Impact of the <i>Ananya</i> program on reproductive, maternal, newborn and child health and nutrition in Bihar, India: early results from a quasi-experimental study.
Gary L. Darmstadt, Yingjie Weng, Kevin T Pepper, Victoria Ward, Kala M. Mehta, Evan Borkum, Jason Bentley, Hina Raheel, Anu Rangarajan, Debarshi Bhattacharya, Usha Kiran Tarigopula, Priya Nanda, Swetha Sridharan, Dana Rotz, Suzan L. Carmichael, Safa Abdalla, Wolfgang Munar
Abstract
BACKGROUND: program aimed to support the GoB to improve reproductive, maternal, newborn and child health and nutrition (RMNCHN) statewide. Here we summarise changes in indicators attained during the initial two-year pilot phase (2012-2013) of implementation in eight focus districts of approximately 28 million population, aimed to inform subsequent scale-up. METHODS: interventions were not implemented. We analysed changes in indicators across the RMNCHN continuum of care from baseline to midline in intervention and comparison districts using a difference-in-difference analysis. RESULTS: program was found for 10% (five of 51) of RMNCHN indicators. Positive impacts were most prominent for mother's behaviours in contraceptive utilisation. CONCLUSIONS: using theory-informed, equity-sensitive (including gender), mixed-methods approaches can help elucidate causality and better explain pathways through which supply- and demand-side interventions contribute to changes in behaviour among the actors involved in the production of population-level health outcomes. Evidence from Bihar indicates that deep structural constraints in health system organisation and delivery of interventions pose substantial limitations on behaviour change among health care providers and beneficiaries. STUDY REGISTRATION: ClinicalTrials.gov number NCT02726230.