Model Districts Health Project

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 Challenge

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 (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 (UNICEF)
The public health spending is less than 1% 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 advocated and focused on the use of data driven planning at all levels of the health systems to address gaps.

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 was 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 Model Districts Health Project focused on bridging the gap between policy and practice by delineating the reasons why services were not reaching the population, and then supporting the government to strengthen systems and piloting innovations to resolve identified bottlenecks.

The project was embedded at state and district levels to accelerate strengthening of facilities, community-based health systems and service delivery. This required enhancing district level capacity for data-driven planning and management. The project supported and participated in formation of district level strategy and planning and continuous facility improvement in each district through block monitoring. This included the development of the annual District Health Action Plan (DHAP) that was 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 conducted 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 were 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 provided an evidence base for future steps.

The IKEA Foundation generously supported 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 sought 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 was also a designated high-priority district lead for RMNCH+A in designated districts, and worked closely with the state leads (UNFPA, UNICEF, and USAID-MCHIP).