This project is an exploratory study to test out the merit in and need of the ASER approach used in the education sector to the health sector in India. The first phase of this work was focused on getting experts from the field of policy, practice and research together to discuss the feasibility and need of ASER approach in health sector, which, unlike the education sector, has always had a focus on outcome measures.
The basic question brainstormed was:“Based on the ASER approach, are there any measurable and actionable indicators in health that can be identified to enable ordinary people to get involved in assessments at scale?”The enquiry areas for the study were selected as :
- Mother and Infant and Young Child Food, Nutrition and Health (MIYCN) (for children below 1 year of age)
-Adolescent Health and Nutrition
Assessing not just “what” people do or don’t do but also “why” was decided as actionable pathways to better implementation of social sector programs and performance indicators. Hence the key dimensions which were covered included:
Knowledge: What do people know about the issue/s. This is to identify gaps in the knowledge of the best practices
Practice: What people do and Why? What are the actual practices that people follow in their day-to- day life and why?
Access: Are people aware of the relevant services- policy provisions? Do they access them? Why (or why not)? Identifying the level of participation.
Duration: 2016 - Present
Partners: Bill and Melinda Gates Foundation
Location: One district each in two states – Rajasthan and UP were selected as the survey states.
Project Update: The preliminary phase consisted of extensive literature review, designing the framework and defining the enquiry areas. Post this phase, five pilot exercises were conducted across Rajasthan and UP. Feedback and experiences of the field staff were taken into consideration post each pilot and incorporated into the final development of the survey tool.
From August- October 2017, district level surveys of 60 villages each in Jaipur, Rajasthan and Rai Bareilli, Uttar Pradesh, were conducted. The team is in the process of analyzing the data and generating a district level report card for the same.
This phase is the first step in understanding the application of ASER approach to health. Learnings from this phase will help feed into how and if this should be taken forward. The hope is that this might pave the way for an independent ASER type citizen led assessment surveys in one or all of decided health domains among one or all the target groups being looked at now.
The aim of this study is to develop and test scalable interventions that promote child development and ultimately improve adult outcomes, thereby breaking the cycle of poverty.
The study consists of two projects, both of which implement a stimulation programme that focuses on improving the interactions between mothers or principal caregivers and their infants/children. The programme follows a systematic, weekly curriculum based on the natural developmental stages of a child. The curriculum was originally developed and tested by Sally Grantham-McGregor and colleagues in Jamaica, and has been shown to improve cognitive and socio-emotional outcomes from childhood through adulthood.
The second and larger study combines stimulation with nutrition communication and will focus on informing and training mothers/caregivers in sound infant and young child feeding practices that have been known to play a crucial role in under-nutrition. In this study, we will test alternative service provisions, which include delivery of the curriculum by local women. The interventions will be accompanied by an evaluation based on a randomized control trial.
This is a small-scale pilot implemented by Pratham in Cuttack and will deliver to the treatment communities a one-year stimulation programme involving weekly home visits delivered by local women. The programme will cover 400 children between 1 and 2 years of age at the start of the intervention. Evaluation will take place based on a randomised control trial where 54 communities will be divided equally into treatment and control.
Partners: UCL, IFS, J-Pal, ICDDR-B, Pratham Education Foundation-ASER Centre, CECED and Yale University.
Location: Cuttack, (urban slums) - Odisha
The second project is a large-scale trial implemented in three districts in Odisha. For evaluation purposes the communities are randomly allocated to three treatment arms and a control group. Two of the treatment arms combine nutrition communication with: i) stimulation by home visiting; or ii) stimulation by group intervention. The third treatment arm includes only nutritional communication. The intervention will last for two years.
Duration: 2013 - 2018
Partners: Yale University, NIH, IFS, University of Pennsylvania, Pratham Education Foundation - ASER Centre, CECED, J-Pal
Location: 200 communities in Balasore, Balangir and Cuttack (rural) - Odisha
Project update: A multi-partner, collaborative early years research study has been underway in Odisha since 2013. A stimulation program was delivered to the treatment communities in Cuttack by Pratham as part of the initial pilot phase. This was delivered through weekly home visits by local women in urban slums of Cuttack.
In the second phase, a large-scale RCT was rolled out where Pratham Odisha implemented an early stimulation and nutrition programme. The intervention was delivered through home visits and a group model. The first phase of trainings has been completed and intervention has rolled out. This coincided with a collaborators meet-up during the second week of February, 2016. During the meeting, collaborators reviewed progress and discussed the way forward. Field visits were made to the implementation sites in Odisha. The completion of the second phase was followed by a meeting in New Delhi during which preliminary results from the urban pilot phase were discussed and observations from the current roll-out were consolidated. In May 2016, the next phase of training district-level mentors was rolled out, followed by home visits in the months of June and July 2016.Concepts were refreshed and an additional curriculum for stimulation was introduced. A variety of interactive nutrition and health-based games and activities were introduced to involve the caregivers through weekly visits. For more information, read the ECD baseline report.
In the last phase of mentor trainings, fundamental concepts were revised and an additional stimulation curriculum was introduced. Strategies to improve and sustain the attendance of mothers in group sessions and ways to bridge the gap in delivery of nutrition supplementation services for children were discussed. This will be followed by a third round of trainings of home visitors and group facilitators in the districts over June 2017.
Endline survey preparations commenced in August leading to training of surveyors. The intervention will wrap up by December-January post which the endline survey will begin.
Globally and in India, access to vaccination is lower for children from less educated families and communities. The objective of the Leveraging Literacy for Immunization project is to enhance equitable access to vaccines in underserved communities in India.
Based on approaches pioneered by Pratham and ASER Centre, the project team will develop effective grassroots communication approaches to improve the availability of vaccines in low-literacy populations, and to develop strategies for community-based monitoring and advocacy to improve demand for immunisation services.
ASER Centre partnered in a winning Grand Challenges Explorations grant which was awarded to The University of Montreal Hospital Research Centre (CRCHUM).The grant was awarded by the Bill and Melinda Gates Foundation.The details of this partnership are available here.
Duration: November 2012- May 2014
Partners: Bill and Melinda Gates Foundation, University of Montreal Hospital Research Centre (CRCHUM), Pratham
Location: Hardoi (UP) & Delhi
Highlights: Authors Mira Johri, Dinesh Chandra, S.V. Subramanian, Marie-Pierre Sylvestre and Smriti Pahwa closely examine the Millennium Development Goal target, 7c that promises to halve the proportion of the population without sustainable access to safe drinking water and basic sanitation. Read The Lancet, Volume 383, Issue 9926, published on April 19, 2014. The paper has received wide media coverage (The Hindu,Times of India,Sanitation & Water for All) since its publication.The authors have also published papers in the Journal of Epidemiology and Community Health on the association between maternal health literacy and child vaccination in India and in the WHO Bulletin on strategies to increase the demand for childhood vaccination in low and middle-income countries.
Vaccination is one of the most effective, available medical interventions and of critical importance to child survival.Among all countries, India has the highest absolute number of un-vaccinated children and a relatively poor system performance.
The project aims to: 1) Use a participatory approach to create and assess health communication material at the grassroots level; 2) Build capacity of the core NGO staff; and 3) Build capacity of the target community through integration in the research process.
Duration: 2012 - 2014
Partners: International Health Unit, University of Montreal (CHUM)
Location: Delhi, Lucknow (UP), Dadri (UP) & Mumbai (Maharashtra)
Documents: Summary report.
PAHELI seeks to apply the ASER (Annual Status of Education Report) model to other social sectors in order to understand the status of key human development indicators. For basic parameters in education, ASER focuses on whether a child is in school and learning. For other sectors too, the challenge was to identify a key outcome and to develop simple tools,measures and methods to understand the status of that outcome in a given area (whether it be a neighbourhood, hamlet, village, block or district).
PAHELI 2011 is a product of these efforts. It stands for people’s assessment of health, education and livelihoods. The PAHELI framework is built around four key human development domains: Life & Livelihoods, Water & Sanitation, Education & Literacy, Mother and Infant Health & Care. Based on theMilleniumDevelopmentGoalsgoals andonnational priorities, it is a household survey which looks at the provision of basic services at the village level through key central government social schemes and the links of these services to households. The schemes covered are Sarva Shiksha Abhiyan, ICDS, public health services, PDS and MGNREGS. More
Partners: Government of India - United Nations Joint Programme on Convergence (GoI-UNJPC), Planning Commission, Unicef, UNFPA & UNDP.
Location: Udaipur, Bhilwara, Nalanda, Korba, Hardoi, Gumla, Sundargarh and Rajgarh districts