Strengthening public health systems is crucial for effective and efficient health service delivery. The National Health Mission (NHM) by the Government of India runs many focused programs for the improvement of health indicators, especially related to maternal and child health as women and children living in rural areas bear the brunt of the burden of poor health services. Implementation challenges prevent the execution of policies and programs in its completeness. Assessing gaps to bridge them and using evidence based solutions in building a road map to a sustainable health system is imperative to the process of strengthening.
The Model Districts Health Project works in a total of six focus districts across three states. One of the two districts in each state is a "high-priority district" (HPD) designated by NHM for rapid rollout of its Reproductive Maternal Neonatal Child and Adolescent Health (RMNCH+A) agenda initiated in 2013.
- Rajasthan (program page): Dausa and Rajsamand (HPD)
- Jharkhand (program page): Khunt and Simdega (HPD)
- Telangana (program page): Medak and Mahbubnagar (HPD)
Click to map enlarge
- 60 percent of India’s population lives on less than $2 a day (World Bank)
- Despite strong economic growth since 1990, health indicators in India still lag behind other countries in the region, with a ranking of 135 out of 187 countries in the human development index. (World Bank)
- India’s under five child mortality is 52 (Sample Registration System 2012) with the highest number of under five deaths in the world (Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation)
- An estimated 40 infants die per 1,000 live births (Sample Registration System 2013), while the MDG target for infant mortality rate is 26
- Close to half of India’s children are undernourished (Source: Government of India)
- The Maternal Mortality Ratio of India is 167 (Sample Registration System 2013), lagging behind the MDG target of 109.
- India has more maternal deaths than any country in the world (Source: UNICEF)
- The public health spending is less than 1 percent of its GDP
India suffers from great inequalities in health, with the poor lacking even the most basic services while others in the country receive world-class health care. Reaching the MDGs is one challenge, while improving quality of service delivery to bring sustainable and continuous change is another. Therefore a robust public health system is crucial to deliver services reliably and equitably. The Model Districts Health Project advocates and focuses on the use of data driven planning at all levels of the health systems to address gaps.
Center for Sustainable Development, Earth Institute at Columbia University
In 2005, the Government of India launched the National Rural Health Mission (NRHM) to inject increased spending into the public health care system with the aim of improving the availability and quality of care for rural populations with a focus on women and children. At the request of the then Minister for Health and Family Welfare, Government of India, the Earth Institute at Columbia University convened an International Advisory Panel (IAP) to review NRHM activities, assess progress, conduct evaluations and provide international best practices and policy recommendations.
Subsequently, in 2010, based on the recommendations of a mid-term evaluation of the NRHM undertaken by the Earth Institute at the request of the Union Health Ministry, the Model Districts Health Project was initiated to work with state and district governments to strengthen service delivery on the ground and scaling up of successful interventions.
The project’s goal is to provide support in activities related to Millennium Development Goals 1, 4 and 5: improving the nutrition status of women and children and reducing maternal and child mortality by 2015. Therefore the focus of the Model Districts Health Project has been on bridging the gap between policy and practice by delineating the reasons why services are not reaching the population, and then supporting the government to strengthen systems and piloting innovations to resolve identified bottlenecks.
The project is embedded at state and district levels to accelerate strengthening of facilities, community-based health systems and service delivery. This requires enhancing district level capacity for data-driven planning and management. The project supports and participates in formation of district level strategy and planning and continuous facility improvement in each district through block monitoring. This includes the development of the annual District Health Action Plan (DHAP) that is supposed to feed into the state plan submitted for funding at the national level and supporting government initiatives in the districts.
The Model Districts Health Project conducts research on core policy issues on community health workers (ASHAs) and Auxiliary Midwife Nurses who are the primary interface between households and the public healthcare system. In addition innovations and strategies are piloted to assess the feasibility and acceptance for scale up of those activities. Operations research on activities related to antenatal care services and others in district-specific focus areas provide an evidence base for future steps.
The IKEA Foundation generously supports the Model Districts Health Project, with aims to reduce maternal and infant mortality in India (Millennium Development Goals 4 and 5) by 2015. The Foundation’s support seeks to strengthen India’s National Health Mission in providing efficient and accessible healthcare to the millions of women and children living in rural areas. The Model Districts Project is also a designated high-priority district lead for RMNCH+A in designated districts, and works closely with the state leads (UNFPA, UNICEF, and USAID-MCHIP).
Research and Documentation
The following documents highlight strategies and operational research conducted in the field.
- Public Health Strategies - State
- Public Health Strategies - Block
- Block Health Action Plan - Mahwa (Dausa Rajasthan)
- Block Health Action Plan - Khamnor (Rajsamand, Rajasthan)
- Block Health Action Plan -Narayankhed (Medak, Telangana)
- Block Health Action Plan - Kalwakurthy (Mahbubnagar, Telangana)
- Vision Documents
- Antenatal Care and Institutional Delivery Service Barriers- Rajsamand, Rajasthan
- Survey of women who recently delivered a child
- Key Informant interviews - Service Providers Perspective
- Focus Groups - Community Perspective
- On-Site Coaching - “Mentoring” - Mahbubnagar, Telangana
- Sahhiya (ASHA) Incentivization - Exploring Knowledge and Barriers - Khunti, Jharkhand
- Anemia - Assessing Knowledge of ANMs (Auxiliary Nurse Midwife) - Simdega, Jharkhand
Improving the Performance of Accredited Social Health Activists in India (PDF)
Nirupam Bajpai and Ravindra H. Dholakia
Working Paper Series No. 1
Improving the Integration of Health and Nutrition Sectors in India (PDF)
Nirupam Bajpai and Ravindra H. Dholakia
Working Paper Series No. 2
Model Districts as a Roadmap for Public Health Scale-up in India (PDF)
Nirupam Bajpai, Megan Towle, and Jyothi Vynatheya
Working Paper Series No. 4
Model Districts as a Roadmap for Public Health Scale-Up in India: Strategic planning experience from Assam (PDF)
Nirupam Bajpai, Ranvir Dhillon, Megan Towle, and Jyothi Vynatheya
Working Paper Series No. 6
Increasing the Availability of Specialist Services in Rural India (PDF)
Nirupam Bajpai, Ravindra Dholakia, and Jyothi Vynatheya
Working Paper Series No. 8
Increasing the Availability of Skilled Birth Attendance in Rural India (PDF)
Nirupam Bajpai, Ravindra Dholakia, and Megan Towle
Working Paper Series No. 9
- Dr. Nirupam Bajpai, Project Director and Principal Investigator
- Dr. Esha Sheth, Research Associate
- Mr. Dinesh Songara, State Technical Consultant, Rajasthan
- Dr. Akanksha Goyal, District Project Coordinator (Dausa, Rajasthan)
- Dr. Pankaj Suthar, District Project Coordinator (Rajsamand, Rajasthan)
- Dr. Chetan Purad, State Technical Consultant, Telangana
- Dr. Vikram Reddy, District Project Coordinator (Mahbubnagar, Telangana)
- Dr. Rajesh Kumar Dandi, District Project Coordinator (Medak, Telangana)