing outcomes (Individual level): There has been an improvement in the quality of life and significant reductions in symptomatology and disability. In three of the four localities, there is a substantial reduction in levels of depression symptoms.

Summary

The objective is to explore the acceptability and utility of a low-cost and simple-to-use feeding toolkit consisting of a bowl with marks to indicate meal volume and frequency, a slotted spoon, and an illustrated counseling card to cue optimal dietary practices during the first 1,000 days.

Outcomes/Observations

The proportion of pregnant and breast-feeding women taking an extra meal portion per day and the number of meals taken per day increased. For children 6 to 18 months of age, meal frequency, quantity and thickness of the foods increased. The illustrated counseling cards also proved to be very useful teaching tools.

Summary

This pilot study examined the role of teleophthalmology (TO) in the diagnosis and treatment of anterior segment conditions (including adnexal conditions) in rural areas. 5,604 patients visited primary vision centers (VCs) for 1 week from 1-7 September 2018 and were examined by a vision technician (VT) to identify those who may need teleconsultation. The demographic profile and role of teleconsultation were reviewed.

Outcomes/Observations

Health and wellbeing Outcomes: During a 1-week period from 1 to 7 September 2018, 5,604 outpatients visited Vision Centers in Andhra Pradesh, Telangana, Odisha, and Karnataka. The most common diagnosis was lens-related (38.3%), followed by ocular surface pathologies (30.2%), lid and adnexa-related pathologies (8.6%), and corneal pathologies (6.3%). Teleconsultation was higher in the older population.

Summary

This study tested an intervention in which urban slum-dweller women's groups worked to improve local perinatal health. A cluster randomized controlled trial in 24 intervention and 24 control settlements covered a population of 283,000. The primary outcomes were perinatal care, maternal morbidity, and extended perinatal mortality. The analysis included 18,197 births over 3 years from 2006 to 2009. No differences between trial arms were found in the uptake of antenatal care, reported work, rest, and diet in later pregnancy, institutional delivery, early and exclusive breastfeeding, or care-seeking.

Outcomes/Observations

Health and wellbeing outcomes (Population level): Group members were enthusiastic about acquiring new knowledge and made efforts to reach out to other local women. However, collective action was difficult due to time pressure and immediate concerns. Results showed no differences between intervention and control arms in the uptake of antenatal care, reported work, rest, and diet in later pregnancy, institutional delivery, early and exclusive breastfeeding, or care-seeking for maternal or neonatal problems. The occurrence of serious antenatal symptoms was less common in the intervention arm.

Summary

This study aimed to qualitatively explore barriers and facilitators to the provision of optimal obstetric and neonatal emergency care and implementation of simulation-enhanced mentorship at PHC’s in Bihar.
India implemented a mobile nurse mentoring program called AMANAT. Through this program, trained nurse mentors visited PHCs in pairs, conducting week-long visits to four PHCs every month over a period of 7 to 8 months to train nurse-midwives. Simulation-enhanced mentoring, using PRONTO, was implemented in 320 PHCs across Bihar.

Outcomes/Observations

Provider/managerial outcomes: shortage of physical and human resources, coupled with high patient volume and doctor-nurse and nurse-nurse hierarchy. Improved skills and confidence, inclusion of doctors in training, and increased training frequency.

Summary

An innovative communication package was designed to help people to examine vision at home and the impact of publishing the DIY kit in newspapers was evaluated.
The number of people who noticed the insertion, read the instructions carefully and self-appraised their vision, followed by consultation with an ophthalmologist (if needed) was evaluated. Four tumbling Es corresponding to the 6/12 line of the standard E chart, were used for testing visual acuity.

Outcomes/Observations

 The majority of the people noticed the DIY insertion and stated that they read and followed the instructions carefully. Younger respondents and males were more likely to have noticed the DIY insertion.

Summary

This study aimed to determine if an age- and stage-based mobile phone voice messaging initiative for pregnant women, during pregnancy and up to 1 year after delivery, can reduce low birth weight and child malnutrition and improve women's infant care knowledge and practices. A pseudo-randomized controlled trial was conducted among pregnant women from urban slums and low-income areas in Mumbai, India. Infant birth weight, anthropometric data at 1 year of age, and status of immunization were obtained from MCH cards to assess the impact on primary infant health outcomes.

Outcomes/Observations

Health and wellbeing outcomes (Individual level): The intervention group performed significantly better than the control group on two practice indicators, feeding colostrum to babies, having a health checkup at discharge, and giving their infant oral rehydration solution plus zinc. Women receiving messages for 7-9 months performed significantly better on five infant care practices, especially in two key immediate infant care practices.

Health and wellbeing outcomes (Population level): This study found a 33% increase in odds of a baby being born at or above the ideal birth weight, 17% decreased odds of having a malnourished child, and a statistically significant increase in the practice of fully immunizing the infant.

Summary

The study aims to assess the effectiveness of the SCC program in reducing facility-based stillbirths (SBs) and very early neonatal deaths (vENDs, deaths within three-days after birth), in Rajasthan, India.
The WHO Safe Childbirth Checklist (SCC) is a facility-based reminder tool. For this study, the SCC program was implemented only at district and sub-district level facilities in Rajasthan and they used a pragmatic mixed-methods design to study the feasibility, effectiveness and cost-effectiveness of the WHO SCC-based program in preventing intrapartum mortality.

Outcomes/Observations

Changes in provider behavior at the CHCs were much higher than at district-level facilities. Nurses at the CHCs also reported that the SCC intervention resulted in early identification, management, and timely referral of pregnancy-related complications. Nurses at the district level facilities found the checklist to be a useful reminder tool.

Summary

The study is a situation analysis to highlight the strengths, challenges and opportunities for developing and strengthening mental health components within routine government HMIS across the participating countries. The cross-country situation analysis of HMIS (Health Management Information Systems) was conducted in six LMICs. The paper compares the baseline policy context, human resources situation as well as the processes and mechanisms of collecting, verifying, reporting and disseminating mental health related HMIS data.

Outcomes/Observations

Across sites, in-service training was given by the HMIS department on an ad-hoc basis. All countries had HMIS training manuals, which were widely used in India, Nepal and Uganda. Most of the countries had dedicated HMIS staff at a central and regional level.

Summary

Community mobilization through participatory women's groups can improve birth outcomes in poor rural communities. The authors assessed this approach in three districts in eastern India, assigning 18 clusters to intervention or control using stratified randomization. Women were eligible to participate if they were aged 15-49 years and had given birth during the study. Intervention clusters included 13 groups every month to support participatory action and learning, and the primary outcomes were reductions in NMR and maternal depression scores. Analysis was by intention to treat.

Outcomes/Observations

Health and wellbeing outcomes (Population level): The study noted a 32% reduction in NMR during the 3-year trial. Perinatal mortality rates in the intervention clusters decreased compared with those in the control clusters. In year 3, when 55% of all pregnant women in the intervention clusters had joined a group, a 57% reduction was noted in moderate depression among mothers in the intervention clusters.

Summary

The Matrika social franchising model was a multifaceted intervention that established a network of private providers and strengthened the skills of both public and private sector clinicians. This study aimed to evaluate whether the Matrika social franchising model could improve the quality and coverage of health services for maternal, newborn, and reproductive health in low-income and middle-income countries. A quasi-experimental study was conducted to compare 60 intervention clusters with a social franchisee to 120 comparison clusters in six districts of Uttar Pradesh, India. The primary outcome was the proportion of women who gave birth in a health-care facility, and 56 prespecified outcomes measured maternal health-care use, content of care, patient experience, and other dimensions of care. Multivariate difference-in-differences methods were used for the analyses and accounted for multiple inference.

Outcomes/Observations

Provider/ Managerial Outcomes: The Matrika social franchise model was not effective in improving the quality and coverage of maternal health services at the population level, suggesting lessons for other social franchising programmes.

Summary

The availability of basic mental health services in rural areas of India is limited due to the health system and individual-level factors. To address this, a mental health services delivery model was implemented that leveraged technology and task sharing to facilitate the identification and treatment of common mental disorders such as stress, depression, anxiety, and suicide risk. A mixed method pre-post evaluation assessed the intervention using quantitative service usage analytics and qualitative interviews with different stakeholders. Barriers and facilitators in implementing the intervention were identified.

Outcomes/Observations

Provider/managerial outcomes: 1243 calls were placed to the community, ASHAs, and doctors, of which 78.6% were successful. The majority of participants reported that the training provided was useful, helping them to operate the tablets and record observations on a regular basis

Health and wellbeing outcomes (Individual level): Community members found the project helpful and learned new things about mental illness, reducing anxiety and stress. Medical camps in villages helped people understand their health status and access to doctors.

Summary

This study aims to develop and evaluate a simplified cardiovascular management program (SimCard) delivered by community health workers (CHWs) with the aid of a smartphone-based electronic decision support system. 2,086 'high cardiovascular risk' individuals aged 40 years or older with self-reported history of coronary heart disease, stroke, diabetes, and/or measured systolic blood pressure 160 mmHg were recruited and managed by CHWs through an Android-powered "app" on a monthly basis.

Outcomes/Observations

Health and wellbeing outcomes (Individual level): The primary outcome of patient-reported anti-hypertensive medication use increased significantly after the intervention, with a net pre-post difference of 25.5%. The interaction between the countries on the primary outcome was significant, with a net increase in the proportion of high-risk individuals taking aspirin and a reduction in mean SBP.

Summary

The study evaluates the sustainability of the effects after treatment termination and the cost-effectiveness of Counseling for Alcohol Problems (CAP) over 12 months. CAP was a brief intervention delivered by lay counsellors that improved remission and abstinence among male primary care attendees with harmful drinking in India. Male primary care attendees aged 18–65 years screened with harmful drinking on the Alcohol Use Disorders Identification Test (AUDIT) were randomized to either CAP plus enhanced usual care (EUC) or EUC alone, of whom 89% completed assessments at 3 months, and 84% at 12 months.

Outcomes/Observations

Health and wellbeing Outcomes: CAP participants maintained the gains they showed at the end of treatment, with higher remission and abstinence rates than individuals who received EUC alone. CAP participants also fared better on secondary outcomes. The intervention effect for remission was higher at 12 months than at 3 months.

Summary

The study aims to evaluate the feasibility and effectiveness of the Chhattisgarh Integrated Mental Health and Addiction NIMHANS ECHO (CHG IMA NIMHANS ECHO) in the Indian context through pre and post-tests and assignments focused on knowledge, self-confidence, as well as patient identification and engagement data. Project ECHO uses a ‘hub and spoke’ model that connects an interprofessional specialist team at a centralized academic center (hub) with Primary Care Providers (PCPs) (spokes) using multipoint video conferencing technology for regular ECHO clinics.

Outcomes/Observations

Provider/Managerial Outcomes: Over 6 months, 41 patients' case summaries were discussed with NIMHANS Hub Specialists. Half of the counsellors joined > 80% of clinics and overall there were no drop-outs. The participants liked the relevance of the courses to clinical practices, group-based discussions, and a reduction in professional isolation. The results indicate the potential for capacity-building in mental health and addiction in remote and rural areas.

Summary

This study seeks to quantitatively examine the primary outcome of timely DTP3 adherence amongst all 3 study arms and 3 key secondary outcomes of the Khushi Baby cluster Randomized Controlled Trial (cRCT).
Two data collection tools were compared in this study: the NFC (Near Field Communication) sticker and the NFC necklace worn by the child.

Outcomes/Observations

Neither the NFC necklace nor the necklace with additional voice call reminders in the local dialect directly resulted in an increase in infant immunization timeliness through DTP3. Process outcomes suggest that the culturally symbolic necklace has potential to be an assistive tool in immunization campaigns.

Summary

This study aimed to determine the effect of community health workers carrying out home visits and participatory group meetings on children’s linear growth. A cluster-randomized controlled trial was conducted in two adjoining districts of Jharkhand and Odisha, India. A lottery randomly allocated 120 clusters (around 1000 people each) to intervention or control. In each intervention cluster, the worker carried out one home visit in the third trimester of pregnancy, monthly visits to children younger than 2 years to support feeding, hygiene, care, and stimulation, and monthly women’s group meetings to promote individual and community action for nutrition. Participants were pregnant women identified and recruited in the study clusters and their children. Data collectors visited each woman during pregnancy, within 72 h of her baby’s birth, and at 3, 6, 9, 12, and 18 months of age

Outcomes/Observations

Health and wellbeing Outcomes: This study measured the length-for-age Z score of 1253 eligible children at 18 months in intervention and control clusters. The intervention did not significantly affect exclusive breastfeeding, timely introduction of complementary foods, morbidity, appropriate home care, or care-seeking during childhood illnesses. However, more pregnant women and children achieved minimum dietary diversity, mothers washed their hands before feeding children, fewer children were underweight, and fewer infants died.

Summary

The study aims to document an innovative partnership between the health department of the State Government of Gujarat in India, and private obstetricians to provide skilled birth attendants (SBA) and comprehensive emergency obstetric care (EmOC) to the poor. This is a descriptive analysis of the scheme and analysis of secondary data. The study estimates the lives of mothers and newborns potentially saved because of the scheme.

Outcomes/Observations

Provider/managerial outcomes: The statewide scale-up program saw more than 850 obstetricians sign contracts, increasing the availability of skilled birth attendants and EmOC services to poor women.

Health and wellbeing outcomes (Population level): The Chiranjeevi scheme in Gujarat has seen a rapid increase in deliveries of poor women, with coverage of deliveries increasing from 27% to 53%. Poor women who delivered in private maternity homes reported fewer neonatal deaths.

Summary

This article evaluated task shifting and mobile-technology-based electronic decision support systems to enhance the ability of primary care health workers to provide evidence-based mental health care for stress, depression, and suicidal risk in 30 remote villages in Andhra Pradesh, India. The Systematic Medical Appraisal Referral and Treatment (SMART) Mental Health project between May 2014 and April 2016trained lay village health workers (Accredited Social Health Activists– ASHAs) and primary care doctors to screen, diagnose and manage individuals with common mental disorders using the electronic decision support system. An anti-stigma campaign was conducted across the villages at the outset of the project, and a pre–post evaluation using mixed methods assessed the change in mental health service utilization by screen-positive individuals. This paper reports on the quantitative aspects of that evaluation.

Outcomes/Observations

Health and wellbeing Outcomes: The intervention led to individuals being screened for common mental disorders by village health workers and an increase in mental health service use. The model was deemed feasible and acceptable. Stigma and mental health awareness in the broader community improved.

Summary

The study aims to document trends, profile of abortion seekers and patterns of care seeking in a rural and low resource setting of Rajasthan, India, and to inform the programs on how medical abortion could be integrated into abortion services.
This paper describes a service delivery intervention for women attending with unwanted pregnancies over 14 years in four primary care clinics of Rajasthan, India. The analysis is based on data on women coming with unwanted pregnancies to any of three primary care centers operated by ARTH.

Outcomes/Observations

Of 9076 women presenting with unwanted pregnancy at the ARTH facilities, 70% were provided abortion services. The proportion of women coming with earlier pregnancies increased. Majority of women preferred medical abortion because of its non-invasive nature.

Summary

The Comprehensive Rural Health Project in rural Maharashtra has had a long-term effect on childhood mortality in rural Maharashtra. Methods included household surveys and interviews with women. Control villages were randomly selected from an area enclosed by two ellipses. Cox models with robust standard errors were used to compare the hazard of death among children under 5 years of age in the project and control villages. Background information and full birth histories were collected by conducting household surveys and interviewing women.

Outcomes/Observations

Health and wellbeing Outcomes (Population level): The study found a 30% reduction in the hazard of child death after the neonatal period for CRHP villages in comparison with villages in the control area. In 2007, more households in CRHP villages had toilet facilities and treated drinking water. Women in the intervention villages achieved a higher health knowledge score.

Summary

This study was aimed to develop a comprehensive package of interventions for improving maternal and child care. The approaches of interventions that were utilized for developing the comprehensive MCH care package: (i) By training the team of existing health personnel (ii) By educating the community and mobilizing the community resources (iii) By developing a feasible referral system (iv) By developing an inbuilt system of collecting health statistics.

Outcomes/Observations

Results of this study show that it is possible to improve the quality and coverage of the MCH care using the comprehensive MCH care package. The coverage of pregnant women with IFA tablets and TT immunization showed a marked improvement. The percentage of low birth weight babies showed a decreasing trend.

Summary

The paper describes the first eight years of program implementation, including the past three years, during which the program has been implemented on a large scale. The paper analyzed the effects of new policies introduced in 1993 that have resulted in increased resources, improved laboratory-based diagnosis, direct observation of treatment, and the use of standardized anti-tuberculosis regimens and reporting methods

Outcomes/Observations

About 3.4 million patients had been evaluated for tuberculosis, and nearly 800,000 had received treatment, with a success rate greater than 80 percent. The program has been successful in improving access to care, the quality of diagnosis, and the likelihood of successful treatment. The study estimates that the improved program has prevented 200,000 deaths, with indirect savings of more than $400 million.

Summary

The objective is to develop and implement a need-based, situation-specific education program for mothers to bring about changes in complementary feeding practices, with emphasis on the quantity and nutritional quality of complementary feeds. 414 mothers or caregivers from five slums in Mumbai participated in a 3-month intervention study. Education was given by trained fieldworkers, first to groups of 8 to 10 mothers or caregivers using innovative modules and demonstrations, followed by weekly monitoring and reinforcement.

Outcomes/Observations

Health and wellbeing Outcomes (Individual level):  The results indicated that such intervention helps to sensitize mothers or caregivers and brings about favorable behavioral change that improves the dietary quality and nutrient intake of young children in urban slums. By the third follow-up, more than three-fourths of the children were given at least three complementary feedings per day.

Summary

The overall aim of this study was to assess the effect of a ‘supportive supervision’ strategy on the quality of immunization services. A quasi-experimental post-test study design was adopted to compare the opinion and practices of frontline health workers and their supervisors in four intervention districts (IDs) with two control districts (CDs). 111 supervisor-supervisee pairs were interviewed using semi-structured interview schedules and case vignettes. The data collection captured information on technical knowledge, role clarity, and practices at the immunization site of supervisors and supervisees.

Outcomes/Observations

Provider/managerial outcomes: Intervention districts had higher correct responses than Control districts/CDs on issues related to waste disposal, correction of the site of injection, reconstitution of diluents, correction of needle touching, improvement of skills among health staff, and rectification of doses of hepatitis B vaccine.

Summary

The study explains a community-based model of manpower development and coordination of services for people with intellectual disabilities in the unified state of Andhra Pradesh, India. 130 women were trained in five groups of 25-30 per group and deployed in the community to screen, identify and refer children with intellectual disabilities. The training content included basic stimulation and interface with functionaries of other government departments. Neighborhood centers were established where the community resource persons could meet with families collectively.

Outcomes/Observations

Health and wellbeing outcomes (Individual level): Children with developmental delays have shown considerable improvement in their milestones.
Social outcomes: The village community was observed to be sensitive to the needs of these families and recognized the role of the community resource persons and respected them.

Summary

The objective was to evaluate the efficiency of school teachers' role vis-a-vis CHVs' in imparting health education to school children. ICMR designed a study project to investigate the feasibility of a primary school teacher as a primary health care worker. This study included a total of 36 villages, in 17 of which school teachers were working as health care workers while in 19, CHVs were delivering primary health care.

Outcomes/Observations

Health and wellbeing Outcomes (Individual level): It is observed that the percentage of children conscious about personal hygiene is more in Group-I villages (teacher=educator) as compared to that in Group-II villages (CHW=educator). The prevalence rate of infective conditions like scabies, scalp infections, and spongy and bleeding gums also suggests that the cleanliness status of children in Group-I villages is better.

Summary

In this study,  2-year community-based cluster randomized controlled trial was conducted in an underserved region of West Bengal, India. Participants were recruited through home-based screening into 12 clusters, which were randomized to either a control or intervention arm before screening. After the screening, CHWs followed up with participants enrolled in the intervention arm for a period of 2 years through home visits. The CHW arm followed a behavioral strategy focused on modifying the individual's lifestyle, increasing knowledge of CVD, promoting smoking cessation, increasing physician-seeking behavior, and promoting medication adherence.

Outcomes/Observations

Health and wellbeing Outcomes: The study found that the decrease in SBP was significantly greater in the intervention group than in the control group, but this difference was statistically not significant. The diastolic blood pressure decreased more in the intervention group, but this difference was not statistically significant. The dichotomized control rates for both hypertension and diabetes improved more in the intervention group, but the use of statin and aspirin was negligible. The mean number of medications used for hypertension and diabetes increased, with a greater increase in the intervention group for both conditions.

Summary

The study implemented and evaluated a psychiatric 'task shifting' program for a rural, marginalized, impoverished South Indian tribal community. The program was added to a pre-existing medical program and utilized community workers to improve health care delivery. Health workers were trained to provide community education and identify and refer individuals with psychiatric problems to a community hospital. They also followed up with psychiatric patients to improve treatment adherence.

Outcomes/Observations

Provider/Managerial Outcomes: In the first year of the program, 60% of new patients were referred by the health animators and more than a quarter were self-referred. By the fourth year, the proportion of self-referrals doubled while the proportion referred by the health animators fell to 31.4%. Physicians and other villagers continued to form the minority of referral sources.

Health and wellbeing Outcomes: The most notable change was the proportion of individuals who believed mental illness was a disease (93%) and could be treated (85%). Medical records indicate significant improvement in individual function. The change in referral patterns suggests increased acceptability.

Summary

A retrospective analysis of Avahan clinic data between 2005 to 2009 was conducted to study the trends in the coverage of syphilis screening and sero-reactivity.
Avahan is a large-scale HIV prevention program for key populations including female sex workers, men who have sex with men, and injecting drug users, providing services since 2004 in 83 out of 130 districts in six high HIV prevalence states in India. Screening was performed using either the Rapid Plasma Reagin (RPR) test or point-of-care immunochromatographic strip test (ICST).

Outcomes/Observations

The data showed improved rates of screening of clinic attendees and declining trends in sero-reactivity over time. The introduction of point-of-care syphilis tests may have contributed to the improved coverage of syphilis screening. The ICST may be considered for initial syphilis screening at other resource-constrained primary care sites in India.

Summary

A longitudinal field trial including before-and-after comparisons formed the research design. The study sample consisted of 54 children (7–17 years old) with mild to severe mental disabilities. Interventions included gathering data on the parameters of the cariogram, creating an individual caries profile, putting a preventive programme in place, and contrasting the baseline and follow-up caries profiles. Comparing the baseline and follow-up caries profiles allowed researchers to evaluate the effectiveness of the preventive programme. For statistical analysis, the Wilcoxon Signed Ranks test was used.

Outcomes/Observations

Health and wellbeing Outcomes: The 10-month preventive program reduced caries risk by 31%, followed by bacteria (12%), diet (7%), and circumstances (6%). The distribution for 'chance of avoiding caries' was uniform at baseline, with 47 children moving out of the 2 greatest risk categories and 47 of the 54 children have moved out of the lowest risk category.

Summary

The objective is to investigate women’s acceptability of home assessment of abortion and whether acceptability of medical abortion differs by in-clinic or home assessment of abortion outcome in a low-resource setting in India. Abortion outcome assessment through routine clinic follow-up by a doctor was compared with home assessment using a low-sensitivity pregnancy test and a pictorial instruction sheet.

Outcomes/Observations

85% of women were successfully followed up, of those 96% were satisfied. The majority preferred home assessment in the event of a future abortion.

Summary

The Bellary model of district mental health program (DMHP) has been adopted by the government of India under the National mental health program with the primary aim of making mental health care accessible to all by setting up psychiatric services in peripheral areas, training primary health care personnel and involving the community in the promotion of mental health care. The DMHP was set up in a 50 bedded Civil Hospital in a suburb of Chandigarh.

Outcomes/Observations

In DMHP, Chandigarh, a large number of patients sought psychiatric treatment for the first time with a 62% follow up

Summary

This study sought to determine the efficacy of a brief alcohol and tobacco intervention based on the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) in a primary healthcare setting in Karnataka. The study included 100 patients in each of the control and intervention PHCs. Patients in the control PHC received an informational pamphlet on the risks of alcohol and smoking as well as the ASSIST questionnaire. For statistical analysis, the chi-square test, paired t-test, and independent sample t-test were utilized.

Outcomes/Observations

Health and wellbeing Outcomes: With regard to tobacco use, the percentages of the high-risk category of tobacco users at baseline declined at follow-up. At follow-up, the percentage of alcohol users with moderate-risk scores dropped from 60.5% to 45.2% in the intervention PHC.

Summary

The study was designed to assess the effectiveness of intervention in strengthening the integration of NLEP (National Leprosy Eradication Programme) into primary health care by comparing different leprosy indicators. In a one-day workshop at the block PHC, a consensus was developed on the division of tasks and operational aspects of the revised strategy for the overall effective management of the leprosy program involving healthcare providers. It was followed by two days of training in skills development at each sector PHC center.

Outcomes/Observations

Organizational Outcomes: The involvement of PHC functionaries has improved appreciably after the intervention. The involvement of grassroot level workers has facilitated early detection and regular treatment of leprosy cases.

Summary

The MESU(mobile eye surgical unit) presents an innovative solution to accessibility by providing a stable, self-sufficient mobile platform that guarantees a controlled and sterile environment for performing cataract surgery in rural locations. Two buses connected by a vestibule were built to meet the requirements for a self-sufficient operation theater (OT). In every camp, safe transportation of units, good alignment of buses, safe water, and maintenance of sterile environments were achieved with optimal utilization of OT.

Outcomes/Observations

Organizational Outcomes: MESU provides an alternative to the base hospital approach by giving the same standard eye care in a peripheral eye camp in rural and remote areas. Careful selection of the team, strict adherence to protocol, and averaging above 25 surgeries per day to decrease per surgery cost will allow MESU a safe and viable alternative in community eye care.

Summary

In the present study, we have made an attempt to study the impact of training of Traditional Birth Attendants (TBAs) on the Newborn care in resource poor settings in rural areas.
Training was conducted for two days which included topics on techniques of conducting safe delivery and newborn care practices. Gain in knowledge of safe delivery and newborn care was assessed at the end of one month impact on the Newborn care provided by TBAs, Impact on the advice regarding breast-feeding.

Outcomes/Observations

Early and late post-test evaluation revealed a significant improvement in the percentage of untrained TBAs who gained knowledge regarding referral service in case of newborn complications, correct breast feeding practices and the importance of child’s immunization.

Summary

The World Health Organization (WHO) Safe Childbirth Checklist, a QI tool, promotes systematic adherence to practices that have been associated with improved childbirth outcomes. The study conducted a matched-pair, cRCT in 60 pairs of facilities across 24 districts of Uttar Pradesh, testing the effect of the BetterBirth program, an 8-month coaching-based implementation of the Safe Childbirth Checklist, on a composite outcome of perinatal death, maternal death, or maternal severe complications within 7 days after delivery.

Outcomes/Observations

The BetterBirth program had no significant effect on the primary composite outcome with respect to maternal and perinatal health (nor on any secondary health outcomes), despite significantly higher rates of birth attendants’ adherence to essential practices in intervention facilities than in control facilities.

Summary

In this study, Technology-enabled non-invasive diagnostics screening (TES) using smartphones and other point-of-care medical devices was evaluated in conjunction with conventional routine health screenings for primary care screening of patients. A novel remote web platform was developed to allow expert physicians to examine TES data and compare efficacy with routine health screenings. The study was conducted at a primary care center during the 2015 Kumbh Mela in Maharashtra, India, with 494 consenting 18–90 year old adults tested.

Outcomes/Observations

Health and wellbeing Outcomes: TES identified clinically significant abnormalities in routine health screenings, which were validated by physicians and used to diagnose at-risk patients. TES identified a high prevalence of oral diseases, hypertension, obesity, and ophthalmic conditions among the middle-aged and elderly Indian population.

Summary

The Certificate Course in Management of Hypertension (CCMH) is a joint certification program that was born as a result of the collaborative efforts of the aforementioned organizations. This design provided an opportunity for the participants to enhance their technical competencies and knowledge without hampering their clinical practice schedule. The course modules were developed to ensure holistic learning and covered a range of topics that included historical aspects, epidemiology, lifestyle management, pharmacotherapy, innovations in hypertension treatment, and cardiovascular risk reduction.

Outcomes/Observations

The cumulative results of the evaluation revealed that 92% of the participants perceived an improvement in their knowledge regarding hypertension and its complications after the course. Participants reported an improvement in confidence in initiating pharmacotherapy in patients with hypertension and that their confidence in evaluating patients for complications of hypertension had improved.

Summary

The paper developed a pregnancy registry that contains demographic information, risk factors, and outcomes, allowing for high rates of detection and follow-up while operating within the existing health system. It also focuses on increasing the quality of the findings, it's vital to understand the components of the system that was used to construct the register. Maternal and neonatal mortality can be reduced by keeping track of pregnancies and their outcomes.

Outcomes/Observations

The paper exhibited sustained increases in both enrollment coverage and accuracy of reporting pregnancy outcomes within the designated catchment region in Belgaum, India, from 2008 to 2014.

Summary

A single hospitalization can drain household resources due to inadequate funding, particularly in India. The Rashtriya Swasthya Bima Yojana (RSBY), a national health insurance plan, enhanced access to hospitalization and financial protection. The study's goals were to better understand the governance (including regulatory) environment and contract arrangements and to measure provider compliance and customer satisfaction. In each district, enrolled /non-enrolled hospitals were mapped, and service availability was assessed; enrollee characteristics were examined; information on structural quality and process of care, and out-of-pocket payments was obtained for the 12 hospitals

Outcomes/Observations

Health and wellbeing Outcomes: The Rashtriya Swasthya Bima Yojana (RSBY) is a national health insurance plan that provides access to hospitalization and financial protection. This study mapped enrolled/non-enrolled hospitals, assessed service availability, examined enrollee characteristics, and obtained out-of-pocket payments for 12 hospitals.

Summary

The purpose of this study was to assess the efficacy of a computerized Health Management Information System in India's rural health system. The main benefit of computerization has been that it has allowed health personnel to save time in record keeping and report preparation. The original capital expenses of computerization can be repaid within two years after deployment. Because of computerization, a good system for service delivery can now be implemented.

Outcomes/Observations

Provider outcomes: More than 95% of the data was verified to be correct. It provides a better monitoring, supervision, and data management tool for program managers. Managerial outcomes: The initial cost of computerizing two PHCs was projected to be $ 35,622. $ 4213 was calculated as the equivalent yearly additional cost of capital goods. The annual savings are estimated to be roughly $ 11,924.

Summary

Diabetes registries keep track of the prevalence and incidence of diabetes in the general population, monitor diabetes control programs, and serve as a sample frame for interventional research. The process of developing a prospective diabetes registry in a primary health-care environment in Puducherry is documented in this paper. The methodological specifics obtained while creating a diabetes registry at the PHC level, as well as the scope for upscaling to a Diabetes Management Information System and a State-wide Registry, are described in this study.

Outcomes/Observations

Demographic data, risk factors, complications, concomitant chronic illnesses, lifestyle and medical management, and clinical outcomes were all collected in the first phase. Out of a total of 2948 participants seeking care from a chronic illness clinic, over 2177 people with diabetes have been recorded in six PHC’s. In these centers, registration coverage ranged from 61% to 105 percent.

Summary

The Mother and Child Tracking System is a centralized (IT)-based program that uses name-based tracking. After 5 years of installation, there is no data in the literature evaluating the operational features of such a name-based tracking system. The methodological specifics and learning experiences obtained while creating a diabetes registry at the PHC level were described in this study. An essential element envisioned by this registry is the improvement of patient care through needs assessment and quality assurance in service delivery.

Outcomes/Observations

Lack of sufficient training, overworked data entry operators (DEO) and auxiliary nursing midwives (ANM), poor Internet access, and frequent power outages have all been identified as serious barriers to MCTS deployment. Only 6% of consumers could interpret the SMS of the 18% of clients who reported getting the SMS.

Summary

In this article, we look at primary care in rural India and how a portable health record system may make medical information more accessible at the time of service. Over the course of nine months, we monitored a geriatric cohort and a maternal cohort of 308 people. A web-based EHR was used to document physician visits. 135 individuals were chosen at random from the cohort and given a USB-based memory card with their comprehensive medical information, which could be read on most PCs.

Outcomes/Observations

This issue was largely handled with the introduction of the EHR, health card, and SMS service since standardized templates were available to chart information, much of the content was selection based, and data could be maintained indefinitely and backed up and recovered in the case of a disaster. Most crucially, the CHTC now has a full patient record.

Summary

In South Asia, cardiovascular disease (CVD) is the main cause of morbidity and death among diabetics. The CARRS translation study examines the efficacy, cost-effectiveness, and long-term sustainability of a clinic-based multi-component CVD risk reduction strategy in Indian and Pakistani diabetics.

Outcomes/Observations

The CARRS translation study examines a low-cost diabetes care delivery paradigm in urban South Asia with the goal of achieving complete cardiometabolic disease case management for high-risk patients

Summary

This randomized clinical trial evaluated the role of voucher incentives on linkage and retention in care among drug users (DUs) in India. 120 DUs aged 18 years, HIV-infected, antiretroviral therapy (ART) naive, and ART eligible were randomized to incentive (INC) or control (CTL) conditions for 12 months. Participants randomized to the INC arm received incentives (redeemable for food/household goods) for achieving prespecified targets, while subjects in the CTL group could win vouchers in prize-bowl drawings. The primary endpoint was time for ART initiation.

Outcomes/Observations

Health and wellbeing Outcomes: Participants in the INC arm were more likely to visit the government ART center, initiated ART, and had more visits to the ART center. However, no difference in viral suppression was observed. Modest voucher incentives improved linkage to and retention in HIV care but did not significantly impact viral suppression among DUs in India.

Summary

The study aimed to study a service model that enables a clinic to be open to all members of the community, regardless of their ability to pay. Sampling methodology was used to gather information in two phases, with the city of Indore as the target region. The questions to answer were related to dental health care access problems and resources needed, human and financial.

Outcomes/Observations

Organizational Outcomes: The aim of an open-to-all clinic is to provide care to as many people as possible, so a fixed facility is needed to serve a large number of people. Discounts are now provided to various income groups, with a baseline charge of Rs. 400 per visit.

Summary

The influence of India's National Rural Employment Guarantee (NREG) plan, the world's biggest workfare program, on healthcare utilization, particularly maternity healthcare, is examined. We expect NREG to boost the utilization of maternal health care by raising household income and removing certain financial obstacles, such as OOP expenditures. We assess the impact of NREG on the use of maternal health care, namely births in health facilities, using a nationally representative household survey and a difference-in-differences technique that takes advantage of the scheme's gradual deployment.

Outcomes/Observations

NREG did not boost overall facility deliveries, despite an increase in delivery at public facilities. There is insufficient data to demonstrate that NREG reduced births at private institutions. Furthermore, sub-group analysis suggests that facility deliveries have decreased while home deliveries have increased among poorer households, who are more likely to engage in NREG. NREG enhanced delivery to public facilities for wealthier families. Households belonging to underprivileged castes were unaffected. 

Summary

To evaluate the number of patients with presumptive tuberculosis (TB) and the number of TB cases identified and treated among patients who accessed MMU services in the Mohali district of Punjab, India, from May to December 2012.

Outcomes/Observations

663 (8%) of the 8346 patients who attended the MMUs showed symptoms that were indicative of tuberculosis. And among them, 540 (81%) had a sputum examination or a chest X-ray to rule out pulmonary TB. In all, 58 individuals (11%) exhibited clinical or laboratory evidence of pulmonary tuberculosis, with 21 (36%) starting anti-tuberculosis treatment

Summary

On World Health Day, 2017, based on the theme of “Depression-let's talk”, a screening cum awareness camp for depression was organized by involving the district health authorities and local administration Khera village of Haryana. The participants were informed about the availability of the psychiatric services at the health center. They were encouraged to be open about it and consult if required. The study documents the successful experience of integrating mental health into primary care for addressing the problem of depression in villages.

Outcomes/Observations

Health and wellbeing outcomes (Individual level):
Out of the 250 individuals consented and screened, 34.4% scored ≥10 in the PHQ-9 scale and were labeled as screen positives. A total of 56 (65.1%) screen-positive individuals consulted the psychiatrist and 54 (96.4%) out of the 56 screen positives were confirmed as having depressive disorder as per ICD-10 criteria.

Summary

The Breteau index (BI), container index (CI),and (HI) were established to determine the severity of a large dengue outbreak in Tirunelveli, TN and were assessed in a PHC in Maruthamputhur hamlet by conducting an investigation. Anti Larval (AL) work entailed going door to door looking for immature stages of lice, mosquitoes by field workers and trained volunteers. As there are no vaccines, entomological surveillance and its importance can be employed to control dengue outbreaks.

Outcomes/Observations

Before the AL work, the reported numbers of fever cases in Maruthamputhur from Week 1 to Week 5 were 211, 394, 244, 222, and 144, with two fatalities. The HI was reduced from 48.2 percent to 1.6 percent, the CI was reduced from 28.6 percent to 0.4 percent

Summary

The study uses formative research to build the intervention, pairing eight communities based on their baseline characteristics and randomly assigning one to the intervention group and other to the control group. In the nine months following training,1115 newborns were enrolled, 552 in the intervention communities and 473 in the control areas. Feeding at 3 months, as well as anthropometry and diarrhea prevalence at 3 and 6 months, were evaluated.

Outcomes/Observations

Provider/managerial outcomes: The intervention had a small effect on the proportion of infants delivered by traditional birth attendants, but had a large effect on the number of visits to the home by Anganwadi workers.

Health and wellbeing outcomes (Individual level): Infants receiving animal milk decreased by 50% and breastfeeding was practiced more frequently in the intervention group. Fewer mothers reported infants with diarrhea at the 3-month and 6-month visits, and fewer infants were sent to a healthcare provider.

Summary

This study describes children who have severe pneumonia from the perspective of the Integrated Management of Childhood Illness (IMCI) strategy. Between May 1997 and June 1998, a civil hospital in the northern hilly state of India prospectively evaluated 115 consecutive children, ranging in age from 2 months to 10 years, who were hospitalized with severe pneumonia.

Outcomes/Observations

Organizational Outcomes: IMCI strategy is effective in managing childhood pneumonia, but bottlenecks such as feeding malpractices, vaccination inconsistencies, exposure hazards, unqualified practitioners, the burden on mothers, failure to recognize signs and symptoms, lack of oxygen facilities, accessibility and faith in primary health care services remain. This study emphasizes improving family and community practices, health care systems, and case management skills of health workers.

Summary

The study aims to evaluate whether neonatal mortality can be reduced through systemic changes to the provision and promotion of healthcare. A cluster-randomized controlled trial involving 464 villages in Mahabubnagar District in Andhra Pradesh. The intervention will include a community health promotion campaign and a system to contract out healthcare to non-public institutions. The intervention group will also have subsidized access to pregnancy-related healthcare services at non-public health centers.

Outcomes/Observations

Health and wellbeing Outcomes: In small villages in an Indian state with high mortality rates, the CHAMPION trial found that a package of interventions addressing health knowledge, and contracting out important areas of maternal and child healthcare resulted in a reduction in neonatal mortality of almost the hypothesized 25%. The intervention is well warranted, and it might be useful in other comparable situations.

Summary

The objective of the study was to determine the effectiveness of a culturally appropriate nutrition educational intervention to improve complementary feeding of infants of age six months to 12 months in Chandigarh, North India. A quasi-experimental study was conducted in a non-randomized intervention (Burail) and control area (Maloya) among a vulnerable population. The primary outcome was a mean change in weight. The effectiveness of the intervention was measured by conducting a DID analysis.

Outcomes/Observations

Health and wellbeing outcomes (Individual level): There was significant weight gain in intervention group infants and length gain from the baseline.
Health and wellbeing outcomes (Population-level): Community-based nutrition educational intervention and digitized tracking of malnourished children can effectively improve the complementary feeding and growth of children from six months to one year among vulnerable populations.

Summary

The study evaluates the effects of community-based parental education/counseling when combined with usual treatment on children’s anemia cure rate. A pragmatic cRCT in children aged 12 to 59 months from 55 villages from the rural Chamarajanagar district was conducted between November 2014 and July 2015; 6-month follow-up ended in January 2016. Villages were randomly assigned to either usual treatment or to the intervention. Among 1144 participating children, 534 were diagnosed as having anemia and constituted the study sample in analysis.

Outcomes/Observations

Health and wellbeing Outcomes (Individual level): This intervention significantly improved the child’s anemia cure rate after 6 months when compared with the usual treatment alone. The results also suggested that 7 mothers of children with anemia need to be exposed to the intervention to revert the hemoglobin in children with anemia to nonanemic levels.

Summary

VISHRAM was a community-based mental health programme to address mental health risk factors for suicide in 30 villages in Vidarbha, India. To assess whether implementation of VISHRAM was associated with an increase in the proportion of people with depression who sought treatment, a baseline cross-sectional survey was conducted before and 18 months after VISHRAM was enacted. The primary outcome was change in contact coverage with VISHRAM, and secondary outcomes included whether the distribution of coverage was equitable, the type of services sought, and mental health literacy.

Outcomes/Observations

Health and wellbeing Outcomes: VISHRAM provided mental health first aid to 1441 individuals, 55% of whom were referred to counsellors for further management. Prevalence of current depression fell from baseline to 113%, contact coverage was six-times higher, and suicidal thoughts decreased from 52% to 25%.

Summary

Considering the burden of cervical cancer in India, the study recognizes the need for innovative approaches to improve coverage of cervical cancer screening. From May 2014 to January 2017, a project was implemented in 10 cities in Uttar Pradesh using the WHO-recommended ‘screen and treat’ approach for cervical cancer prevention. A pilot phase was implemented in three cities during May 2014 and December 2015 and the project was scaled-up to additional seven cities between January 2016 and January 2017.

Outcomes/Observations

Health and well-being outcomes: A total of 100,836 women aged between 30 and 60 years were screened by visual inspection with acetic acid (VIA) of which 5477 were VIA positive. Treatment with cryotherapy was given to 3735 women.

Summary

A longitudinal study was conducted to examine the effectiveness of family centered approach (FCA) in addressing health and related issues in an urban area of Mangalore, India. Family folders were created, demand generation and health education activities were conducted, and an FCA package was implemented by interns. Effect was assessed by comparing practices and service utilization before and after the study..

Outcomes/Observations

Health and wellbeing Outcomes: A statistically significant increase in healthcare service utilization was observed after 6 months of implementation.  Reported malaria cases reduced to 90 from 150/1000 population per year.  Nearly 32% of the eligible couples were practicing family planning. 

Unintended Outcomes: Capacity building of medical and nursing interns as future family physicians and community health nurses was an important collateral benefit

Summary

This article describes a participatory action research project situated in Maharashtra. This initiative is aimed at enabling representatives of local communities to effectively occupy the spaces for decentralized
planning provided by NRHM and engaging with the planning processes. A project on capacity building for decentralized health planning was implemented in selected districts of
Maharashtra during 2010–13. A specific project on capacity building for decentralized planning included a structured learning course and workshops for major stakeholders.

Outcomes/Observations

Provider/managerial outcomes: Monitoring and Planning Committees (MPCs) had increased knowledge levels, participation in the Project Implementation Plans (PIPs) the process increased, and local priorities were addressed through decentralized planning, even when the state-level PIP process did not accept the proposal.

Summary

This is a study on the training programme for Accredited Social Health Activists (ASHAs) on primary eye care (PEC) that was undertaken and evaluated in a district of a capital city. ASHAs were given one-day training and expected to refer patients to nearby Vision Centre. Knowledge was assessed before and after training and re-evaluated 1 year later. Focus Group Discussions were held to find barriers and facilitating factors in engaging ASHAs in PEC. The training was evaluated using Kirkpatrick's evaluation model.

Outcomes/Observations

Provider/Managerial Outcomes: Immediately after training, there was an improvement in knowledge related to all sections. According to ASHAs, it was noticed that attendance at vision centers increased after ASHAs were involved in training. ASHAs perceived a heightened level of respect in the community after engaging in activities other than just maternal and child health.

Summary

The study aims to examine three theoretically-informed mediators of the peer-delivered Thinking Healthy Program Peer-delivered (THPP), an evidence-based psychosocial intervention for perinatal depression,
on symptom severity in two parallel RCTs in Goa, India and Rawalpindi, Pakistan. The study examines whether three pre-specified variables—patient activation, social support, and mother-child attachment at 3 months post-childbirth mediated the effects of the THPP interventions of perinatal depressive symptom severity (PHQ-9) at the primary endpoint of 6 months post-childbirth.

Outcomes/Observations

Health and wellbeing Outcomes: The study found that improved patient activation and social support at 3 months post-childbirth mediated the effects of the THPP intervention on reduced depressive symptom severity. This was not the case for mother-child attachment, which had an effect on depressive symptoms. Two of the three pre-specified variables, patient activation, and social support mediated the effects of the THPP intervention on depression outcomes at 6 months post-childbirth.

Summary

The study objective is to apply our sociotechnical model to develop a comprehensive evaluation strategy for the Swasthya Slate and use this evaluation to address both technical and non-technical areas of
improvement during the all-important design, development, and usability testing phases of user-centered design. The study applied a comprehensive socio-technical model of safe and effective health IT use to the formative evaluation of a novel tablet-based device designed to support primary care practice in rural India.

Outcomes/Observations

Provider/managerial outcomes: A composite scoring system was developed for each of the 7 usability domains. The mean usability rating across all of the domains was 8.9/10. The lowest domain score was for user customization. The highest domain score was suitability for the task. The final design aims to provide a more robust look, improved software reliability, and improved user interface by focusing on both affect and functionality.

Summary

This report describes the reduction of OOP expenditure incurred by persons with severe mental illness. As part of CBR program, since August 2015, mental health camps have been conducted twice a month at
the ten PHCs & taluk hospitals. The psychiatrists from the team visit the taluk twice in a month during camps and attend to persons with mental illness. The program involves grass-root health workers
including ASHA, Village health nurse, Anganwadi workers, Village rehabilitation workers and ANMs. Medication was dispensed free of cost.

Outcomes/Observations

After switching to Jagaluru CBR, PSMI being accompanied by a family member for follow-up with the psychiatrist reduced from 99% to 68% ; PSMI visiting a psychiatrist alone increased from 1% to 32%.

Summary

The study evaluated the effectiveness of integrated care centers in India that provided single-venue HIV testing, prevention, and treatment services for people who inject drugs (PWID) and men who have sex
with men (MSM). They implemented integrated care centers in 11 cities, with a single integrated care center per city in all but one city. After a 2-year intervention phase, they conducted respondent-driven sampling evaluation surveys of target population members who were aged 18 years or older.

Outcomes/Observations

In prespecified individual-level analyses, evaluation survey participants who had ever visited an integrated care centre had significantly higher rates of recent HIV testing, were more likely to be aware of their status and to be taking antiretroviral therapy, and had lower rates of injection-related and sexual risk behaviour, than did participants who had not visited an integrated care centre.

Summary

A pilot, pre-post-intervention study was conducted in a sub-district level birth center in Karnataka, India between July and December 2010.Twenty-nine essential practices that target the major causes of
childbirth-related mortality, such as hand hygiene and uterotonic administration, were evaluated. The primary endpoint was the average rate of successful delivery of essential childbirth practices by health
workers.

Outcomes/Observations

Health and wellbeing outcomes: An increase in health workers attending after the introduction of the checklist program was observed. The rate of successful delivery of essential practices at each birth event increased. Medication use increased at some periods and decreased at others. Overall, there was an average 150% increase in adherence to accepted clinical practices at any given birth event.

Summary

This paper presents the results of a secondary analysis to examine the effect of the Integrated Management of Neonatal and Childhood Illness (IMNCI) strategy on inequities in health indicators. The population was divided into subgroups by wealth status, religion and caste, education of mother and sex of the infant. Multiple linear regression analysis was used to examine inequality gradients in neonatal and post-neonatal mortality, care practices and care seeking, and the differences between intervention and control clusters.

Outcomes/Observations

Health and wellbeing Outcomes (Population level): The IMNCI trial enrolled 60 702 infants, with significant improvements in newborn and infant care practices. However, there were large inequities in health outcomes across different population subgroups, with mortality outcomes being higher among more vulnerable population subgroups. The intervention did not significantly change neonatal mortality, but concentration curves for post-neonatal mortality indicated greater equity.

Summary

The study evaluated the effect of ciKMC on neurodevelopmental outcomes during infancy. This RCT was conducted among 552 stable LBW infants, majorly late preterm or term small for gestational age infants without any problems at birth and weighing 1500–2250 g at birth. The intervention consisted of the promotion of skin-to-skin contact and exclusive breastfeeding by a trained intervention delivery team through home visits. The intervention group of mother-infant-dyads was supported to practice ciKMC till day 28 after birth.

Outcomes/Observations

Health and wellbeing Outcomes (Individual level): Within the intervention group, the median time to initiate ciKMC after birth was 48 h (IQR 48 to 72). Among these mothers, the mean duration of SSC practice was 27.9 (3.9) days with 8.7 (3.5) hours per day. There is no significant effect of ciKMC on any child developmental outcomes during infancy.

Summary

The study aimed to evaluate the effectiveness of a peer-support lifestyle intervention in preventing type 2 diabetes among high-risk individuals identified on the basis of a simple diabetes risk score. Participants from intervention clusters participated in a 12-month community-based peer-support program comprising 15 group sessions and a range of community activities to support lifestyle change. Participants from control clusters received an education booklet with lifestyle change advice.

Outcomes/Observations

Health and wellbeing Outcomes (Individual level) : The intervention resulted in a non-significant reduction in diabetes incidence at 24 months in a high-risk population identified on the basis of a diabetes risk score. However, there were significant improvements in some cardiovascular risk factors, including IDRS score, fruit and vegetable intake, and alcohol use, and physical functioning score of the HRQoL scale.

Summary

The shortage of skilled birth attendants (SBA) is one of the determinants of maternal mortality in India. To combat this, innovative task-shifting strategies are being implemented to engage providers of the Indian system of medicine (AYUSH practitioners) to provide SBA services. 73 in-depth interviews were conducted in 3 states of India to assess the engagement of AYUSH practitioners for SBA service provision. The interviews explored the providers' SBA training experience, barriers to SBA service provision, workplace and community acceptance, and the perspective of programme managers on the competence and quality of SBA services provided.

Outcomes/Observations

Provider/Managerial Outcomes: SBA training led to skill enhancement with the adoption of appropriate maternal and newborn care practices. A dedicated trainer, more hands-on practice, and strengthening training on newborn care practices and management of complications emerged as the training needs. Conditional involvement in SBA-related work, a discriminatory attitude at the workplace and lack of legal/regulatory authorization were identified as barriers to the inclusion of APs in SBA service provision.

Summary

This study evaluated the impact of aa ‘Team-Based Goals and Incentives’ (TBGI) intervention in Bihar, India, designed to improve front-line (community health) worker (FLW) performance and health-promoting behaviors related to reproductive, maternal, newborn, and child health and nutrition. The study used a cluster randomized controlled trial design and difference-in-difference analyses of improvements in maternal health-related behaviors related to the intervention's team-based goals. Evaluation participants included 1300 FLWs and 3600 mothers at baseline and after 2.5 years of implementation.

Outcomes/Observations

Provider/ Managerial Outcomes: Most FLWs attended subcentre meetings at least monthly, but no statistically significant differences between control and intervention area FLWs. 30% of FLWs considered AWWs or ASHAs from different villages to be part of their team, but not for ASHAs. Frequencies of advice about behaviors were higher among mothers who received home visits.
Health and wellbeing outcomes: Intervention village mothers were more likely to receive advice on iron-folic acid (IFA) tablets, exclusive breastfeeding, keeping the cord clean, starting complementary feeding at 6 months, and family planning.

Summary

The study examines the relationship between prenatal care use and postpartum health practices among women in rural Tamil Nadu. It was carried out through sending a community-based, cross-sectional questionnaire survey to 30 randomly chosen regions covered by health sub centers. It takes place in rural areas of Tamil Nadu's Salem District.

Outcomes/Observations

Health and Wellbeing Outcomes: Pregnant women who had a large number of antenatal visits, initiated antenatal care in the first trimester, or received information about breastfeeding were more likely to feed colostrum. However, the use of antenatal care facilities was not associated with maternal postpartum dietary habits. Further research is needed to explain the gap between intentions and actual outcomes of antenatal care.

Summary

This study evaluated the integrated counseling and testing centers (ICTCs) in New Delhi. Twenty ICTCs were selected on the basis of population proportion to the size of clients catered. The evaluation tool was a structured tool for evaluating HIV voluntary counseling and testing (VCT). It consists of an assessment of components including the availability of infrastructure, laboratory services, referral services, and staff availability. Counseling sessions were also observed for assessing content and quality. Means and proportions were calculated.

Outcomes/Observations

Organizational Outcomes: ICTCs lack the necessary staff, a waiting area, and a counseling room. The record-keeping and laboratory quality control at the ICTCs were considered satisfactory. Client confidentiality may be jeopardized due to a lack of privacy in the counseling rooms. Few areas of counseling need improvement.

Summary

The study aimed to understand the issues in the design and implementation of the Public-private partnerships (PPPs) for EmOC under the JSY in Maharashtra and how they affect the availability of EmOC services to women. A cross-sectional research was carried out in the Ahmednagar district of Maharashtra utilizing the fast assessment technique. Primary data was gathered through interviews with women, service providers, and administrators at various levels.

Outcomes/Observations

Organizational Outcomes: The study discovered that no public-private partnerships were executed for EmOC provision in the study district under the JSY. The contracting-in model of PPPs faces significant challenges due to insufficient infrastructure and the complacent attitude of implementers. Provider/ Managerial Outcomes: The scheme is not owned by the administrators at the district and block levels.

Summary

This study aimed to assess the efficacy of a 12-week individualized nutritional supplementation (INS) and Nordic walking (NW) program in pre-frail older Indians. The primary measure was physical performance, as indicated by Fried's Frailty scale, cognition, mood, and nutritional status. Participants were sixty-six pre-frail elderly, who were randomly allocated into three subgroups. One-way ANOVA was used to statistically assess differences in baseline characteristics, while the Chi-Square/Fischer exact test was utilized for qualitative variables.

Outcomes/Observations

Health and wellbeing outcomes (Individual level):Combining NW and INS results in a simple, practical intervention that is effective in managing functionally fragile older people and allows them to maintain their independence. Future studies should replicate this intervention in a larger cohort with a longer follow-up period.

Summary

This is a study of COmmunity care for People with Schizophrenia in India (COPSI) trial that compared the efficacy of a collaborative community-based care intervention with standard facility-based care. Patients aged 16–60 years with a primary diagnosis of schizophrenia were randomly assigned (2:1) to receive either collaborative community-based care plus facility-based care or facility-based care alone. The primary outcome was a change in symptoms and disabilities over 12 months, measured by the different scales.

Outcomes/Observations

Health and wellbeing outcomes (Individual level): In this study it was found that combining community-based and facility-based care did not result in any additional changes in caregivers' understanding and knowledge of schizophrenia. Social outcomes: The stigma-related findings support the explanation that only facility-based care is effective in reducing stigma and discrimination for patients with mental health problems.

Summary

There is little evidence that services for people with psychotic disorders are feasible, acceptable, or effective in low- and middle-income nations. A longitudinal study was carried out in a rural Indian village to investigate the scaling up and impact of a community-based rehabilitation programme for patients with psychotic disorders in a very-low resource context. A community-based intervention package that included psychotropic drugs, psychoeducation, adherence management, psychosocial rehabilitation, and support for daily living was given to each participant. The main result was a change in the scores for disabilities.

Outcomes/Observations

Health and well-being outcomes (Individual level): Adherence to psychotropic medication and participation in self-help groups emerged as outcomes in community-based care. Medication adherence has been shown to be effective in reducing disability in community cohorts of schizophrenia patients in rural India.

Social outcomes: Through connections with existing employment schemes, the programme facilitated the social participation of people with psychotic disorders and assisted in addressing their economic concerns.

Summary

This study investigates the feasibility of implementing an innovative agricultural extension program in rural India to improve maternal, infant, and young child nutrition behavior change. The program involves producing low-cost videos promoting best practices and disseminating them through village-level women's self-help groups. The nutrition intervention involved 10 videos produced and disseminated in 30 villages. Data was collected through interviews, structured observations, nutrition knowledge tests, and a social network questionnaire.

Outcomes/Observations

Health and Wellbeing Outcomes (Population level): Acted as the principal source of health and nutrition information at the community level.

Social Outcomes: The intervention was viewed as reinforcing the efforts of the health workers and welcomed MIYCN videos as job aids. 

Unintended Outcomes: Boost demand for government nutrition- and health-related services, which may increase frontline health workers’ capacity and accountability to fulfil the full range of work responsibilities

Summary

In this study, women received a 75 g oral glucose load irrespective of when they had their previous meal, and their 2-h Plasma Glucose was identified as Gestational Diabetes Mellitus(GDM). A modified version of the WHO standard for determining the presence of GDM was used to evaluate the efficacy of Diabetes in Pregnancy Study Group India (DIPSI) guidelines.

Outcomes/Observations

Health and wellbeing outcomes: DIPSI criterion requires estimation of plasma glucose in one blood sample to diagnose GDM. This cost-effective and evidence-based procedure meets the responsibility of offering "a single-step definitive glucose test" to every pregnant woman belonging to any socioeconomic status.

Summary

A random sample of four sub-centres in Jamnamarathur Primary Health Centre area was organized to sensitize the tribal community to Tuberculosis , various health education methods such as exhibitions on TB with audio-visual aids and talks on TB, by the literate youths to villagers. This was done to investigate the feasibility of (1) involving literate (who can read and write) tribal youth volunteers for detecting cases of pulmonary tuberculosis (PT) in their respective hamlets; and (2) antituberculosis drug delivery to sputum-positive patients at their homes by village health nurses (VHNs).

Outcomes/Observations

Provider/ Managerial outcomes: This process was done to train literate tribal youth volunteers within a short time to detect cases of pulmonary tuberculosis in a tribal area. In 1 year (1992-93), the total population screened was 9383 persons; a total of 338 symptomatic subjects were identified; 12 sputum-positive cases were detected and started on treatment. Thus making the community participate in the National Tuberculosis Programme one of the practical means available for detection and treatment of pulmonary tuberculosis cases.

Summary

A cluster randomized controlled trial (MANAS; MANashanti Sudhar Shodh, which means “project to promote mental health” in Konkani) was conducted to develop an intervention for common mental disorders that aimed to address the barriers in routine primary health care in Goa, India.The aim of the study was to assess the effectiveness of collaborative stepped-care interventions led by lay health counsellors on patients’ recovery from common mental disorders in PHC as defined by the ICD-10 at 6 months. The secondary outcome was the severity of depression and anxiety symptoms, assessed at 6 months.

Outcomes/Observations

Health and wellbeing outcomes: The results of the MANAS trial indicate that such a collaborative-stepped care intervention delivered by lay health counsellors can improve recovery rates for patients with common mental disorders in public primary care settings, but not in private facilities. The intervention also suggests some preventive effect in reducing the prevalence of common mental disorders in subthreshold cases.

Summary

The study focussed on increased provider training and awareness regarding the free diagnostic tests to facilitate scale-up. Outreach and education approaches were undertaken on a regular basis to ensure effective and increasing uptake of project interventions. The provider database was maintained in each of the project cities, with details of mapped, approached, and engaged providers. The aim was to address TB diagnostic challenges in the pediatric population, by offering free-of-cost Xpert testing to pediatric presumptive TB cases, with a view to positively enhance TB care.

Outcomes/Observations

Provider/ Managerial outcomes: The current project provided useful insights into the paediatric patient pathways and was able to engage an increasing number of providers from the public and private sectors. Overall 42,238 paediatric presumptive TB cases were enrolled in the project, across the four cities. During the project period, quarterly diagnostic uptake and paediatric TB case detection rates increased more than two-fold.

Summary

This is a study of a comprehensive strategy for the prevention of oral cancer. It comprises improved community engagement, a strengthened primary healthcare workforce, and a supportive policy environment. The use of digital technologies could make operationalizing the framework for oral cancer much easier. There is evidence supporting the effectiveness of using appropriately trained primary healthcare workers to conduct oral visual examinations for the detection of oral cancer.

Outcomes/Observations

Provider/managerial outcomes, Organizational outcomes: In this study,training primary health-care workers in early detection and prevention of oral cancer has been incorporated into the national cancer control strategies in India and Sri Lanka. Health and well being outcomes : Enhanced community engagement for avoidance of all forms of tobacco; healthy living; and participation in oral cancer screening. Social outcomes: One key policy requirement is empowering and deploying frontline health workers to carry out screening.

Summary

The 4 year Revitalizing Health for all international research program supported 20 research teams located in 15 low and middle-income countries to explore the strengths and weaknesses of comprehensive primary health care (CPHC) initiatives. Multiple regional and global team capacity enhancement meetings were organized to refine methods and to discuss and assess cross-case findings. Most research projects used mixed methods, incorporating analyses of qualitative data ,secondary data, and key policy and program documents.

Outcomes/Observations

Provider/managerial outcomes: In India and the Democratic Republic of Congo groups of women and Accredited social health activists (ASHAs) are increasing awareness of health services and improving access to facilities for pregnant women. Organisational outcomes:In the studies the role of community health workers in improving access to primary health care services Health and wellbeing outcomes:In communities implementing a community health strategy showed greater immunization coverage, antenatal care, use of insecticide-treated nets and vitamin A uptake. Social outcomes: Strengthening of policies concerning the integration of different levels of care within the Family Health Program

Summary

Both diabetes and hypertension are chronic diseases, they are more complicated than lung diseases and cancers, which are also chronic disorders. In this study Chronic Care Model (CCM) has been investigated for its applicability in LMICs and how it may be modified. The healthcare systems of these nations can benefit from sharing and implementing the lessons learned from this study.

Outcomes/Observations

Organisational outcomes: The CCM is described as a visible support for care improvement at all levels of the system. NCD staff competence, review criteria, and communication with medical doctor/specialists were not captured in most care models. Patient outcomes: According to the CCM, self-management emerged as a dominant theme emphasizing the central role of the patient and empowering her/him with skills to manage disease and sustain lifestyle changes. Health and well-being outcomes: the study found Clinical follow-up care facilitated by clinical information systems is improving, access to medicines, equipment, laboratory supplies, and personnel is needed for provision of health services.

Summary

In a cluster randomized controlled study in south India, the efficacy of a single round of visual inspection with acetic acid (VIA) screening on cervical cancer incidence and death was studied. The screening was completed by 30,577 eligible women, with younger, more educated, married, multiparous, low-income women, and those who underwent tubal sterilization having higher compliance. 1498 (72.4%) of the 2069 women diagnosed with CIN (cervical intraepithelial neoplasia) and invasive cancer got therapy. Young women, those who use contraception, and those with high-grade precursor lesions and invasive tumors were more likely to follow treatment instructions.

Outcomes/Observations

Health and wellbeing outcomes (Individual level):Of the 2069 women diagnosed with CIN and invasive cancer among the screened women, 1498 (72.4%) received treatment. 80.2% of women with high-grade lesions complied with treatment as compared to 71.0% with low-grade disease.This indicates that a reasonable participation might be achieved in screening programs using this simple and low-cost test for cervical cancer.

Summary

A leprosy project was established in a difficult to reach area under guidelines of the Government of India. The leprosy services were provided by Koraput Leprosy Eradication Project (KORALEP) and general health services by Primary Health Care (PHC).The intervention consisted of a village-wise search operation conducted by a team of local Anganwadi workers and voluntary workers. They examined the suspects' list to identify cases of leprosy. Households were given a visiting card by the local team for their follow-up visits.

Outcomes/Observations

Provider/managerial outcomes: Briefly trained Anganwadi workers to correctly identify cases of leprosy. Organisational outcomes: An enquiry survey of about 70% of the population was conducted. Health and wellbeing outcomes (Population level): 576 patients were detected over a period of 150 working days. Nearly half of the case detection was achieved by adopting Modified Leprosy Elimination Campaigns(MLEC) in a short span of 6 days. Social outcomes:The awareness levels among the general population regarding leprosy improved. Unintended outcomes: An interest regarding the issue was generated among local health workers and voluntary workers.

Summary

This article is a review and stakeholder consultation process that revealed the need for additional study on the best layouts of PHC financing interventions at the system, provider, or community level in LMICS of the Asia-Pacific region. The development of an evidence gap map involved a two-step process: (1) a systematic review of financing interventions aimed at PHC service delivery in the Asia-Pacific region; and (2) an electronic-Delphi (e-Delphi) exercise with important national PHC stakeholders to determine the importance of the evidence needs.

Outcomes/Observations

Organizational outcomes : The article presents the primary health care financing studies in the Asia-Pacific region examining the issues like PHC Outcomes ,Quality of care, Efficiency ,Coverage/accessibility, Responsiveness and Equity.

Summary

Aims to improve the lives of the local tribal communities through various programs under healthcare, community health, farming and craft work. Nurses are hired from the local communities and are trained to perform OP procedures, reducing the dependency on the doctors.

Outcomes/Observations

The proportion of pregnant mothers coming for antenatal check-ups has increased, Infants dying within one year of birth have dropped and undernourishment has come down as well.

Summary

The program aims to provide health care services at a local cost to the tribal and rural areas of Bilaspur, Chhattisgarh. They have certain innovative and appropriate tech solutions for malaria diagnosis and tracking, for water quality checks.

Outcomes/Observations

The infant mortality rate has been reduced and marginalized tribal groups make up 45% of the recipients of JSS services.

Summary

The model Sky social franchise aims to to improve quality and coverage of maternal health services in three districts of Uttar Pradesh. To increase the demand for maternal health services, there were village-level information activities such as wall paintings, billboards, radio spots, and film shows.

Outcomes/Observations

By the end of the programme, 365 SkyCare providers, 50 SkyHealth centres, and 8 Franchise Clinics were part of the network. One day of training was given to 2149 ASHAs.

Summary

The Ananya program aims to partner with the state government to work with the private sector and community organizations on several health-related issues to help meet national health targets and in turn contribute to India’s progress toward the relevant Millennium Development Goals. There is a Mobile Academy where an audio course is delivered via Interactive Voice Response (IVR) called the "Mobile Kunji" which provides information on  health issues for health workers.

Outcomes/Observations

Ananya program had significant impacts on newborn care practices,

complementary feeding practices, and the use of modern contraceptive methods. 

Summary

The model aims to reduce neonatal mortality in poor resource settings through detailed and focused group behaviour change communication. Shivgarh Community Health Intelligence Platform(CHIP): The Shivgarh CHIP has also been set up as a community-embedded innovation ecosystem in rural Uttar Pradesh. Each rural household in this area is uniquely identifiable, and each village is mapped onto a geographical information system.

Outcomes/Observations

Results indicated that newborn deaths were halved in the villages in which Community Health Workers were active.

Summary

The faith-based organizational model aims to transform the lives of the poor and marginalized in Uttarakhand through the Support and Learning Team (SALT) team. They go as a team to the neighbourhood and have discussions with strategic questioning to bring out the problems and solutions from the community themselves.

Outcomes/Observations

Community health worker training program trained over 300 ASHAs. The cluster has succeeded in bringing organizational change towards disability-inclusive development.

Summary

The Model offers reliable and affordable primary healthcare solutions in middle-class and low-middle-class localities. It is a chain of urban primary care clinics. Clinics are located in highly densely populated areas. It provides doctor consultation and diagnostic services according to software-based standardized treatment protocols. They also maintain electronic patient profiles in order to minimize errors and enable quality follow-up of patients.

Outcomes/Observations

Implemented 85 clinics

Summary

At the Center for Innovation, the Computational Medicine Team develops models for the eye care Eco- system right from the clinicians at the highest level in an urban setting to the associated eye care professionals at the rural level. These solutions help empower eye care professionals to identify and classify the anomalies of the eye. This provides opportunities to scale up services in much broader coverage in a low-resource setting. Using AI, to make healthcare more affordable and accessible even in rural settings.

Outcomes/Observations

30.64 million people were reached through OPD, cornea distribution, surgeries, innovative stem-cell procedures, cornea collection and community eye health initiatives. 

Summary

This Model aims to provide subsidized services at eye hospitals for low economic group people. ‘Mobile Eye Surgical Unit’ (MESU)- ‘operation theatre on wheels’ developed jointly with the Indian Institute of Technology – Madras (IIT-M) has facilitated the most advanced Cataract surgery performed right at the doorsteps of indigent patients living in the most inaccessible regions including tribal and hilly belts, totally cost-free.

Outcomes/Observations

At SankaraNethralaya, each year, on average, perform about 19,000 Cataract surgeries, totally free of cost to the Indigent Patients who come to the hospital. Colour Vision and Career Choice Counseling among School Children: 200 schools in Tamilnadu.

Summary

This article describes the effectiveness of ImTeCHO, a mobile phone and web-based application for scheduling home visits, screening for complications, counseling during home visits, and supportive monitoring by PHC staff, i.e., ASHA workers. They were provided an Android phone with the application and a post-paid data plan. An open cluster-randomized study was carried out at 22 PHCs in six tribal blocks of India's Bharuch and Narmada districts.

Outcomes/Observations

Provider /Managerial outcome: Throughout the study period ASHAs were found to have a satisfactory adherence and uptake to the ImTeCHO application. Health and wellbeing outcomes: The use of ImTeCHO mobile- and web-based applications as a job aid by government ASHAs and PHC staff improved coverage and quality of MNCH services in hard-to-reach areas. There was an improvement in the coverage of at least two home visits within the first week of birth.

Summary

The goal of this paper was to enhance MNCH outcomes through the NRHM nurse mentorship (NM) program. On-site peer mentorship of staff nurses (SN) and auxiliary nurse midwives (ANM) in charge of labor, birth, and postpartum care at primary health care centers (PHC), where 24% of deliveries occurred. The program emphasized increasing clinical skills and practices, as well as team cooperation and problem resolution, and supported initiatives to solve process-related concerns, such as enhanced infrastructure, supplies, and referral logistics.

Outcomes/Observations

Health and wellbeing outcomes: Substantial decline however in neonatal mortality among children delivered in PHCs supported by NM. A decline in reported complications during pregnancy and no neonatal deaths were reported among infants who delivered in NM facilities from day 8–28 post-birth. Social outcome: An increasing proportion of marginalized women utilized services at the health facilities where the nurse mentoring program was implemented Unintended outcomes: Increase in the proportion having Cesarean section or assisted deliveries (from 10 to 13%)

Summary

The objective of this article was to develop a Home based neonatal care package to provide low cost primary care by the human potentials available in the villages to reduce NMR. Adjacent blocks of villages in Gadchiroli, were selected as the intervention and the control areas in 1993 for the field trials.

Outcomes/Observations

Health and wellbeing outcomes: It was possible to provide HBNC to most (93%) neonates in the community to reduce neonatal morbidity load (by 50%). All reductions were highly significant. The total reduction in neonatal mortality during intervention was ascribed to sepsis management, supportive care of low birth weight (LBW) neonates, asphyxia management, primary prevention, and management of other illnesses or unexplained.

Summary

The study aimed at assessing the quality of child health services provided through primary healthcare centres in Gujarat's Vadodara district. The study was carried out using a modified quality assessment checklist of the Program on District Quality Assurance for Reproductive and Child Health (RCH) services.Inputs assessment was done by facility survey. Process assessment for the four child health service components used actual observation of service, review of records and interview of service providers and clients.

Outcomes/Observations

Organizational outcomes: The ‘Input’ section (structural attributes) fared better than the ‘process’ sections wherein a score of 65% and 55% were obtained respectively. There's a lack of MOs, staff nurses, ENBC training, emergency transport mechanism, and protocols and guidelines at the PHCs.

Summary

The study aimed to determine whether village ASHAs can be trained to identify and refer potential visceral leishmaniasis cases to local PHCs for diagnosis and treatment. Approximately, 1000 ASHAs in total from the 4 PHCs were trained in batches of 100–150 by the faculty from Rajendra Memorial Research Institute of Medical Sciences, Patna for Visceral leishmaniasis /Post-Kala Azar Dermal Leishmaniasis identification, symptoms, transmission, treatment, vector control, and DDT spray.

Outcomes/Observations

Provider/ Managerial outcomes: After a single round of ASHAs training in the PHCs of Paroo and Marhoura, VL referral rates by ASHAs increased from 7% to 28%. After the second round of training approximately one year later , the referral rate increased to 46%. Health and wellbeing outcomes (population level): In four PHCs where training was provided, the number of Visceral Leishmaniasis cases dropped substantially.

Summary

The study aimed to assess the effectiveness of a multitopic training program for informal providers in the Indian state of West Bengal. The program (72 sessions and 150 teaching hours over a 9-month period) provided a generic curriculum to train clinicians on a variety of topics such as fundamental physiology and anatomy, harm reduction concepts, and particular conditions. The application was also tested with unannounced standardized patients, or trained actors playing the roles of patients suffering from a certain ailment.

Outcomes/Observations

Provider/ Managerial outcomes: Providers allocated to the training group were morewere, more likely to adhere to condition-specific checklists. The training increased rates of correct case management and patient caseload and patients per day.

Summary

The study aimed at assessing the association of participation in microcredit programs, and awareness of these programs, with maternal and reproductive health service utilization, among women in India. Data from the National Family Health Survey (NFHS-4) were utilized, and women aged 15 to 49 were questioned. Three variables and two questions were used to measure maternal health service usage. To test the understanding of microcredit programs, questions were posed.

Outcomes/Observations

Health and wellbeing outcomes: In India, there is an increase in self-help group-led health treatments aimed at improving maternal, child, and reproductive health outcomes. Postpartum contemporary contraception is being used more often. Social outcomes: Increased ability to pay for health services. Unintended outcomes: Nonparticipants of the microcredit program benefited from health programs due to increased awareness.

Summary

The study aimed at using a multifaceted intervention to reduce inappropriate antibiotic use in non-specific urinary tract infections (UTRIs). This consisted of a repeated process of audit and feedback, interactive training sessions, one-to-one case-based discussion and antibiotic guideline development. Pooled audit feedback on URTI prescribing was presented at pre-established monthly doctors' meetings.Three seminars (1 hour) combining PowerPoint and round table discussion were planned for the doctors’ meetings to provide the evidence for antibiotic use in URTI.

Outcomes/Observations

Organizational outcomes: There was a considerable reduction in antibiotic prescribing and an increase in documented examinations after the first and second Plan, Do, Study, Act ( PDSA) cycle. Unintended outcomes: Development of a new disease coding system for the outreach clinics.