Community health workers known as mitanins undertook family-level counseling and mobilized the co... more Community health workers known as mitanins undertook family-level counseling and mobilized the community to improve coverage of maternal and child health services in the state of Chhattisgarh, India. The Nutrition Security Innovation (NSI) project was launched in selected blocks with additional inputs for promoting appropriate complementary feeding practices and disseminating information on Public Distribution System (PDS) entitlement. Within 3 years of project implementation, all NSI inputs in the project group (PG) were scaled up in the entire state. To study the impact of interventions on nutritional status in PG and non-NSI comparison group (CG) blocks. Quasi-experimental mixed methods were used. The sample consisted of 3,626 households with children under 3 years of age and 268 mitanins. A ratio of 1 mitanin per 250 to 500 population was effective. The coverage of exclusive breastfeeding, timely introduction of complementary feeding, DPT immunization, and antenatal care services was more than 70%. The PDS reached almost 90% of beneficiaries. In both the PG and the CG, one-third of children were undernourished, with one-quarter of children undernourished by 6 months of age. The prevalence of low birthweight was over 40%, and half of all women were undernourished. The estimated annual average reduction rate (AARR) for the entire state was estimated to be 4.22% for underweight and 5.64% for stunting. The strategy of Mitanin Programme in the Indian state of Chhattisgarh was unique with the implementation of direct nutrition actions being spearheaded by the health sector and community health volunteers in coordination with the Integrated Child Development Services (ICDS) and the Public Distribution System (PDS). The highest priority was given to interventions in the first 92 weeks of life. This implied ensuring frequent counseling and delivery of services through the entire pregnancy period and continued follow up till the children were at least one year of age. An accelerated decrease in the annual rate of reduction of underweight and stunting was observed. The emerging findings point to the significant contributions that can be made by the National Rural Health Mission (NRHM) in India by involvement of community health volunteers known as Accredited Social Health Activists (ASHAs) towards reducing the persistent problem of undernutrition in the country.
Since its formation in 2000, the state of Jharkhand in India has grappled with major challenges i... more Since its formation in 2000, the state of Jharkhand in India has grappled with major challenges in the field of reproductive health. Inadequate infrastructure and personnel combined with settlements scattered over a hilly terrain have resulted in poor indicators. A key initiative which aims to address these issues through community mobilization and collective action is the Ranchi Low Birth Weight Project. Established in 2003, as a partnership between Krishi Gram Vikas Kendra, Child In Need Institute, Social Initiatives Group of ICICI Bank, and the Government of Jharkhand, the project covers a population of around 200,000 across two blocks of Ranchi district. The project aims to evaluate the effectiveness of life cycle based community level behavioural interventions in reducing incidence of low birth weight and improving a host of related reproductive and child health outcomes. In fact, low birth weight has acted as an important starting point in rallying all stakeholders (community,...
BACKGROUND Despite economic growth, hunger and undernutrition continue to plague India. Nearly a ... more BACKGROUND Despite economic growth, hunger and undernutrition continue to plague India. Nearly a third of Indian children are born undernourished and by age three almost 46 percent are underweight. Women’s health and nutritional status is also among the worst in the world. Over 40 percent of women have low BMI, calorie intakes are inadequate, multiple micronutrient deficiencies are very common and anemia levels are extremely high with over 50 percent of pregnant and lactating women suffering from anemia. Despite various efforts to address anemia through government and civil-society interventions, data from the state of Jharkhand in India reported increase in anemia levels over the past 5 years. OBJECTIVE To explore the causes, trends and patterns of rising anemia levels in a tribal community in Jharkhand. METHOD Qualitative research was used as a follow up to a baseline-endline evaluation of a quasi-experimental study - Reduction of Low Birth Weight Project - to explore causes behin...
Public health research has gained increasing importance in India&... more Public health research has gained increasing importance in India's national health policy as the country seeks to address the high burden of disease and its inequitable distribution, and embarks on an ambitious agenda towards universalising health care. This study aimed at describing the public health research output in India, its focus and distribution, and the actors involved in the research system. It makes recommendations for systematically promoting and strengthening public health research in the country. The study was a bibliometric analysis of PubMed and IndMed databases for years 2000-2010. The bibliometric data were analysed in terms of biomedical focus based on the Global Burden of Disease, location of research, research institutions, and funding agencies. A total of 7,893 eligible articles were identified over the 11-year search period. The annual research output increased by 42% between 2000 and 2010. In total, 60.8% of the articles were related to communicable diseases, newborn, maternal, and nutritional causes, comparing favourably with the burden of these causes (39.1%). While the burdens from non-communicable diseases and injuries were 50.2 and 10.7%, respectively, only 31.9 and 7.5% of articles reported research for these conditions. The north-eastern states and the Empowered-Action-Group states of India were the most under-represented for location of research. In total, 67.2% of papers involved international collaborations and 49.2% of these collaborations were with institutions in the UK or USA; 35.4% of the publications involved international funding and 71.2% of funders were located in the UK or USA. While public health research output in India has increased significantly, there are marked inequities in relation to the burden of disease and the geographic distribution of research. Systematic priority setting, adequate funding, and institutional capacity building are needed to address these inequities.
The new state of Jharkhand in India has grappled with major challenges in the field of public hea... more The new state of Jharkhand in India has grappled with major challenges in the field of public health with its unfavourable health indicators. Inadequacies in infrastructure, personnel and supporting structures compounded the problem. A key initiative that aims to address these issues through community based interventions and health systems’ strengthening is the Ranchi Low Birth Weight Project. Established in 2003, as a partnership between Krishi Gram Vikas Kendra, Child In Need Institute, ICICI Centre for Child Health and Nutrition, and Government of Jharkhand, the project covers a population of around 200,000 across two blocks of Ranchi district. The project aims to evaluate effectiveness of life cycle based interventions in reducing incidence of low birth weight and improving maternal and child health outcomes - the utmost priority for health policy and practice in India. This paper highlights the role played by female, hamlet based community health volunteers (known as Sahiyya) a...
Community health workers known as mitanins undertook family-level counseling and mobilized the co... more Community health workers known as mitanins undertook family-level counseling and mobilized the community to improve coverage of maternal and child health services in the state of Chhattisgarh, India. The Nutrition Security Innovation (NSI) project was launched in selected blocks with additional inputs for promoting appropriate complementary feeding practices and disseminating information on Public Distribution System (PDS) entitlement. Within 3 years of project implementation, all NSI inputs in the project group (PG) were scaled up in the entire state. To study the impact of interventions on nutritional status in PG and non-NSI comparison group (CG) blocks. Quasi-experimental mixed methods were used. The sample consisted of 3,626 households with children under 3 years of age and 268 mitanins. A ratio of 1 mitanin per 250 to 500 population was effective. The coverage of exclusive breastfeeding, timely introduction of complementary feeding, DPT immunization, and antenatal care service...
ABSTRACT With considerable investments in innovative institutions within the current health polic... more ABSTRACT With considerable investments in innovative institutions within the current health policy context in India, it becomes imperative to understand their impact—for course-correction, replication, and evidence-based policy. However, studying the impact of such institutions is a challenge within the paradigm of conventional evaluation designs. This study was an attempt to comprehensively evaluate the roles of a quasi-governmental institution—the State Health Resource Centre (SHRC) in Chhattisgarh, India. The aims of the study were to identify possible outcomes of the SHRC in the area of convergence between health and nutrition systems, to measure the extent of these changes, and to understand the pathways of change in these identified outcomes.
Journal of Health Organization and Management, 2012
The aim of this paper is to highlight the significance of integrated governance in bringing about... more The aim of this paper is to highlight the significance of integrated governance in bringing about community participation, improved service delivery, accountability of public systems and human resource rationalisation. It discusses the strategies of innovative institutional structures in translating such integration in the areas of public health and nutrition for poor communities. The paper draws on experience of initiating integrated governance through innovations in health and nutrition programming in the resource-poor state of Chhattisgarh, India, at different levels of governance structures--hamlets, villages, clusters, blocks, districts and at the state. The study uses mixed methods--i.e. document analysis, interviews, discussions and quantitative data from facilities surveys--to present a case study analyzing the process and outcome of integration. The data indicate that integrated governance initiatives improved convergence between health and nutrition departments of the state at all levels. Also, innovative structures are important to implement the idea of integration, especially in contexts that do not have historical experience of such partnerships. Integration also contributed towards improved participation of communities in self-governance, community monitoring of government programs, and therefore, better services. As governments across the world, especially in developing countries, struggle towards achieving better governance, integration can serve as a desirable process to address this. Integration can affect the decentralisation of power, inclusion, efficiency, accountability and improved service quality in government programs. The institutional structures detailed in this paper can provide models for replication in other similar contexts for translating and sustaining the idea of integrated governance. This paper is one of the few to investigate innovative public institutions of a and community mobilisation to explore this important, and under-researched, topic.
Community health workers known as mitanins undertook family-level counseling and mobilized the co... more Community health workers known as mitanins undertook family-level counseling and mobilized the community to improve coverage of maternal and child health services in the state of Chhattisgarh, India. The Nutrition Security Innovation (NSI) project was launched in selected blocks with additional inputs for promoting appropriate complementary feeding practices and disseminating information on Public Distribution System (PDS) entitlement. Within 3 years of project implementation, all NSI inputs in the project group (PG) were scaled up in the entire state. To study the impact of interventions on nutritional status in PG and non-NSI comparison group (CG) blocks. Quasi-experimental mixed methods were used. The sample consisted of 3,626 households with children under 3 years of age and 268 mitanins. A ratio of 1 mitanin per 250 to 500 population was effective. The coverage of exclusive breastfeeding, timely introduction of complementary feeding, DPT immunization, and antenatal care services was more than 70%. The PDS reached almost 90% of beneficiaries. In both the PG and the CG, one-third of children were undernourished, with one-quarter of children undernourished by 6 months of age. The prevalence of low birthweight was over 40%, and half of all women were undernourished. The estimated annual average reduction rate (AARR) for the entire state was estimated to be 4.22% for underweight and 5.64% for stunting. The strategy of Mitanin Programme in the Indian state of Chhattisgarh was unique with the implementation of direct nutrition actions being spearheaded by the health sector and community health volunteers in coordination with the Integrated Child Development Services (ICDS) and the Public Distribution System (PDS). The highest priority was given to interventions in the first 92 weeks of life. This implied ensuring frequent counseling and delivery of services through the entire pregnancy period and continued follow up till the children were at least one year of age. An accelerated decrease in the annual rate of reduction of underweight and stunting was observed. The emerging findings point to the significant contributions that can be made by the National Rural Health Mission (NRHM) in India by involvement of community health volunteers known as Accredited Social Health Activists (ASHAs) towards reducing the persistent problem of undernutrition in the country.
Since its formation in 2000, the state of Jharkhand in India has grappled with major challenges i... more Since its formation in 2000, the state of Jharkhand in India has grappled with major challenges in the field of reproductive health. Inadequate infrastructure and personnel combined with settlements scattered over a hilly terrain have resulted in poor indicators. A key initiative which aims to address these issues through community mobilization and collective action is the Ranchi Low Birth Weight Project. Established in 2003, as a partnership between Krishi Gram Vikas Kendra, Child In Need Institute, Social Initiatives Group of ICICI Bank, and the Government of Jharkhand, the project covers a population of around 200,000 across two blocks of Ranchi district. The project aims to evaluate the effectiveness of life cycle based community level behavioural interventions in reducing incidence of low birth weight and improving a host of related reproductive and child health outcomes. In fact, low birth weight has acted as an important starting point in rallying all stakeholders (community,...
BACKGROUND Despite economic growth, hunger and undernutrition continue to plague India. Nearly a ... more BACKGROUND Despite economic growth, hunger and undernutrition continue to plague India. Nearly a third of Indian children are born undernourished and by age three almost 46 percent are underweight. Women’s health and nutritional status is also among the worst in the world. Over 40 percent of women have low BMI, calorie intakes are inadequate, multiple micronutrient deficiencies are very common and anemia levels are extremely high with over 50 percent of pregnant and lactating women suffering from anemia. Despite various efforts to address anemia through government and civil-society interventions, data from the state of Jharkhand in India reported increase in anemia levels over the past 5 years. OBJECTIVE To explore the causes, trends and patterns of rising anemia levels in a tribal community in Jharkhand. METHOD Qualitative research was used as a follow up to a baseline-endline evaluation of a quasi-experimental study - Reduction of Low Birth Weight Project - to explore causes behin...
Public health research has gained increasing importance in India&... more Public health research has gained increasing importance in India's national health policy as the country seeks to address the high burden of disease and its inequitable distribution, and embarks on an ambitious agenda towards universalising health care. This study aimed at describing the public health research output in India, its focus and distribution, and the actors involved in the research system. It makes recommendations for systematically promoting and strengthening public health research in the country. The study was a bibliometric analysis of PubMed and IndMed databases for years 2000-2010. The bibliometric data were analysed in terms of biomedical focus based on the Global Burden of Disease, location of research, research institutions, and funding agencies. A total of 7,893 eligible articles were identified over the 11-year search period. The annual research output increased by 42% between 2000 and 2010. In total, 60.8% of the articles were related to communicable diseases, newborn, maternal, and nutritional causes, comparing favourably with the burden of these causes (39.1%). While the burdens from non-communicable diseases and injuries were 50.2 and 10.7%, respectively, only 31.9 and 7.5% of articles reported research for these conditions. The north-eastern states and the Empowered-Action-Group states of India were the most under-represented for location of research. In total, 67.2% of papers involved international collaborations and 49.2% of these collaborations were with institutions in the UK or USA; 35.4% of the publications involved international funding and 71.2% of funders were located in the UK or USA. While public health research output in India has increased significantly, there are marked inequities in relation to the burden of disease and the geographic distribution of research. Systematic priority setting, adequate funding, and institutional capacity building are needed to address these inequities.
The new state of Jharkhand in India has grappled with major challenges in the field of public hea... more The new state of Jharkhand in India has grappled with major challenges in the field of public health with its unfavourable health indicators. Inadequacies in infrastructure, personnel and supporting structures compounded the problem. A key initiative that aims to address these issues through community based interventions and health systems’ strengthening is the Ranchi Low Birth Weight Project. Established in 2003, as a partnership between Krishi Gram Vikas Kendra, Child In Need Institute, ICICI Centre for Child Health and Nutrition, and Government of Jharkhand, the project covers a population of around 200,000 across two blocks of Ranchi district. The project aims to evaluate effectiveness of life cycle based interventions in reducing incidence of low birth weight and improving maternal and child health outcomes - the utmost priority for health policy and practice in India. This paper highlights the role played by female, hamlet based community health volunteers (known as Sahiyya) a...
Community health workers known as mitanins undertook family-level counseling and mobilized the co... more Community health workers known as mitanins undertook family-level counseling and mobilized the community to improve coverage of maternal and child health services in the state of Chhattisgarh, India. The Nutrition Security Innovation (NSI) project was launched in selected blocks with additional inputs for promoting appropriate complementary feeding practices and disseminating information on Public Distribution System (PDS) entitlement. Within 3 years of project implementation, all NSI inputs in the project group (PG) were scaled up in the entire state. To study the impact of interventions on nutritional status in PG and non-NSI comparison group (CG) blocks. Quasi-experimental mixed methods were used. The sample consisted of 3,626 households with children under 3 years of age and 268 mitanins. A ratio of 1 mitanin per 250 to 500 population was effective. The coverage of exclusive breastfeeding, timely introduction of complementary feeding, DPT immunization, and antenatal care service...
ABSTRACT With considerable investments in innovative institutions within the current health polic... more ABSTRACT With considerable investments in innovative institutions within the current health policy context in India, it becomes imperative to understand their impact—for course-correction, replication, and evidence-based policy. However, studying the impact of such institutions is a challenge within the paradigm of conventional evaluation designs. This study was an attempt to comprehensively evaluate the roles of a quasi-governmental institution—the State Health Resource Centre (SHRC) in Chhattisgarh, India. The aims of the study were to identify possible outcomes of the SHRC in the area of convergence between health and nutrition systems, to measure the extent of these changes, and to understand the pathways of change in these identified outcomes.
Journal of Health Organization and Management, 2012
The aim of this paper is to highlight the significance of integrated governance in bringing about... more The aim of this paper is to highlight the significance of integrated governance in bringing about community participation, improved service delivery, accountability of public systems and human resource rationalisation. It discusses the strategies of innovative institutional structures in translating such integration in the areas of public health and nutrition for poor communities. The paper draws on experience of initiating integrated governance through innovations in health and nutrition programming in the resource-poor state of Chhattisgarh, India, at different levels of governance structures--hamlets, villages, clusters, blocks, districts and at the state. The study uses mixed methods--i.e. document analysis, interviews, discussions and quantitative data from facilities surveys--to present a case study analyzing the process and outcome of integration. The data indicate that integrated governance initiatives improved convergence between health and nutrition departments of the state at all levels. Also, innovative structures are important to implement the idea of integration, especially in contexts that do not have historical experience of such partnerships. Integration also contributed towards improved participation of communities in self-governance, community monitoring of government programs, and therefore, better services. As governments across the world, especially in developing countries, struggle towards achieving better governance, integration can serve as a desirable process to address this. Integration can affect the decentralisation of power, inclusion, efficiency, accountability and improved service quality in government programs. The institutional structures detailed in this paper can provide models for replication in other similar contexts for translating and sustaining the idea of integrated governance. This paper is one of the few to investigate innovative public institutions of a and community mobilisation to explore this important, and under-researched, topic.
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Papers by Anuska Kalita