India has the highest number of child deaths in the world. An estimated 1.2 million children under the age of five died in 2015. Of these deaths, 12 percent were caused by diarrhea and 23 percent by pneumonia—a situation caused in part by poor access to health facilities, especially among marginalized populations, and a lack of quality care at health facilities.
Improving Child Health through Measurement, Learning, and Evaluation
In Uttar Pradesh and Bihar, two Indian states with particularly high child mortality rates, the Gates Foundation worked to reduce child deaths by improving the quality and availability of child health services, particularly for pneumonia and diarrhea.
Under Research and Evaluation for Action in Child Health (REACH), we supported the measurement, learning, and evaluation (MLE) of these efforts. We worked closely with the project’s implementing partners—the University of Manitoba in Uttar Pradesh and CARE in Bihar—to measure progress towards objectives and develop evidence to help modify and adapt the program’s interventions so they are most effective.
Our goal was to learn how to increase access to quality child health care in order to save lives from these two preventable and treatable illnesses.
Evaluating Impact at Multiple Levels
REACH conducted an impact evaluation using a quasi-experimental research design. Our surveys adapted to changing program interventions, investigating whether these interventions affected
- Quality of care provided in health facilities
- Knowledge, attitudes, and skills of facility-based health providers and frontline health workers
- Ways that caregivers seek care for their children.
A team that functions independent of the survey team assessed the data to ensure its high quality.
In late 2016, REACH India completed baseline surveys in Uttar Pradesh and Bihar. Major findings revealed that
- When it comes to caring for an ill child, frontline health workers know proper protocols, but don’t always carry these out. This is called the “know-do” gap.
- Many providers at health facilities lack the knowledge and assessment skills to manage pneumonia and diarrhea.
Sharing Results to Reduce Child Deaths
We disseminated and discussed these findings with implementing partners and donors. As a result, project implementers were able to modify and refine their interventions, shifting focus from frontline health workers to health facilities. They also began conducting skills-based training, particularly targeted towards addressing the “know-do" gap among health care providers.
REACH India’s approach was unique. Embedding independent learning and evaluation objectives into a project is not a usual practice, but we found that this approach helps to increase acceptance of and action based on survey findings. REACH staff worked directly with project implementers, enabling the MLE team to track program changes and adapt the MLE approach to effectively measure the impact of the intervention.
To help maximize the impact of our work on children’s health in India, we also shared findings with government officials, donors, nongovernmental organizations, and other stakeholders focused on child health.
Our MLE efforts in support of REACH included another round of surveys and analysis at the project’s midpoint, followed by a final evaluation in 2018. Ultimately, with robust evidence on the effectiveness of interventions, health facilities and providers in Bihar and Uttar Pradesh will be better able to reduce child mortality rates and safeguard the health of children across the two states.