Training manual on basic monitoring and evaluation of social and behavior change communication health programs

Social and behavior change communication (SBCC) interventions are key for addressing social and cultural barriers and achieving goals laid out for health programs. Often these interventions are not evidence based and monitoring and evaluation (M&E) is limited. Lack of trained and skilled human resources for M&E has been a limitation in general. A serious effort is needed to build the capacity of M&E personnel to monitor and evaluate performance of SBCC interventions in terms of reach and effectiveness among intended audiences. The Improving Healthy Behaviors Program of FHI360 aims to provide technical assistance to strengthen capacities to monitor and evaluate SBCC intervention for maternal health, family planning, tuberculosis, and HIV/AIDS of public program managers at national, state, and district levels. The Population Council will train a cadre of master trainers on M&E of SBCC activities at the national and state level who would further build capacity of human resources responsible for M&E of SBCC activities at the district level. This training manual has been prepared to address capacity building for M&E of SBCC interventions

Increasing choice of and access to family planning services via outreach in Rajasthan, India

This report documents a service evaluation of Marie Stopes (MS) India’s mobile outreach program in the state of Rajasthan, which was conducted by the Population Council between March and October 2012. This study was made possible through the United States Agency for International Development (USAID)-funded Support for International Family Planning Organizations–Marie Stopes International project. It provides important findings on the safety and effectiveness of MS India’s outreach program in expanding choice and access to long-acting reversible contraception methods and voluntary surgical permanent methods of contraception, as well as recommendations for MS India and other family planning programs to consider in scaling up and strengthening the provision of mobile outreach services. The study demonstrates the safety and effectiveness of providing tubal ligation and IUDS through MS India’s mobile outreach services in the state of Rajasthan, and the importance of using this service model to increase access and choices for poor men and women living in rural areas

Facilitator\u27s guide for training on monitoring and evaluation of social and behavior change communication health programs

Social and behavior change communication (SBCC) interventions are now incorporated within state project implementation plans and increasing resources are being allocated for SBCC activities. A close monitoring of SBCC activities and an evaluation in terms of reach and effectiveness among intended audiences is thus necessary. This calls for a serious effort to build the capacity of monitoring and evaluation (M&E) personnel to monitor and evaluate performance of SBCC activities. FHI 360’s Improving Healthy Behaviors Program, funded by USAID, aims to provide technical assistance to strengthen the capacities of public program managers at the national, state, and district level to monitor and evaluate SBCC interventions for health. This Facilitator’s Guide, designed for a three-day workshop, can be used to train a cadre of master trainers on M&E of SBCC activities at the national and state levels who would further build the capacity of staff responsible for M&E of SBCC activities within the state at the district level. Depending on the participants—whether program managers, monitoring officers, or evaluators—trainers may modify the emphasis on the content of each of the modules

Contraceptive use dynamics in India: A prospective cohort study of modern reversible contraceptive users

This report highlights the contraceptive use dynamics among 2,699 married women in India who began using one of four reversible contraceptive methods over one year. Women aged 15-49 were enrolled into the study from Odisha and Haryana states within one month of starting their reversible method—interval intrauterine device (IUD), postpartum IUD (PPIUD), injectable contraceptive, or oral contraceptive pill (OCP)—and were interviewed at four time points: at enrollment into the study, and three, six, and 12 months after enrollment. Study findings include the quality of care received at the time of method adoption, experience and management of side effects, reasons for discontinuation of the enrollment method, dynamics of contraceptive use after one year, changes in fertility preferences, and the method-specific experiences related to contraceptive use and pregnancy over the course of the study. The findings from this study will be useful to program designers, policymakers, and health care professionals in delivering voluntary family planning services in India

Civil society involvement in family planning: A review of global programming and evidence

Civil society plays an important role in the provision of high quality family planning programs. Civil society organizations (CSOs) are often involved in expanding services, raising awareness, generating demand, and advocating for an improved enabling environment to ensure women and men have full, free and informed choice to determine whether and when they have children. Despite being a valued partner in many programs, there is little evidence on the contribution that CSOs have made to family planning and reproductive health (FP/RH) programs in terms of the types of activities undertaken and the impact that they can have. This review summarizes the evidence on civil society’s engagement in improving family planning programs and highlights the possible opportunities to further strengthen civil society engagement in family planning programs

Understanding demand for family planning and reproductive health services through the Indian National Health Insurance Scheme in Uttar Pradesh

The Indian National Health Insurance Scheme, Rashtriya Swasthya Bima Yojana (RSBY), was launched by the Ministry of Labour and Employment in 2008 to promote equitable access to health services through the private and public sectors. This scheme is intended to offer economically disadvantaged families living below the poverty line in urban and rural areas access to a pre-specified package of health services including: general surgery, general medical care, pediatric care, gynecological care, family planning (FP) and other reproductive health (RH) services, dental, ophthalmology, urology, neurosurgery, and oncology. Almost eight years into the program, this is an opportune time to examine usage levels and barriers and facilitators to the program’s effectiveness. The Evidence Project conducted a study among the urban poor in Uttar Pradesh to look at awareness and use of RSBY for FP/RH services, understand concerns of those administering the program and providing services, and provide programmatic recommendations for improvement

Care-seeking behaviors for maternal and newborn illnesses among self-help group households in Uttar Pradesh, India

Background: India has made large strides in reducing maternal mortality ratio and neonatal mortality rate, yet care-seeking behavior for appropriate care is still a challenge. We conducted a qualitative study to understand the process of recognition and care-seeking for maternal and newborn illnesses in rural India where a health intervention through women\u2019s self-help groups (SHG) to improve maternal and newborn health behaviors is implemented by a non-governmental organization, the Rajiv Gandhi Mahila Vikas Pariyojana. The study aimed to understand the process of recognition and care-seeking for maternal and newborn illnesses from SHG and non-SHG households in the intervention area. Methods: Thirty-two illness narratives, 16 of maternal deaths and illness and 16 of newborn illnesses and deaths, were conducted. Women, their family members, and other caretakers who were present during the event of illness or death were included in the interviews. About 14 key informants, mainly frontline health workers (FLWs), were also interviewed. The interviews were conducted by two Population Council staff using a pre-tested guideline in Hindi. Results: Our findings suggest that perceptions of causes of illness as \u201csupernatural\u201d or \u201cmedical\u201d and the timing of onset of illness influence the pathway of care-seeking. Deep-rooted cultural beliefs and rituals guided care-seeking behavior and restricted new mothers and newborns\u2019 mobility for care-seeking. Though families described experience of postpartum hemorrhage as severe, they often considered it as \u201cnormal.\u201d When the onset of illness was during pregnancy, care was sought from health facilities. As the step of care for maternal illness, SHG households went to government facilities, and non-SHG households took home-based care. Home-based care was the first step of care for newborn illnesses for both SHG and non-SHG households; however, SHG households were prompt in seeking care outside of home, and non-SHG households delayed seeking care until symptoms were perceived to be severe. Conclusion: Our findings indicate that care-seeking behavior for maternal and newborn morbidities could be improved by interventions through social platforms such as SHGs

Shaping Demand and Practices to Improve Family Health Outcomes: Findings from a Quantitative Survey, Volume 3: Bihar

This report provides findings of a study undertaken to generate comprehensive information on eight target behaviors that have direct bearing on family health in rural Bihar. Behaviors include: 1) Increasing the proportion of deliveries that occur in a facility and mothers who have access to basic emergency obstetric care; 2) Increasing the proportion of safe deliveries at home; 3) Increasing the uptake of preventive postnatal-care services for newborns and mothers; 4) Increasing the practice of skin-to-skin care/Kangaroo Mother Care for newborns; 5) Increasing the practice of early and exclusive breastfeeding of infants during the first six months of life; 6) Increasing the proportion of children (6–23 months) who receive appropriate complementary feeding; 7) Increasing the uptake of postpartum family planning methods to adequately space births; 8) Increasing the rate of compliance for recommended schedules of child immunization. Objectives were to: assess the present status of each of the behavior targets, identify the key barriers and facilitating factors to the adoption of these health behaviors, suggest how findings could be utilized for developing a BCC comprehensive strategy. This study generated information that could be used to develop a comprehensive communication strategy

Addressing supply side factors to improve family planning and reproductive health services in the Indian National Health Insurance Scheme in Uttar Pradesh

The Indian National Health Insurance Scheme, Rashtriya Swasthya Bima Yojana (RSBY), was launched by the Ministry of Labour and Employment, Government of India in 2008 to promote equitable access to health services through the private and public sectors. Almost eight years into the program, it was an opportune time to examine usage levels and barriers and facilitators to the program’s effectiveness. The Evidence Project conducted a study among the urban poor in Uttar Pradesh to look at awareness and use of the RSBY program and family planning/reproductive health (FP/RH) services, examine concerns of those administering the program and providing services, and provide programmatic recommendations for improvement. This study identified several supply side factors of the insurance scheme that hinder knowledge of and access to services, including FP/RH services, among enrollees and potential enrollees, some of which are highlighted in this study brief

Utilization of national health insurance for family planning and reproductive health services by the urban poor in Uttar Pradesh, India

In 2008, the Government of India launched the National Health Insurance Scheme, Rashtriya Swasthya Bima Yojana (RSBY), to enable families living below the poverty line in both urban and rural areas to access a range of private health services. The available evidence suggests several limitations and barriers that may affect the utilization of RSBY services and warrants a more in-depth examination of the contexts of family planning/reproductive health (FP/RH) services. The Population Council, under the Evidence project, conducted a study among the urban poor to: 1) determine RSBY awareness and barriers to enrollment; 2) identify barriers and facilitating factors to utilizing RSBY for FP/RH services; 3) assess the concerns and limitations of administrators and providers at RSBY-empaneled private hospitals for providing FP/RH services under RSBY; and 4) provide programmatic recommendations to improve the delivery and utilization of RSBY for various FP/RH services. Based on the results of this study, this report suggests a number of programmatic recommendations to improve the supply-side and demand-side barriers of the RSBY program, including for FP/RH services