Maternal & neonatal mortality rates in India have declined yet fell short of 2015 millennium development goals (MDG). Several maternal and neonatal health indicators show improvement yet inequities in population-wide coverage in certain geographies and gaps in quality and continuity of care remain unresolved.
Reaching scale to ensure coverage of migrant, high-risk women and children in the care-continuum is a visible gap. Ensuring coverage during their antenatal and postnatal periods in a seamless manner with high-quality emergency obstetric & neonatal care requires newer innovative approaches. Meaningful engagement of grass-root structures such as Gram Panchayats (GP) /Village Health Sanitation and Nutrition Committees (VHSNC) needs to reach scale. Integration of technology interfaces to ensure continuity and real-time data-based planning is required.
Our Approach
Our approach focuses on improving availability, accessibility, quality, utilization, and coverage of critical MNCH interventions among the rural poor through Facility, Community, Health Systems, and Technology. It includes strengthening of health care providers’ knowledge and skills to threshold levels to deliver quality MNCH services in district-level public health care facilities. Our focus is on prioritizing the integration of respectful maternity care principles and practices
We also have a community-level focus on vulnerable populations, which includes community participation and accountability through frontline workers, Village Health, Sanitation and Nutrition Committees (VHSNCs), and Arogya Raksha Samitis. We look to building capacities and scaling up the reach of quality community-based services. This will improve functionality, and generate ownership and accountability of Gram Panchayats and VHSNCs.
We also implement health system strengthening activities to improve the availability of drugs and supplies, accessibility for maternal and neonatal complications, a robust referral system that ensures stabilization of complications and effective infection control practices to reduce maternal and neonatal sepsis.
We aim to integrate and expand the use of technology across the continuum of MNCH care from community to facility levels to expand identification and service delivery for vulnerable populations and strengthen the quality of clinical care at facilities.
Our Achievements
We work to improve maternal, neonatal health outcomes and address their nutritional status deficits to achieve India’s ‘Good Health and Wellbeing’ target of Sustainable Development Goal 3 in the areas of project implementation. We focus on creating innovative quality Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCHA) care models including strengthening grassroots level community structures and building integrated technology RMNCHA solutions in high priority states in India.
Improve rural women’s health and nutrition before, during and after pregnancy
Improve new-borns’ health through management of complications and post-birth care
About the project:
While the Government of India’s Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCHA) program has a robust and proven package of lifesaving interventions, inequities in population-wide coverage in certain geographies and gaps in quality and continuity of care remain unresolved. Current strategic approaches lack the required focus on reaching high-risk, vulnerable women, early enough particularly in the urban context.
KHPT is developing an Urban Comprehensive Primary Health Care (CPHC) model at Singasandra Urban Primary Health Centre in Bengaluru city, with the aim of creating a comprehensive service package for pregnant, lactating mothers and children (below 5 years) among identified vulnerable groups including the urban poor, migrants, and persons with pre-existing health conditions.
The project, which is funded by Wipro Cares, aims to identify specific vulnerable groups and assess/explore gaps in critical service delivery among them; to improve access, strengthen referrals, linkages and follow-up of MNCH services within the facility area; and to strengthen the CPHC model in the context of MNCH services.
Geography and duration:
The model is being operationalized at Singasandra Urban Primary Health Centre, from August 2021-September 2023, and will reach out to approximate 21000 vulnerable population.
Key Activities:
Expected outcomes:
KHPT expects to ensure that vulnerable groups will avail an antenatal care package, skilled obstetric care, immediate essential newborn care and resuscitation, emergency obstetric and new born care, as well as postpartum care for mother and newborn, and care and nutrition counselling for children below the age of 5 in a timely manner. KHPT aims to leverage existing efforts and formulate strategies to scale these interventions to a larger population, while instituting mechanisms to identify vulnerable populations and retain them in the continuum of care.
About the project:
KHPT is implementing a project of St. Johns Research Institute (SJRI), a home-based study to scientifically evaluate the long-term efficacy (two years) of daily consumption of indigenously developed extruded micronutrient fortified rice in improving iron stores in school going children (6-12 years). The study is funded by the Department of Biotechnology, Government of India.
KHPT aims to determine the efficacy of micronutrient fortified rice (containing micronized ferric pyrophosphate, vitamin B12 and folic acid) in improving iron stores in school children; in improving the micronutrient status in school children and their mothers; the acceptability of the rice, and the adverse effects, if any, of its long-term consumption.
Geography and duration: KHPT is implementing the project in Koppal taluk of Koppal district between September 2019 and October 2022.
Key Activities:
About the project:
Deficiency of micronutrients including Vitamins A, D, iron and folic acid in the diet can result in poor cognitive and learning abilities in children, lower productivity and immune responses, and increase morbidity and mortality. Fortification of staple foods such as oil, milk and wheat flour with these micronutrients, is a safe, cost-effective, evidence-based strategy to ensure that everyone, including the most vulnerable, has access to essential micronutrients.
KHPT is working to assist in the catalysing, coordination and implementation of the scale up of large-scale staple food fortification across 18 states in India according to standards set by the Food Safety and Standards Authority of India, and through effective engagement with the government and food industry representatives.
Geography and duration: The two-year project is proposed to be implemented in 18 states/UTs of India, including Madhya Pradesh, Gujarat, Rajasthan, Maharashtra, Andhra Pradesh, Telangana, Karnataka, Tamil Nadu, Uttar Pradesh, Punjab, Haryana, Odisha, Chattisgarh, Bihar, Tripura, Himachal Pradesh, Kerala and the Andaman & Nicobar Islands.
Key activities:
Expected Outcome:
KHPT expects to contribute to an increase in the availability of fortified staple food in the open market and in making fortified staples available to the most vulnerable populations through government social safety net food supply programs in all these states.
I knew KMC means ‘keeping the low birth weight baby covered and keeping the baby next to the mother’. In 2016, I received exclusive training on KMC and there I learnt that KMC is much beyond this and how it benefits both mother and baby and also the practical sessions on KMC. Now I confidently speak about KMC and promote KMC in the community.
I delivered 3 female babies in Koppal district hospital and they were very small when they were born. After hearing that I had delivered three girls, my husband left me alone in the hospital and went away. I was heartbroken, but the doctor and hospital staff counselled me about the importance of female children and told me about the importance of doing Kangaroo Mother Care. If they hadn’t counselled me, my babies wouldn’t have survived today! Don’t discriminate against girl children. They are a gift.
The ASHA told me that even fathers can give KMC (Kangaroo Mother Care) to low birth weight babies. I then decided to support my wife and started giving KMC to my baby. It brought me and my baby together!
Increasing the practice of Kangaroo Mother Care to improve newborn health outcomes
Improving facility and community level care of new mothers, infants and children
About the project:
India has more than 70 million undernourished women of reproductive age. The consequences of pre-conception and maternal undernutrition on fetal growth, birth outcomes, childhood stunting and adulthood chronic diseases has been well established. Dietary habits, anthropometric measurements, and nutrient stores before and during early conception are vital for good pregnancy outcomes.
With a grant from the HCL Foundation, KHPT aims to build an informed and responsive ecosystem within the public health domain to address the pre-conception nutrition needs of Newly Married Women within vulnerable communities in Niti-Aayog designated aspirational districts in Karnataka. KHPT conducted an in-depth situational needs assessment to understand challenges and opportunities and present these findings to state and national-level decision makers through dissemination workshops.
Geography and duration:
KHPT’s qualitative research was conducted in Surpur taluk of Yadgir district and Devadurga taluk of Raichur district between April 2021 and March 2022
Key activities:
Expected Outcome:
This initiative is intended to catalyze national and state thought leaders to develop nutrition solutions which will help newly-married women to attain optimal nutrition status in the pre-conception stage, and help to achieve a reduction in maternal and neonatal mortality (SDG 3) & zero hunger (SDG-2). It will also help build a community-transformative, gender-inclusive and multisectoral convergence model to enhance gender equality in nutrition access (SDG 2 and 5).
About the project:
Deficiency of micronutrients including Vitamins A, D, iron and folic acid in the diet can result in poor cognitive and learning abilities in children, lower productivity and immune responses, and increase morbidity and mortality. Fortification of staple foods such as oil, milk and wheat flour with these micronutrients, is a safe, cost-effective, evidence-based strategy to ensure that everyone, including the most vulnerable, has access to essential micronutrients.
KHPT worked to assist in the catalysing, coordination and implementation of the scale up of large-scale staple food fortification across 18 states in India according to standards set by the Food Safety and Standards Authority of India, and through effective engagement with the government and food industry representatives. The aim of the project, funded by Global Alliance for Improved Nutrition (GAIN) was to create a favourable policy environment to promote food fortification, build the capacity of industries to adopt fortification of edible oil, milk and wheat flour and increase awareness on the benefits of fortified foods among general population in intervention states.
Geography and duration:
The large scale fortification project was implemented between October 2017 and October 2021 in the states of Andhra Pradesh, Karnataka, Maharashtra, Uttar Pradesh, Andaman and Nicobar, Kerala, Meghalaya, Tamil Nadu, Assam, Gujarat, Odisha, Telangana, Bihar, Haryana, Punjab, Tripura, Himachal Pradesh, Madhya Pradesh, and Rajasthan.
Key activities:
• Providing trainings and building capacity on technical processes of fortification for edible oil, milk and wheat flour industries across intervention states.
• Sensitization of officials and technical support to officials from Food Safety Departments including Commissioners, Assistance Commissioners and Food Safety Officers.
• Analysis of fortified edible oil, Milk and wheat flour samples from production plant and open market to ascertain the level of fortificants available in the products.
• Working with social safety net programs like PDS, MDM and ICDS providing food to vulnerable population to adopt fortification.
• Gap assessment of laboratories of various Government departments including Food Safety Department and Food and Civil Supplies Department across 5 states with respect to analysis of fortificants in the fortified staples and prerequisites to obtain NABL certification for fortificant analysis.
Impact:
• Over 1360 officials from Food Safety Department across 11 states including Commissioner’s, Assistant Commissioner’s, DO’s and FSO’s were sensitized on food fortification.
• 7 round table meetings were conducted in the states of Kerala, Bihar, UP, AP, Telangana, Tamil Nadu and Meghalaya with the senior government officials from Food Safety department and social safety net programs.
• More than 400 edible oil industries (small, medium and large scale) are fortifying their oil with Vitamin A and D in 14 states.
• More than 35 milk dairies are fortifying their products with Vitamin A and D in 6 states.
• With the technical support from KHPT, around 80 metric tons of fortified wheat flour is supplied to Akshaypatra Kitchen Lucknow every month, reaching around 97,366 children in 1354 schools.
• Launch of a training course, with support from the KLE Society, Belgaum, on Analytical Methods for Estimation of Micronutrients in Fortified Wheat Flour and Edible Oil for laboratory analysts/professionals under the guidance of Prof. M.M. Godbole, Padma Shri Awardee and renowned endocrinologist in India.
• Conducting a nation- wide survey to better understand the experience of food companies (edible oil mills, milk dairies and roller flour mills), especially the impact of COVID-19 on production and fortification process during the pandemic. The report can be found here (link to be inserted)
• Creating a resource pool of edible oil fortification experts through technical trainings in collaboration with the Food Fortification Resource Centre (FFRC), FSSAI.
• Process documentation of different types of edible oil fortification processes; the report can be accessed here (link to be inserted)
About the project:
It is widely agreed that communities should take an active part in improving their own health outcomes and that frontline health workers can play a vital role in increasing both access to and utilization of maternal healthcare. The ASHA, ANM and AWW work across the primary health care spectrum to provide health education and promotion, distribute commodities, diagnose and manage illness, and provide referrals.
With the support of the Bill & Melinda Gates Foundation, the Bihar Technical Support Program, spearheaded by CARE, focused on supporting the Government of Bihar to improve the performance of frontline workers, specifically to increase the quantity and quality of interactions between the frontline workers and the community to drive critical RMNCH behaviours. KHPT worked with CARE to build the capacity of the ASHAs and ANMs through District Trainers to effectively engage pregnant women, mothers, newborns, their family decision makers and community structures. The model was focused on developing audio-visual online modular training for a team of trainers within CARE, district and block-level health functionaries and select ASHA Facilitators.
Geography and duration:
The project was implemented from July 2020- March 2021 in 38 districts of Bihar.
Key activities:
KHPT conducted capacity building sessions for the District trainers comprising of Block Coordinators of CARE and Block Community Mobilizers of the Health and Family Welfare department to :
Impact:
About the project: Kangaroo Mother Care (KMC), which is comprised of skin-to-skin contact and exclusive breastfeeding, is proposed as a ‘game-changer’ for improved newborn health among low birth weight newborns. It has also proven to improve bonding between mother and infant, reduce newborn infections, lower stress levels, and many other benefits.
KMC coverage is minimal in India and across the globe due to various barriers at the community, health care workers, and facility level. The World Health Organization awarded funds to St. John’s Research Institute and KHPT for an implementation research initiative for scaling up KMC in Koppal district, Karnataka. The project aimed to develop, implement and evaluate an innovative implementation model designed to attain KMC coverage of 80% among all eligible babies with birth weight <2000gms.
Geography and duration: Koppal was selected since it is a high-priority district of the National Health Mission and because of prior experience of the study teams with MNCH work in Koppal. The project was implemented between 2016-18.
Key activities:
The project had interventions at two levels:
Impact
About the project:
In India, while 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. A combination of complex multi-level factors increase the vulnerability of this segment to poor health outcomes.
The project, funded by the Bill and Melinda Gates Foundation, supported the National Rural Health Mission to improve the functioning of programmes and resources, and was 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.
KHPT partnered with University of Manitoba, Canada, St. John’s Academy of Health Sciences, Karnataka, Karuna Trust, and Intra Health to implement the programme.
Geography and duration:
The Sukshema project was implemented from 2009 – 2015 in eight priority districts in north Karnataka – Bagalkot, Bellary, Bijapur, Gulbarga, Koppal, Raichur and Yadgir.
Key Activities:
Impact:
Outcomes:
An external evaluation through baseline (2013) and end-line surveys (2016) indicated one of the fastest decline in mortality rates.
About the project:
KHPT’s intervention research project chose four First Referral Units (FRUs) facilities as intervention and control facilities to evaluate the diagnosis and management of select maternal and newborn complications. The Bill & Melinda Gates Foundation funded the project, and KHPT implemented it with support from IECS, Argentina and the University of Manitoba, Canada.
Geography and duration:
The project was implemented at two First Referral Units each in Bagalkot and Koppal districtsin northern Karnataka, from 2013-2014.
Key activities:
The intervention focused on strengthening providers’ skills and team work, along with documentation. A formative research study 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. The intervention was a composite of:
Impact:
About the project:
The NRHM and Karnataka Health System Development Project (KHSDRP) included a Public Health Competitive Fund (PHCF) in their project design, recognizing the need to strengthen the capacities of Village Health Sanitation and Nutrition Committees (VSHNCs) and Arogya Raksha Samitis (ARSs) to achieve their active participation in health activities. This fund was granted to KHPT and Swami Vivekananda Youth Movement (SVYM).
The objectives were to clarify the roles and responsibilities of the members of various committees to enable them to achieve their corresponding monitoring and implementation goals; to strengthen community involvement to better public and individual health by creating awareness on health related issues; to create a sense of ownership of healthcare facilities among the community, making healthcare service staff more accountable, responsible, competent and efficient. The project also aimed to
inform the community about the various healthcare facilities and services they could avail, and empower them to coordinate the convergence of various healthcare facilities provided by various organisations and relevant departments
Geography and duration:
The capacity-building project was implemented in the districts of Bagalkot and Koppal in Karnataka from April 2010-March 2012.
Key Activities:
Impact: