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Papers by kultar singh

Indian Journal of Community Health

Background: To improve coverage of key child health community practices, Home Based Infant Care (... more Background: To improve coverage of key child health community practices, Home Based Infant Care (HBNC+) was implemented with support of Norway India Partnership Initiative (NIPI) in 4 States of Rajasthan, Madhya Pradesh, Bihar and Odisha. The innovation aimed at improving coverage of key child health interventions through home visits by community health worker, Accredited Social Health Activist (ASHA). Aims & Objective: This paper elucidates the results from the assessment of implementation in intervention versus control districts of Rajasthan. Material & Methods: A cross-sectional intervention-control design with a sample size of 3211 mothers of children in age group 0 to 23 months was adopted. Results: 85 percent of the children (aged 3-23 months) received at least one infant care home visit in the intervention districts in comparison to 32 percent in control. Significant improvements were found in terms of exclusive breastfeeding, weighing and Iron Folic Acid (IFA) consumption ...

PLOS ONE, 2021

Background Quality of care in family planning traditionally focuses on promoting awareness of the... more Background Quality of care in family planning traditionally focuses on promoting awareness of the broad array of contraceptive options rather than on the quality of interpersonal communication offered by family planning (FP) providers. There is a growing emphasis on person-centered contraceptive counselling, care that is respectful and focuses on meeting the reproductive needs of a couple, rather than fertility regulation. Despite the increasing global focus on person-centered care, little is known about the quality of FP care provided in low- and middle- income countries like India. This study involves the development and psychometric testing of a Quality of Family Planning Counselling (QFPC) measure, and assessment of its associations with contraceptives selected by clients subsequently. Methods We analyzed cross-sectional survey data from N = 237 women following their FP counselling in 120 public health facilities (District Hospitals and Community Health Centers) sampled across t...

Data produced as part of a study to evaluate the impact of the Matrika social franchising model –... more Data produced as part of a study to evaluate the impact of the Matrika social franchising model – a multi-faceted intervention that established a network of private providers and strengthened the skills of both public and private sector clinicians – and determine whether it has improved the quality and coverage of health services along the continuum of care for maternal, newborn and reproductive health in Uttar Pradesh, India. The datasets cover two rounds of a household survey, performed in January 2015 and May 2016, of women who had recently given birth.

PLOS ONE, 2020

Background India suffers some of the highest maternal and neonatal mortality rates in the world. ... more Background India suffers some of the highest maternal and neonatal mortality rates in the world. Intimate partner violence (IPV) can be a barrier to utilization of perinatal care, and has been associated with poor maternal and neonatal health outcomes. However, studies that assess the relationship between IPV and perinatal health care often focus solely on receipt of services, and not the quality of the services received. Methods and findings Data were collected in 2016-2017 from a representative sample of women (15-49yrs) in Uttar Pradesh, India who had given birth within the previous 12 months (N = 5020), including use of perinatal health services and past 12 months experiences of physical and sexual IPV. Multivariate logistic regression models assessed whether physical or sexual IPV were associated with perinatal health service utilization and quality. Reports of IPV were not associated with odds of receiving antenatal care or a health worker home visit during the third trimester, but physical IPV was associated with fewer diagnostic tests during antenatal visits (beta =-0.30), and fewer health topics covered during home visits (beta =-0.44). Recent physical and recent sexual IPV were both associated with decreased odds of institutional delivery (physical IPV AOR 0.65; sexual IPV AOR 0.61), and recent sexual IPV was associated with leaving a delivery facility earlier than recommended (AOR = 1.87). Neither form of IPV was associated with receipt of a postnatal home visit, but recent physical IPV was associated with fewer health topics discussed during such visits (beta =-0.26). Conclusions In this study, reduced quantity and quality of perinatal health care were associated with recent IPV experiences. In cases where IPV was not related to care receipt, IPV remained

BMC Pregnancy and Childbirth, 2020

Background This study aims to explore the potential association between unintended pregnancy and ... more Background This study aims to explore the potential association between unintended pregnancy and maternal health complications. Secondarily, we test whether antenatal care (ANC) and community health worker (CHW) visits moderate the observed association between unintended pregnancy and maternal health complications. Methods Cross sectional data were collected using a multistage sampling design to identify women who had a live birth in the last 12 months across 25 highest risk districts of Uttar Pradesh (N = 3659). Participants were surveyed on demographics, unintendedness of last pregnancy, receipt of ANC clinical visits and community outreach during pregnancy, and maternal complications. Regression models described the relations between unintended pregnancy and maternal complications. To determine if receipt of ANC and CHW visits in pregnancy moderated associations between unintended pregnancy and maternal complications, we used the Mantel-Haenzel risk estimation test and stratified...

Journal of Global Health Reports, 2020

Background This paper examines associations between family support and community respect as perce... more Background This paper examines associations between family support and community respect as perceived by community health workers, and their productivity and maternal health care utilization in India. Methods We conducted cross-sectional surveys with the community health workers, known as accredited social health activists (ASHA) and her clients, women with a child aged one year or less. The data were matched and merged for dyadic analysis. ASHA productivity was defined as number of households visited, number of women accompanied to a health facility, and earnings as reported by ASHAs. It also included two variables reported by the clients - number of ASHA visits during the clients’ pregnancy and ASHA visits during postnatal period. Maternal health care utilization included client reports of 4+ antenatal care visits and facility delivery. Husband/family support in domestic work referred to sharing of household responsibilities. Support in ASHA-related work included help in reaching ...

The Lancet Global Health, 2019

Background Report cards are a prominent strategy to increase the ability of citizens to express t... more Background Report cards are a prominent strategy to increase the ability of citizens to express their view, improve public accountability, and foster community participation in the provision of health services in low-income and middle-income countries. In India, social accountability interventions that incorporate report cards and community meetings have been implemented at scale, attracting considerable policy attention, but there is little evidence on their effectiveness in improving health. We aimed to evaluate the effect of report cards, which contain information on village-level indicators of maternal and neonatal health care, and participatory meetings targeted at health providers and community members (including local leaders) on the coverage of maternal and neonatal health care in Uttar Pradesh, India. Methods We conducted a repeated cross-sectional, 2 × 2 factorial, cluster-randomised controlled trial, in which each cluster was a village (rural) or ward (urban). The clusters were randomly assigned to one of four groups: the provider group, in which we shared report cards and held participatory meetings with providers of maternal and neonatal health services; the community group, in which we shared report cards and held participatory meetings with community members (including local leaders); the providers and community group, in which report cards were targeted at both health providers and the community; and the control group, in which report cards were not shared with anyone. We generated these report cards by collating data from household surveys and shared the report cards with the recipients (as determined by their assigned groups) in participatory meetings. The primary outcome was the proportion of women who had at least four antenatal care visits (ie, attended a clinic or were visited at home by a health-care worker) during their last pregnancy. We measured outcomes with cross-sectional household surveys that were taken at baseline, at a first follow-up (after 8 months of the intervention), and at a second follow-up (21 months after the start of the intervention). Analyses were by intention to treat. This trial is registered with ISRCTN, number ISRCTN11070792. Findings We surveyed eligible women for the baseline survey between Jan 13, and Feb 5, 2015. We then randomly assigned 44 clusters to the provider group, 45 clusters to the community group, 45 clusters to the provider and community group, and 44 clusters to the control group. Report cards of collated survey data were provided to recipient groups, as per their random allocation, in October, 2015, and in September, 2016. We ran the first follow-up survey between May 16 and June 10, 2016. We ran the second follow-up survey between June 18 and July 18, 2017. We measured the primary outcome in 3133 women (795 in the provider group, 781 in the community group, 798 in the provider and community group, and 759 in the control group) who gave birth during implementation of the intervention, between Feb 1, 2016, and July 18, 2017 (the end of the second follow-up survey). The report card intervention did not significantly affect the proportion of women who had at least four antenatal care visits (provider vs non-provider: odds ratio 0•85, 95% CI 0•65-1•13; community vs non-community: 0•86, 0•65-1•13). Interpretation Maternal health report cards containing information on village performance, targeted at either the community or health providers, had no detectable effect on the coverage of maternal and neonatal health care. Future research should seek to understand how the content of information and the delivery of report cards affect the success of this type of social accountability intervention. Funding Merck Sharp and Dohme.

PLOS ONE, 2018

Objective To explore intersections of social determinants of maternal healthcare utilization usin... more Objective To explore intersections of social determinants of maternal healthcare utilization using the Classification and Regression Trees (CART) algorithm which is a machine-learning method used to construct prediction models. Methods Institutional review board approval for this study was granted from Public Health Service-Ethical Review Board (PHS-ERB) and from the Health Ministry Screening Committee (HMSC) facilitated by Indian Council for Medical Research (ICMR). IRB review and approval for the current analyses was obtained from University of California, San Diego. Crosssectional data were collected from women with children aged 0-11 months (n = 5,565) from rural households in 25 districts of Uttar Pradesh, India. Participants were surveyed on maternal healthcare utilization including registration of pregnancy (model-1), receipt of antenatal care (ANC) during pregnancy (model-2), and delivery at health facilities (model-3). Social determinants of health including wealth, social group, literacy, religion, and early age at marriage were captured during the survey. The Classification and Regression Tree (CART) algorithm was used to explore intersections of social determinants of healthcare utilization. Results CART analyses highlight the intersections, particularly of wealth and literacy, in maternal healthcare utilization in Uttar Pradesh. Model-1 documents that women who are poorer, illiterate and Muslim are less likely to have their pregnancies registered (71.4% vs. 86.0% in the overall sample). Model-2 documents that poorer, illiterate women had the lowest ANC coverage (37.7% vs 45% in the overall sample). Model-3, developed for deliveries at health

Implementation science : IS, Jan 24, 2018

A prominent strategy to engage private sector health providers in low- and middle-income countrie... more A prominent strategy to engage private sector health providers in low- and middle-income countries is clinical social franchising, an organisational model that applies the principles of commercial franchising for socially beneficial goals. The Matrika programme, a multi-faceted social franchise model to improve maternal health, was implemented in three districts of Uttar Pradesh, India, between 2013 and 2016. Previous research indicates that the intervention was not effective in improving the quality and coverage of maternal health services at the population level. This paper reports findings from an independent external process evaluation, conducted alongside the impact evaluation, with the aim of explaining the impact findings. It focuses on the main component of the programme, the "Sky" social franchise. We first developed a theory of change, mapping the key mechanisms through which the programme was hypothesised to have impact. We then undertook a multi-methods study, ...

The Lancet. Global health, Feb 1, 2018

How to harness the private sector to improve population health in low-income and middle-income co... more How to harness the private sector to improve population health in low-income and middle-income countries is heavily debated and one prominent strategy is social franchising. We aimed to evaluate whether the Matrika social franchising model-a multifaceted intervention that established a network of private providers and strengthened the skills of both public and private sector clinicians-could improve the quality and coverage of health services along the continuum of care for maternal, newborn, and reproductive health. We did a quasi-experimental study, which combined matching with difference-in-differences methods. We matched 60 intervention clusters (wards or villages) with a social franchisee to 120 comparison clusters in six districts of Uttar Pradesh, India. The intervention was implemented by two not-for-profit organisations from September, 2013, to May, 2016. We did two rounds (January, 2015, and May, 2016) of a household survey for women who had given birth up to 2 years previ...

PLoS medicine, 2018

To assess the effect of health information on immunisation uptake in rural India, we conducted an... more To assess the effect of health information on immunisation uptake in rural India, we conducted an individually randomised controlled trial of health information messages targeting the mothers of unvaccinated or incompletely vaccinated children through home visits in rural Uttar Pradesh, India. The study tested a brief intervention that provided mothers face-to-face with information on the benefits of the tetanus vaccine. Participants were 722 mothers of children aged 0-36 months who had not received 3 doses of diphtheria-pertussis-tetanus (DPT) vaccine (DPT3). Mothers were randomly assigned in a ratio of 1:1:1 to 1 of 3 study arms: mothers in the first treatment group received information framed as a gain (e.g., the child is less likely to get tetanus and more likely to be healthy if vaccinated), mothers in the second treatment group received information framed in terms of a loss (e.g., the child is more likely to get tetanus and suffer ill health if not vaccinated), and the third a...

Mathematica Policy Research Reports, 2014

This report summarizes a rigorous randomized evaluation of a teamwork and goal-setting interventi... more This report summarizes a rigorous randomized evaluation of a teamwork and goal-setting intervention in Bihar, India, that uses incentives and lessons from motivational theory to encourage teams of frontline health workers to improve maternal and child health in their communities.

Quantitative Social Research Methods, 2007

Social research covers the entire spectrum of the socio-development sector and is an amalgamation... more Social research covers the entire spectrum of the socio-development sector and is an amalgamation of various research techniques from the fields of economics, project management and other allied subjects. This volume starts with a brief introduction to various development research techniques that are frequently used for making informed social decisions about development action and programmes such as: (i) cost-benefit analysis, (ii) logical framework-approach, (iii) stakeholders' analysis, (iv) social assessment, (v) beneficiary assessment, (vi) social audit, (vii) welfare economics and (viii) game theory. COST-BENEFIT ANALYSIS Cost-benefit analysis (CBA) 1 is based on Jules Dupuit's concept of consumer's surplus theory. It first came to the fore in a study entitled 'On the Measurement of the Utility of Public Works' (Jules Dupuit, 1844). Cost-benefit analysis is a summative measure of analysing net benefits accruing due to project initiation, by identifying the benefits and costs involved in a project. As a framework, CBA helps in analysing the feasibility of a project by enumerating the benefits and costs involved in the project in monetary terms through a well-laid down and established analytical framework. It thus helps planners, policy-makers and implementation agencies to take informed decisions about the financial as well as economic viability of a project by enumerating its social costs and benefits. FINANCIAL VERSUS ECONOMIC ANALYSIS It is imperative to make a distinction between financial analysis and economic analysis before deliberating further on the concept of CBA. Cost-benefit analysis helps to make a decision after taking in account all costs and benefits of a project and discounting them to present value by defining it in terms of net present value (NPV), that is, the present value of the benefits versus the present value of the costs. This method is used extensively in social and development projects as it enumerates Project Means of Particulars Description Indicators Verification Outcome/Comments Key project goal Output activities Component Creating a conducive objective 1 environment Horizontal Logic: Determinant of Monitoring and Evaluation Plan. BOX 1.2 Kaldor and Hicks Criterion Nicholas Kaldor and John Hicks defined Kaldor-Hicks efficiency in relation to Pareto efficiency. In the case of Pareto efficiency, an outcome is termed to be more efficient if at least one person is made better off and nobody is made worse off, but under Kaldor and Hicks criterion, a more efficient outcome can make some people worse off. The key difference between Kaldor-Hicks efficiency and Pareto efficiency is the question of compensation. Kaldor-Hicks efficiency does not require compensation, and thus does not necessarily make each party better off. But, Pareto efficiency does require making every person better off. The Kaldor-Hicks method is used as test of Pareto efficiency to determine whether a system is moving towards Pareto efficiency. Concept of Utility, Marginal Utility and the Indifference Curve Utility as a concept is the core of welfare economics and is defined as the pleasure or satisfaction the consumer wants. Total utility increases as more of a good is consumed whereas marginal utility usually decreases with each additional increase in the consumption of a good. The phenomenon is also known as the law of diminishing marginal utility. Quite naturally, as human beings, we have a certain threshold of satisfaction and after that threshold of satisfaction is achieved, the consumer will no longer receive the same pleasure from consumption. A model that tries to understand and describe individual human behaviour is based on the concept of utility maximization and is defined by the formula: max U = f(x,y) On the basis of this formula, utility function can be defined as a function of the quantities of two goods consumed. The consumer is expected to experience satiation with the increased consumption of any good, that is, the utility function for an individual will exhibit diminishing marginal utility. A curve plotted to describe utility function is called the indifference curve. is prone to soil erosion; dense and closed forests have been markedly declining; and widespread water scarcity and water pollution still exist. Developing countries, in particular India, today face an uphill task of bringing about a turnaround on various social fronts, namely, improving health and nutritional indicators, increasing literacy rates, reducing poverty and conserving natural and environmental resources. This calls for intervention at all levels of the social and developmental process. It requires initiative from the government and a combined and fitting response from social institutions, that is, implementing organizations, in accelerating the process of social change, by intervening at various levels, for better socioeconomic development in India. Intervention targeted at various levels of the development process aims to affect changes in every facet of the socio-development process in a stipulated time frame by way of project-specific intervention. Research plays an instrumental role at all stages of planned intervention, starting with designing of programmatic intervention, by inquiring about the outcomes sought. It also helps in tracking the intervention's impact by conducting an inquiry into the outcomes sought vis-à-vis the resources used and the sustained change that the intervention has been able to make. It is clear, therefore, that social research can make an immense contribution to society at large, by linking research with programmes of sustained social action. Research can guide implementing organizations to undertake constructive action for mid-course correction by ascertaining the change the programme has made vis-à-vis the expectation levels. Although some of the issues and linkages among nutritional indices, low educational indicators, population growth, sustainable development, natural resource conservation, poverty and the environment have received attention from researchers and policy-makers, working out a coherent and concerted strategy still seems to be a far-fetched idea.