| What criteria were used for selection in the context of maternal and neonatal mortality statistics? | based on SRS data, with its high consistency over time and availability for both indicators | The AARCs in maternal and neonatal mortality during 2000-17 were used as the main statistics for selection. The selection was based on SRS data, with its high consistency over time and availability for both indicators. The National Family Health Survey (NFHS) also provides trend data on neonatal mortality. | 126 | definition | 1.000 | The selection was based on SRS data, with its high consistency over time and availability for both indicators. | 15 | page=15,block=1 | 0.850 | valid |
| What is the goal of the Exemplars in Maternal and Newborn Health study? | to systematically and comprehensively research and document factors associated with rapid reductions in maternal and neonatal mortality | The Exemplars in maternal and newborn health (MNH) study aims to systematically and comprehensively research and document factors associated with rapid reductions in maternal and neonatal mortality over the past two decades in select countries that have experienced more rapid declines than countries with similar socio-economic progress. This study contributes to a Gates Ventures initiative on Exemplars in Global Health, which includes other subject areas such as child mortality, stunting, community health worker programs, and vaccine delivery. The study is an international effort to learn from success and understand positive outliers to inform policy and practice. India has made major progress in improving maternal and newborn health outcomes over the past two decades. | 62 | definition | 1.000 | The Exemplars in maternal and newborn health (MNH) study aims to systematically and comprehensively research and document factors associated with rapid reductions in maternal and neonatal mortality over the past two decades in select countries that have experienced more rapid declines than countries with similar socio-economic progress. |
| What are the mechanisms governments use to enhance maternal and newborn health? | the health policy and system levers | Conceptual framework for the Exemplars MNH study The Exemplars in MNH study was guided by a conceptual framework that was developed to identify the drivers of change, dividing the interrelated factors hierarchically in distal, intermediate, and proximate drivers of maternal and neonatal mortality decline (Figure 1). On the far left of the framework, the health policy and system levers are the tools used by governments to improve MNH specifically, and non-MNH issues that may have an enormous impact on MNH. Government actions include changes in policy, services, and financial resources with direct or indirect linkages to MNH. Direct changes include strategies to strengthen the health system, while indirect changes include efforts to enhance gender equity or infrastructure in underserved parts of the country that would affect MNH outcomes. | 352 | definition | 1.000 | On the far left of the framework, the health policy and system levers are the tools used by governments to improve MNH specifically, and non-MNH issues that may have an enormous impact on MNH. | 12 | page=12,block=1 | 0.700 |
| What was the purpose of adopting the aspirational districts approach in Madhya Pradesh? | “in order to ensure the most disadvantaged have the greater focus in terms of equity” | Madhya Pradesh took a geographically targeted approach to strengthening maternal health care. The state implemented the national government’s aspirational districts approach, “in order to ensure the most disadvantaged have the greater focus in terms of equity” (civil society #1). Under the targeted approach, the state mapped delivery points, their functionality, and population clusters, then introduced additional facilities based on patient loads and distances. This type of needs-based planning was a departure from earlier planning, which often involved political influence or a more unsystematic approach. In terms of financial flexibility, the state implemented a “global budget” system (Government health administration #4) to increase access to allocated funds. Earlier, money was provided by the state to the district, then to the facility. | 175 | definition | 1.000 | The state implemented the national government’s aspirational districts approach, “in order to ensure the most disadvantaged have the greater focus in terms of equity” (civil society #1). | 36 | page=36,block=8 |
| What is the guiding principle behind Madhya Pradesh's health approach? | “Jan Bhagidari” or “the responsibility of the people.” | Community participation and demand generation Community level awareness about maternity benefit entitlements is especially high in Madhya Pradesh Complaint grievance redressal systems have created pathways for women to demand access to their maternity benefit and to raise complaints about health care The communitization features of the NRHM/NHM, particularly the ASHA program, have been essential to Madhya Pradesh’s progress Madhya Pradesh’s motto and a founding principle for their approach to health is: “Jan Bhagidari” or “the responsibility of the people.” This ethos has been interpreted by political leaders to mean that all health issues, from vaccination to maternal health, require community education and buy in. | 515 | definition | 1.000 | Community participation and demand generation Community level awareness about maternity benefit entitlements is especially high in Madhya Pradesh Complaint grievance redressal systems have created pathways for women to demand access to their maternity benefit and to raise complaints about health care The communitization features of the NRHM/NHM, particularly the ASHA program, have been essential to Madhya Pradesh’s progress Madhya Pradesh’s motto and a founding principle for their approach to health is: “Jan Bhagidari” or “the responsibility of the people.” This ethos has been |
| What role was ASHA identified to play under the NRHM? | a link worker between the service provider and community | With the launch of NRHM, the focus was on community participation, and that is why ASHA was identified as a link worker between the service provider and community. (Government health expert #2) I mean, many of us skipped a beat when there were talks about the National Health Mission, the possibility that it may not be renewed or something [chuckles]. So, I think this is one of the major things that has driven a reduction in maternal mortality across the country and I think it is something which needs to stay for a long period for the gains to be consolidated and also improved further. Then, of course there have been several hallmark programmes at the national level which have helped in this, including the ASHA program. (Civil society #1) The ASHAs role in demand generation for ANC and institutional delivery was particularly emphasized in tribal areas. | 106 | definition | 1.000 | With the launch of NRHM, the focus was on community participation, and that is why ASHA was identified as a link worker between the service provider and community. | 39 | page=39,block=1 | 0.700 |
| What is Stage V? | the lowest possible maternal and neonatal mortality, wherein mothers and newborns have universal access to high quality are and (almost) all preventable deaths are eliminated | Populations move across stages II, III and IV as access to health services increases, quality improves, inequality patterns change from top to bottom inequality, infectious diseases and peri-partum conditions decrease in importance as causes of death, and fertility decline. Stage V is the lowest possible maternal and neonatal mortality, wherein mothers and newborns have universal access to high quality are and (almost) all preventable deaths are eliminated. During 2000-18, Madhya Pradesh has transitioned from stage I to late stage II, achieving a nearly two-fold reduction in maternal mortality and reducing the neonatal mortality by half (Figure 5). | 286 | definition | 0.980 | Stage V is the lowest possible maternal and neonatal mortality, wherein mothers and newborns have universal access to high quality are and (almost) all preventable deaths are eliminated. | 18 | page=18,block=34 | 0.850 | valid |
| What is Madhya Pradesh? | the first state to introduce a district level call centre that controlled a fleet of vehicles | In 2013 Madhya Pradesh introduced free referral transportation with the support of UNICEF. Madhya Pradesh was the first state to introduce a district level call centre that controlled a fleet of vehicles. Subsequently, the state added an integrated call centre at the state level. | 110 | definition | 0.980 | Madhya Pradesh was the first state to introduce a district level call centre that controlled a fleet of vehicles. | 32 | page=32,block=1 | 0.850 | valid |
| What is District Collector? | made responsible for encouraging year-round blood donations | This district leadership also facilitated coordination between health and women and child development, since the District Collector and District Magistrate would oversee programs under both departments. The District Collector was made responsible for encouraging year-round blood donations. | 230 | definition | 0.980 | The District Collector was made responsible for encouraging year-round blood donations. | 36 | page=36,block=1 | 0.850 | valid |
| What does AARC stand for? | Average Annual Rate of Change | v AARC Average Annual Rate of Change AIIMS All India Institute of Medical Sciences ANC Antenatal Care ANCq Antenatal Care with Content ANM Auxiliary Nurse Midwife ASHA Accredited Social Health Activist AWW Anganwadi Worker BMI Body Mass Index CDPO Child Development Project Officer CHC Community Health Center CM Chief Minister CMHO Chief Medical Health Officer CSSM Child Survival and Safe Motherhood CTPO Chief Technical and Product Officer DBT Direct Benefit Transfer DLHS District Level Household Survey DHS Directorate of Health Services EmOC Emergency Obstetric Care FRU First Referral Unit GBDS Global Burden of Disease Study HIV Human Immunodeficiency Virus HMIS Health Management Information System HMS Higher Mortality States ICU Intensive Care Unit IHAT India Health Action Trust IIPS International Institute for Population Sciences INR Indian Rupee JSSK Janani Shishu Suraksha Karyakaram JSY Janani Suraksha Yojana KII Key Informant Interview LB Live Birth LMS Lower Mortality States LPG Liquefied Petroleum Gas LSAS Life-Saving Anesthesia Skills MCEE Maternal and Child Epidemiology Estimation MCTS Mother and Child Tracking System ABBREVIATIONS ACRONYMS | 7 | definition | 0.980 | v AARC Average Annual Rate of Change AIIMS All India Institute of Medical Sciences ANC Antenatal Care ANCq Antenatal Care with Content ANM Auxiliary Nurse Midwife ASHA Accredited Social Health Activist AWW Anganwadi Worker BMI Body Mass Index CDPO Child Development Project Officer CHC Community Health Center CM Chief Minister CMHO Chief Medical Health Officer CSSM Child Survival and Safe Motherhood CTPO Chief Technical and Product Officer DBT Direct Benefit Transfer DLHS District Level Household Survey DHS Directorate of Health Services EmOC Emergency Obstetric Care FRU First Referral Unit |