"Integrated Management of Neonatal & Childhood Illness Program and Child Survival" - An IndiaCLEN Programme Evaluation Network (IPEN) Field Trial

While significant gains have been made in bringing down the Infant Mortality Rate (IMR) in India, the decline has hit a plateau in the past decade. Faced with the twin challenge of further bringing down the IMR and making a dent in the neonatal mortality, the IMNCI strategy has emerged as a promising approach to deal with the issues related to child survival in a more holistic manner. However since the implementation of the IMNCI requires training a huge number of health functionaries across the country as well as improvement in the overall health systems, it is only prudent that the relevance, feasibility and effectiveness of this strategy is studied in some detail before its countrywide implementation is effected. The IPEN field trial would study in a comprehensive manner the existing baseline in selected study districts. Thereafter, various processes of implementation of IMNCI and its impact on various child survival and development indices would be concurrently assessed.

The study objectives are to determine the impact of introducing IMNCI at district level on public health systems; skills of the health functionaries; health care seeking practice of family and community; care of children / infants/ newborns and intra- sectoral and inter sectoral coordination (within health and with non- health department); interaction between public and private systems and. indicators of child survival. A total of sixteen districts in eight pairs would be studied. In each pair of districts, the IMNCI program will be implemented in one and the other will serve as the control district. A baseline survey would be carried out in all the sixteen districts in the first year of the trial. Thereafter the process of implementation as well as the impact of IMNCI strategy would be studied in a dynamic manner over the next three years. The impact of IMNCI would be assessed using suitable process, output, medium and long term outcome indicators. The study is funded by UNICEF - India Office and funds for phase-I have already been released.

Evaluation of the "Universal Immunization in India (2004-05)" An IndiaCLEN Program Evaluation Network (IPEN) Study

The present study is a process evaluation of the Universal Immunization Program (UIP) and the Acute Flaccid Paralysis (AFP) Surveillance in India. The focus of the exercise is to understand the management and implementation of program activities at various levels and determine client perspectives. The evaluation is being undertaken in both the good and bad performing regions of the country to determine both the strengths and prevalent barriers of the UIP in deterring program performance in the respective regions.

Several rounds of meetings were held with Secretary (FW), Deputy Commissioner (Child Health) and Assistant Commissioner (Immunization). During these, it emerged that IndiaCLEN and WHO-UNICEF will do a review of UIP. The WHO-UNICEF review will be confined to six EAG states namely Uttar Pradesh, Bihar, Jharkhand, Orissa, Rajasthan and Madhya Pradesh and will provide information about macro-level policy and program related recommendations at national and state level. IPEN review is being conducted in 19 states, which include both good and bad performing states. IndiaCLEN will do the process evaluation and provide recommendation about process of program implementation based on in-depth information obtained at the district level. Thus, both these two evaluations of UIP will provide complementary information. It is expected that the recommendations of these national reviews be considered while preparing guidelines for the multi year plan for UIP.

Dr. NK Arora, Coordinator
CEU-AIIMS