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Robust situation assessment to identify gaps, designing pilot programmes, testing innovations, and scaling up of effective interventions constitute our programme components in maternal, neonatal and child health (MNCH). Along with our affiliate organisations, the Centre for Global Public Health, University of Manitoba and Indian Health Action Trust, we provide technical assistance, since 2009, to the National Rural Health Mission of Government of Karnataka to improve MNCH outcomes in the state.
In India, while the maternal and newborn deaths have been declining over the past two decades, the pace has been slow. In particular, progress among the poorest and most marginalised populations in the country continues to lag, with continued disparities in health outcomes. Combination of complex multi-level factors increase vulnerability of this segment to poor health outcomes.Closer home in Karnataka, the state average for infant mortality rate (IMR) is 35 and maternal mortality rate (MMR) is 144. Many of the less developed northern districts in Karnataka with weaker health infrastructure lag in improvements in Maternal Neonatal Child Health (MNCH) outcomes. Nearly half of the maternal deaths and many more neonatal deaths occur at the time of delivery and first week postpartum. In north Karnataka, IMR and MMR are the above state average. In district Raichur, IMR is 67 and MMR is 244 and in Koppal, IMR is 58 and MMR is 236.
The programme was implemented from 2009 – 2015 in eight priority districts in north Karnataka – Bagalkot, Bellary, Bijapur, Gulbarga, Koppal, Raichur and Yadgir. The project supported the National Rural Health Mission to improve the functioning of programmes and resources directed primarily at the interactions between health workers and families/ communities at the home, community and first level health facilities (i.e. up to First Referral Units) to provide a focused set of critical interventions during pregnancy, around birth and during the neonatal period.
Bill and Melinda Gates Foundation funded the programme. KHPT partnered with University of Manitoba, Canada, St. John’s Academy of Health Sciences, Karnataka, Karuna Trust, and Intra Health to implement the programme.
The project resulted in considerable improvement in quality of maternal and newborn care at the facility level.
Several innovative approaches to tackling the problem evolved from the project.
Supportive community monitoring tools and processes to strengthen community accountability at the grass root level
An intervention research project, implemented from 2013 to 2014, chose four First Referral Units (FRUs) facilities, each from two districts, Bagalkot and Koppal, in northern Karnataka, India as intervention and control facilities to evaluate the diagnosis and management of select maternal and newborn complications.
The likelihood of girls from scheduled castes and tribe (SC/ST) families in northern Karnataka completing secondary school is sharply diminished by family poverty, gender discrimination, the traditions of early marriage and devadasi dedication, boys’ actions and attitudes towards girls, inadequate measures to meet girls’ needs at schools and by community authorities and education officials to enforce girls’ right to education. The rates of underage marriage are over 30% among girls from SC/ST communities in Bijapur and Bagalkot districts. Girls who drop out of school are more vulnerable to HIV infection and other health problems, will have a larger, less healthy family, earn less than their better educated peers, and lack voice, agency and are disengaged from larger community issues.
The intervention was a composite of the below activities.
The intervention focused on strengthening providers’ skills and team work along with documentation.
A formative research collected information related to the facility infrastructure, human resource and supplies. This was followed by visits by experts to ensure adherence to some basic infection control practices at all study facilities. Data collection was completed in October 2014.
A study, based on a mixed methods approach, evaluated the effectiveness and impact of ‘skills and drills’ intervention on such complications. It showed that the ‘skills and drills’ intervention, a relatively new mode of facility-based intervention was well accepted and appreciated by the providers, especially by the nursing staff of these facilities.
The delivery record, a new documentation format was highly valued, and used for almost all deliveries in both intervention and control facilities.
We partner with the government to improve outcomes of MNCH programmes.
We empower girls from underserved communities to claim their rights to health and education.
We empower marginalised women to lead a life without violence.
We facilitate public-private collaboration and community engagement for treatment of tuberculosis patients.
We help alleviate under- nutrition through nutrition-specific and nutrition-sensitive interventions
We improve access to health, education, social protection and welfare services for vulnerable children.
We support at risk communities to reduce their vulnerability to HIV / AIDS and access care and services.
We work with communities and help build community institutions to enhance the power of marginalised groups to demand services and assert their rights and dignity.