222 extractive question-and-answer pairs built from Tamil Nadu Exemplars State Report, published by nhsrcindia.org. Every answer is a verbatim span of text the source prints, and each row carries the passage it sits in, its offset in that passage, the source quote, the page and the location in the document, so any row can be checked against the original. 94 of the 222 pairs (42.3%) are explanatory questions and 128 restate a figure. 99.55% of rows pass the corpus quality gate.
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Strong coverage with minor gaps in documentation or freshness.
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First 10 of 222 rows
| question | answer | context | answer_start | question_type | knowledge_quality_score | source_quote | source_page | source_location | confidence | validation_status |
|---|---|---|---|---|---|---|---|---|---|---|
| What was the basis for the selection process using AARCs in maternal and neonatal mortality during 2000-17? | 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 does Stage V represent in terms of maternal and neonatal mortality? | the lowest possible maternal and neonatal mortality, wherein mothers and newborns have universal access to high quality care and (almost) all preventable deaths are eliminated | Populations move across stage 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 care and (almost) all preventable deaths are eliminated. During 2000-18, Tamil Nadu has transitioned from stage II to stage IV, achieving a three-fold reduction in maternal mortality and a four-fold reduction in neonatal mortality (Figure 5). | 285 | definition | 1.000 | Stage V is the lowest possible maternal and neonatal mortality, wherein mothers and newborns have universal access to high quality care and (almost) all preventable deaths are eliminated. | 18 | page=18,block=2 | 0.850 | valid |
| Which study aims to document factors associated with reductions in maternal and neonatal mortality over the past two decades? | The Exemplars in Maternal and Newborn Health Study | The Exemplars in Maternal and Newborn Health Study documents factors associated with rapid reductions in maternal and neonatal mortality over the past two decades. This international effort aims to understand positive outliers and inform policy and practice. India was selected as one of seven “Exemplar” countries and within India the analysis was extended to examine higher- and lower-mortality state clusters separately, and to closely look at six exemplary states: Maharashtra, Tamil Nadu, Rajasthan, Odisha, Uttar Pradesh, and Madhya Pradesh. This report presents the Tamil Nadu sub-study and provides background information on the broader India study and research methodology. Key findings for Tamil Nadu are as follows: Tamil Nadu made major progress in reducing maternal and neonatal mortality between 2000 and 2018. | 0 | definition | 1.000 | The Exemplars in Maternal and Newborn Health Study documents factors associated with rapid reductions in maternal and neonatal mortality over the past two decades. | 9 | page=9,block=2 | 0.700 | |
| What is the focus of the Exemplars in maternal and newborn health study? | 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. | 122 | 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. | 11 | |||
| What are the mechanisms governments use to improve 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 factors at the proximate level affect the survival of mothers and newborns? | the coverage of interventions at promotive, preventive, and curative levels | Contextual factors at the intermediate level include the household and individual-level characteristics, including material circumstances (such as household assets and income), behavioural norms and decision- making, and health status/need of the women and babies concerned, which are seen to affect intervention coverage and mortality outcomes directly or indirectly. These distal and intermediate factors are conceptualized as influencing the proximate factors, namely the coverage of interventions at promotive, preventive, and curative levels. This includes quality-adjusted coverage, and the degree that these are equitable between socio-economic groups and geographical regions. Coverage of interventions is considered most directly associated with a positive impact on maternal and newborn survival. | 471 | definition | 1.000 | These distal and intermediate factors are conceptualized as influencing the proximate factors, namely the coverage of interventions at promotive, preventive, and curative levels. | 12 | page=12,block=1 | 0.700 | |
| What is a distinctive aspect of Tamil Nadu's public health management system? | the Directorate of Public Health | All facilities Public facilities Private facilities All facilities Public facilities Private facilities All facilities Public facilities Private facilities Institutional delivery C-section delivery Vaginal delivery Out -of-pocket cost (in INR 1000) 2015-16 (adjusted for inflation to 2020 value) 2019-21 Human resources for health Tamil Nadu has a unique public health management structure – the Directorate of Public Health – that has enabled integrated, primary health care oriented public health management by experienced and highly trained public health professionals and technical experts Tamil Nadu has invested in public medical colleges where students are accepted based on merit, thus increasing the supply of middle class, service-oriented doctors The state was also the first to incentivize doctors to work in rural government facilities by posting medical students to PHCs and reserving post graduate training seats for “in-service” government candidates A fundamental driver of Tamil Nadu’s success in MNH is the longstanding Directorate of Public Health (DPH) cadre in government. | 394 | definition | 1.000 | All facilities Public facilities Private facilities All facilities Public facilities Private facilities All facilities Public facilities Private facilities Institutional delivery C-section delivery Vaginal delivery Out -of-pocket cost (in INR 1000) 2015-16 (adjusted for inflation to 2020 value) 2019-21 Human resources for health Tamil Nadu has a unique public health management structure – the Directorate of Public Health – that has enabled integrated, primary health care oriented public health management by experienced and highly trained public health professionals and technical experts | ||||
| What strategy did the state use to tackle specific health challenges? | Specific solutions for specific problems | The state’s leadership drove progress on maternal and newborn survival through targeted interventions and an ethos of constant improvement. “Specific solutions for specific problems” ensured that the state used data to identify areas of greatest need (e.g., high mortality among tribal areas, high rates of adolescent pregnancy) and then developed strategies to address these issues in a targeted manner. The ethos of “constant improvement” created a work culture wherein officials responded rapidly to issues and continuously sought new ways to build onto success. Several examples were provided by experts: Hospital blood banks and labour wards were often too far apart, resulting in a delay of up to 30 minutes to walk between these areas. The state developed and implemented a policy to store blood right next to labour rooms. | 141 | definition | 1.000 | “Specific solutions for specific problems” ensured that the state used data to identify areas of greatest need (e.g., high mortality among tribal areas, high rates of adolescent pregnancy) and then developed strategies to address these issues in a targeted manner. | 36 | page=36,block=7 | ||
| What issue do referral audits focus on addressing? | delays in timely referrals for emergencies | operating theaters. The state’s NHM Director was personally notified within 24 hours of any maternal death. Recently, WhatsApp has been used for immediate (same day) reporting of maternal deaths to the DPH and other officials. Referral audits address delays in timely referrals for emergencies and “near miss” audits now examine how to improve maternal health and avoid severe life-threatening complications. High risk pregnant and postpartum women and newborns are closely tracked in Tamil Nadu. Infants using the SNCU are tracked through an online database by the state nodal person, the obstetrician, and a public health official; the state health secretary and even minister also sometimes track infants. | 251 | definition | 1.000 | Referral audits address delays in timely referrals for emergencies and “near miss” audits now examine how to improve maternal health and avoid severe life-threatening complications. | 38 | page=38,block=1 | 0.700 | valid |
| What is Tamil Nadu? | the first state to introduce a maternity benefit program of cash and in-kind goods transfer for poor women | Tamil Nadu was the first state to introduce a maternity benefit program of cash and in-kind goods transfer for poor women. The Dr. | 15 | definition | 0.980 | Tamil Nadu was the first state to introduce a maternity benefit program of cash and in-kind goods transfer for poor women. | 38 | page=38,block=9 | 0.850 | valid |
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| valid |
| page=11,block=0 |
| 0.700 |
| valid |
| valid |
| valid |
| 33 |
| page=33,block=21 |
| 0.700 |
| valid |
| 0.700 |
| valid |