Abstract
BackgroundThe Yashoda program, named after a legendary foster-mother in Indian mythology, under the Norway-India Partnership Initiative was launched as a pilot program in 2008 to improve the quality of maternal and neonatal care at facilities in select districts of India. Yashodas were placed mainly at district hospitals, which are high delivery load facilities, to provide support and care to mothers and newborns during their stay at these facilities. This study presents the results from the evaluation of this intervention in two states in India.MethodsData collection methods included in-depth interviews with healthcare providers and mothers and a survey of mothers who had recently delivered within a quasi-experimental design. Fifty IDIs were done and 1,652 mothers who had delivered in the past three months were surveyed during 2010 and 2011.ResultsA significantly higher proportion of mothers at facilities with Yashodas (55 percent to 97 percent) received counseling on immunization, breastfeeding, family planning, danger signs, and nutrition compared to those in control districts (34 percent to 66 percent). Mothers in intervention facilities were four to five times more likely to receive postnatal checks than mothers in control facilities. Among mothers who underwent cesarean sections, initiation of breastfeeding within five hours was 50 percent higher in intervention facilities. Mothers and families also reported increased support, care and respect at intervention facilities.ConclusionYashoda as mothers' aide thus seems to be an effective intervention to improve quality of maternal and newborn care in India. Scaling up of this intervention is recommended in district hospitals and other facilities with high volume of deliveries.
Highlights
Providing health care services, especially maternal and newborn care, is increasingly understood to be a dynamic system of entitlement and obligations among people, communities, providers, and governments
The paradox is that global community still concentrates on efforts to attain health-related Millennium Development Goals (MDGs) based on national strategies to reach high and equitable coverage of health services
In Rajasthan, the Yashodas were placed in the district hospital (DH) as well as in some community health centers (CHCs) with high delivery load (300 to 1000 deliveries in a month); in Odisha this intervention was restricted to DH only with a delivery load of 500 per month. This independent evaluation study was conducted from January 2010 to September 2011 and used a multidisciplinary approach within a quasi-experimental design to assess and evaluate two Norway-India Partnership Initiative (NIPI) interventions – the Yashoda program and the home-based newborn care support provided by ASHAs (Figure 1)
Summary
Especially maternal and newborn care, is increasingly understood to be a dynamic system of entitlement and obligations among people, communities, providers, and governments. The paradox is that global community still concentrates on efforts to attain health-related Millennium Development Goals (MDGs) based on national strategies to reach high and equitable coverage of health services. The quality of treatment and care provided by health system can be complementary to the global efforts to reach and maintain coverage of health services. The Janani Suraksha Yojana (JSY) launched by the Government of India in 2005 under the ambit of the National Rural Health Mission (NRHM) has resulted in unprecedented increase in institutional deliveries in India. The JSY beneficiaries increased from 700,000 in 2005–2006 to 9.23 million women in 2009–2010 2] This dramatic increase in facility births, a significant public health achievement, has put tremendous pressure on the health institutions. This study presents the results from the evaluation of this intervention in two states in India
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