Our Projects

• The Micronutrient Initiative (MI), under the Right Start Canadian Grant is supporting state governments in increasing the coverage and adherence to IFA among school going, out-of-school adolescent girls (aged 10-19 years) and pregnant and lactating mothers. The program is currently being rolled out in 377 rural blocks in the states of Chhattisgarh, Gujarat, Madhya Pradesh and Uttar Pradesh. For pregnant women IFA programs are to be rolled out in 154 blocks in these states, barring Uttar Pradesh.
• During the initial phase of implementation, it was imperative for Micronutrient Initiative as well as the state governments to understand and assess the current coverage of the IFA supplementation among the target groups. In view of this, MI commissioned AMS to undertake an assessment of the status of WIFS implementation, and iron supplementation for school going and out of school adolescent girls in the project States. Overall, the study covered a total of 3122 villages, spread across 400 blocks of 54 project districts of 4 States.
• This report is an outcome of the survey carried out in all these states to assess the coverage and implementation of Iron Supplementation Programme. Besides this combined report presenting a comparative picture of the study states, separate detailed state-level reports had also been prepared presenting deeper analysis of the pertinent issues.

The objectives of the assignment were to—

• An assessment of the levels of anaemia among non-pregnant and non-lactating women of reproductive age (15-49 years) in BPL families by taking blood samples and tests through Hemo Cue instrument.
• An assessment of the coverage of fortified wheat flour among non-pregnant and non-lactating women of reproductive age (15-49 years).
• An assessment of the acceptability of fortified wheat flour among the consumers
• An assessment of awareness among the consumers regarding Anaemia, and how anaemia could be reduced by regular consumption of nutritious food including the fortified wheat flour.
• An assessment of the availability along with regular and adequate receipt of micronutrient pre-mix by consumers, and identifying the suitable mechanism of making premix available to the consumers.
• Understanding from chakki operators about the process of grinding and the available facilities (like hoppers, etc.) that can be adopted/used for mixing the micronutrient pre-mix with wheat flour.
• Understanding willingness of fair price shop owners to counsel the beneficiaries for mixing micronutrient premix in the wheat flour.

• The overarching objectives of the study were to assess the baseline status of ShubhAarambh Project areas and measure the knowledge and practices of children and adolescents. The key objectives were:
• To measure the knowledge and practice level of children and adolescents on selected components of nutrition in the project
• To check the status of students/ School’s accessibility of health services especially to weekly IFA tablets, dental screening, vision screening and de-worming tablets.
• Development of kitchen gardens was an important aspect of the ShubhAarambh project and an innovative way to exhibit the significance of incorporating healthy fruits and vegetables in one’s regular diet. The survey captured proportion of children who reported to be helping in maintenance of Kitchen Gardens in their area, whether it was at home, school or community area

• Save the children is a leading independent child rights organization that fights for children’s rights and delivers immediate and lasting improvement to children’s lives worldwide. Save the children has been working in India since the pre-independence days. The organization is active on 5 core issues in 16 states and union territories and has reached over 3 million children across India.
• The strategic objective of the study was to understand the community behaviour with respect to treatment of childhood diarrhoea with ORS and Zinc when both of these elements are available together at the point of their use. In other words, the organization wanted to understand if the co-packaging improves the use of Zinc in diarrhoeal treatment in order to adjust program approaches. AMS was commissioned to conduct a study which aimed to assess the effect of ORS and zinc co-packaging along with SBCC on the uptake of Zinc and ORS, to assess the effect of the same on adherence of zinc for 14 days and to understand the preferred mode of zinc uptakes-tablets or syrup.
• The deliverables expected are as follows-
• A baseline and an end-line assessment of the status of Zinc and ORS Co. packaging at the beginning and at the end of the study.
• Data analysis plan
• Reporting template
• Quality control mechanism

• Food for Work programme (FFW), a component of WFP, was initiated in the erstwhile Uttar Pradesh in May 1985 (Uttarakhand was then a part of U.P.) to strengthen the food security for the marginalized people living nearby the forests. Forestry was chosen as the primary conduit for food aid because of the comparatively large labour component of the work, inaccessibility of work areas and because forest workers are the most food insecure groups. The programme worked on the concept of ensuring food security in the households & linking the families with income generation activities for which WFP had collaborated with the Forest Department to run a “Food-for-Work (FFW)” program. During certain seasons of the year, state forest departments employ casual labourers to cut bamboo, tend nurseries, replant trees, and do other forestry activities. WFP, for its part, provided food—wheat or maize, pulses and oil to the Forest Department. The Department then sold the food at half the market rate, or 40 per cent of the daily wage, whichever was less, to forestry workers.
• Encouraged by the grand success of both Phase I & II of FFW programme in U.P., in terms of number of people benefitted, tasks performed and funds generated, the third phase of FFW was implemented in Uttarakhand. The programme with support from the United Nations World Food Programme (WFP) was implemented in seventeen Forest Divisions of the state.
• Under the project the workers engaged in forest development activities were paid daily wages along with food grains for each man day worked and in lieu of the food grains a token amount of Rs. 10/- was deducted from their wages to create a ‘Generated Fund’. The ‘Generated Fund’ so created was ploughed back in the chosen villages in the same area for various developmental activities implemented in consonance with forest department by village committees as ‘Micro-plans or by NGOs’.
• To assess the impact of the programme, WFP- Uttarakhand commissioned AMS to evaluate and document the activities carried out under the programme and their impact on the lives of the beneficiaries.

• The Central Tibetan Administration (CTA), Dharamsala, through its Department of Health (DoH), is currently implementing USAID supported “Tibetan Health System Capacity Strengthening Project (THSC)” for meeting the primary, preventive, secondary and tertiary healthcare needs of its Tibetan refugees in India and Nepal. This it seeks to deliver through its own network of 50 health facilities (38 Clinics, 5 Primary Health Care Centers and 7 Hospitals).
• Initially, the project conducted assessment of 5 thematic areas (Tuberculosis; Reproductive Maternal Neonatal Child Health & Adolescent; Health Systems; Social & Behaviour Change Communication; and Health Information System). This revealed that critical information on key health indicators, such as, morbidity, RMNCH+A, health care seeking behaviour, and out-of-pocket expenses on health care were not available. Besides, gaps / inadequacies were detected in TB diagnostic & treatment services, social & behaviour change communication, and health information system.
• In the absence of detailed data, the task of formulating and implementing any meaningful systemic reform becomes both challenging and hazardous. Thus, to fill-up the aforementioned gaps in Tibetan Health System (THS), the Tibet Fund, on behalf of DoH, has called for undertaking a baseline survey of Tibetan refugees.

• The National Family Health Survey (NFHS) is a large-scale, multi-round survey conducted in a representative sample of households throughout India. The Ministry of Health and Family Welfare (MOHFW), Government of India, had designated IIPS as the nodal agency, responsible for providing coordination and technical guidance for the NFHS. NFHS used to be funded by USAID with supplementary support from United Nation’s Children’s Fund (UNICEF).

• The Annual Health Survey (AHS) conceived at the behest of the National Population Commission, PMO & Planning Commission was launched in 2010-11 across all the 284 districts of the EAG states – Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Orissa, Rajasthan, Uttarakhand, Uttar Pradesh and Assam. The survey yielded benchmarks of core vital and health indicators at the district level and was intended to map its rate of change on a continual basis to assess the efficacy of various health interventions, including those under National Rural Health Mission (NRHM). This survey was executed by the Office of the Registrar General, India on behalf of the Ministry of Health & Family Welfare (MoHFW) keeping in view of its expertise in handling the Sample Registration System (SRS), one of the largest demographic surveys in the world. The Offices of the Directorate of Census Operations (DCOs) of individual states were made responsible to coordinate and supervise the conduct of the survey in their states.
• AMS was commissioned to carry out the survey works in two states — Uttar Pradesh & Uttarakhand. In each of these two states, one zone had been allotted to the organization. In Uttarakhand, AMS conducted the survey in altogether five districts located in zone Ut1—Dehradun, Haridwar, Tehri Garhwal, Pauri & Uttarkashi. Similarly in Uttar Pradesh, the survey work was carried out by AMS in all the allotted 24 districts of the eastern zone. The survey covered the house-listing exercise followed by canvassing of household schedule, mortality schedule, village/urban schedule and schedule for currently married women (Age 15-49 years) & children.
• Thus, a very large volume of data was collected from the field, which was then duly edited, coded and converted into soft format before its analysis for generating the desired estimates through customized software designed on the platform of SPSS.

• The Annual Health Survey (AHS) conceived at the behest of the National Population Commission, PMO & Planning Commission was launched in 2010-11 across all the 284 districts of the EAG states – Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Orissa, Rajasthan, Uttarakhand, Uttar Pradesh and Assam. The survey yielded benchmarks of core vital and health indicators at the district level and was intended to map its rate of change on a continual basis to assess the efficacy of various health interventions, including those under National Rural Health Mission (NRHM). This survey was executed by the Office of the Registrar General, India on behalf of the Ministry of Health & Family Welfare (MoHFW) keeping in view of its expertise in handling the Sample Registration System (SRS), one of the largest demographic surveys in the world. The Offices of the Directorate of Census Operations (DCOs) of individual states were made responsible to coordinate and supervise the conduct of the survey in their states.
• AMS was commissioned to carry out the survey works in two states — Uttar Pradesh & Uttarakhand. In each of these two states, one zone had been allotted to the organization. In Uttarakhand, AMS conducted the survey in altogether five districts located in zone Ut1—Dehradun, Haridwar, Tehri Garhwal, Pauri & Uttarkashi. Similarly in Uttar Pradesh, the survey work was carried out by AMS in all the allotted 24 districts of the eastern zone. The survey covered the house-listing exercise followed by canvassing of household schedule, mortality schedule, village/urban schedule and schedule for currently married women (Age 15-49 years) & children.
• Thus, a very large volume of data was collected from the field, which was then duly edited, coded and converted into soft format before its analysis for generating the desired estimates through customized software designed on the platform of SPSS.

The objectives of the assignment were to—

• Save the Children implemented an initiative named Stop Diarrhoea project which was supported by Reckitt Benckiser and was aimed at contributing to the reduction in diarrhoea-related deaths among children under-five in 9 districts (North and South Delhi, Haridwar, Udham Singh Nagar, Shravasthi, Pilibhit, Behraich, Balrampur and Ward 58 & 65) across 4 states – Delhi, Uttarakhand, West Bengal & Uttar Pradesh. AMS was commissioned to conduct a survey to evaluate the performance of the project on the Key Performance Indicators of WASH and Diarrhoea Management.
• The primary objective of the survey was to understand the improvement in the KPIs after a year of implementation activities undertaken in the concerned states/districts/blocks. The specific objectives were—
• The personal hygiene practices of the households regarding water and sanitation
• The knowledge and practice level of community workers on WASH
• Knowledge and practice level of front line health workers managing Diarrhoea and other associated diseases
• The use of ORS/Zinc therapy by the health service providers
• Percentage of children under five children fully immunized as per the EPI schedule

The objectives of the assignment were to—

• The assignment plans to evaluate the effectiveness of quality improvement initiatives of MCSP in bringing about a change in quality of female sterilization services provided at public health facilities in 2 states of Chhattisgarh and Odisha.
• The specific objective of the study is to undertake data collection in the sampled public health facilities of Odisha and Chhattisgarh to understand and evaluate the impact of MCSP on the quality of public health services provided in the sampled public health facilities in terms of following:
• Improvement in key parameters before and after the intervention
• Significant difference observed between the intervention and control (comparison) groups
• The key parameters based on which the data had to be collected comprised of the following:
• Proportion of key practices (as per national guidelines on female sterilization) being adhered to by the service providers before, during & after female sterilization procedure
• Proportion of service delivery performance standards for female sterilization services being achieved by the facilities
• Facility readiness for female sterilization services
• Level of client satisfaction with female sterilization services

The objectives of the assignment were to—

• Improving health and hygiene of the adolescent girls and boys has been one of the prime agenda for the Government in India. In response to the same, the government has been floating several schemes (like ICDS, ARSH, SABLA, TSC) throughout the country. However, recent studies by the government have revealed serious challenges in the implementation of the program.
• Some of the major challenges faced are:
• Lack of self-esteem and decision-making power amongst adolescents
• Lack of necessary knowledge among the adolescents
• Skills and competence of existing frontline functionaries like AWW and ASHA
• Lack of family/community support due to prevailing cultural and gender norms
• The most important concern in these intervention programs run by the government is the poor reach of the frontline workers (ASHA, ANM, AWW) to the marginalized communities in the state of Uttar Pradesh. In order to solve the problem, the government has announced the RKSK (Rashtriya Kishor Swasthya Karayakram) strategy, using safe space-based peer-led approach and the mobile technology-based M-Health for plugging in the existing gap in transfer of knowledge and resources from frontline workers to adolescents.
• The current project aimed towards improving Nutritional Health and Hygiene of Adolescent Girls and Boys by 2018 in three districts of Uttar Pradesh (Varanasi, Allahabad, Banda) by strengthening decision-making processes of adolescent and parents through community support system and inter-departmental convergence for efficiently managing an inclusive and effective service delivery mechanism.

• The Ministry of Health & Family Welfare (MoHFW), gets conducted a district level household survey for Reproductive Child Health, commonly known as the DLHS. The International Institute of Population Sciences (IIPS), Mumbai has been made the nodal agency by MoHFW for District Level Household and Facility Survey-4 in 26 States and Union Territories and Facility Survey for 9 Annual Health Survey Stales namely Bihar, Jharkhand, Uttar Pradesh, Uttarakhand, Madhya Pradesh, Chhattisgarh, Rajasthan, Orissa and Assam. IIPS had commissioned AMS for conducting Household Survey work of DLHS-4 in the state of Haryana. The expected number of sample households covered in the State for the individual interviews was 33,275.
• In addition, the survey also entailed carrying out Clinical, Anthropometric and Bio-chemical (CAB) test for all members of sub-sample of households fixed for the activity in Uttarakhand and Haryana. The CAB tests consisted of —
• Haemoglobin test
• Height measurement
• Weight measurement
• Blood pressure measurement
• Fasting Blood glucose measurement
• Testing of salt used by sample households.
• As part of DLHS, in the State of Uttarakhand we were also commissioned to undertake the Facility Survey. The survey covered about 780 facilities consisting of Sub Health Centres (SHCs), Primary Health Centres (PHCs), Community Health Centres (CHCs), Sub Divisional Hospitals (SDIs-I) and District Hospital (DHs). The SHCs and PHCs were selected only in the jurisdiction/link of the selected rural PSUs for household survey conducted in AHS; and all CHCs, SDUs, and DHs in the district were covered for facility survey.
• DLHS-4 was different in several aspects from previous rounds of DLHS considering that the household survey was conducted on mini laptops and that clinical anthropometric & biometric tests were also collected besides the RCH data. The health and field experts from AMS trained the field supervisors & enumerators adequately to conduct the study and the tests as per the requirements. GPS was also used extensively during the facility survey in Haryana and Uttarakhand.

• The Ministry of Health & Family Welfare (MoHFW), gets conducted a district level household survey for Reproductive Child Health, commonly known as the DLHS. The International Institute of Population Sciences (IIPS), Mumbai has been made the nodal agency by MoHFW for District Level Household and Facility Survey-4 in 26 States and Union Territories and Facility Survey for 9 Annual Health Survey Stales namely Bihar, Jharkhand, Uttar Pradesh, Uttarakhand, Madhya Pradesh, Chhattisgarh, Rajasthan, Orissa and Assam. IIPS had commissioned AMS for conducting Household Survey work of DLHS-4 in the state of Haryana. The expected number of sample households covered in the State for the individual interviews was 33,275.
• In addition, the survey also entailed carrying out Clinical, Anthropometric and Bio-chemical (CAB) test for all members of sub-sample of households fixed for the activity in Uttarakhand and Haryana. The CAB tests consisted of —
• Haemoglobin test
• Height measurement
• Weight measurement
• Blood pressure measurement
• Fasting Blood glucose measurement
• Testing of salt used by sample households.
• As part of DLHS, in the State of Uttarakhand we were also commissioned to undertake the Facility Survey. The survey covered about 780 facilities consisting of Sub Health Centres (SHCs), Primary Health Centres (PHCs), Community Health Centres (CHCs), Sub Divisional Hospitals (SDIs-I) and District Hospital (DHs). The SHCs and PHCs were selected only in the jurisdiction/link of the selected rural PSUs for household survey conducted in AHS; and all CHCs, SDUs, and DHs in the district were covered for facility survey.
• DLHS-4 was different in several aspects from previous rounds of DLHS considering that the household survey was conducted on mini laptops and that clinical anthropometric & biometric tests were also collected besides the RCH data. The health and field experts from AMS trained the field supervisors & enumerators adequately to conduct the study and the tests as per the requirements. GPS was also used extensively during the facility survey in Haryana and Uttarakhand.

The objectives of the assignment were to—

• The study aims at conducting a market landscape assessment. The key objectives of the assessments are:
• 1. To describe the market landscape having multi-player and multi-functional arrangement comprising of core functions of demand and supply.
• 2. To describe supporting functions and rules, which are performed and shaped by variety of players including public sector on the following:
• a. Understanding the perspective of the of systems-based stakeholders pertaining to policy and rules to utilization of Mother and Child Health (MNCH), Family Planning (FP), and sanitation services by the community.
• b. Assessing the preparedness of the urban health system including Municipal corporation, Public health Engineering Department (PHED), government front line workers for providing mother and child health (MNCH), Family planning (FP), and safe sanitation services at various levels in terms of infrastructure, HR availability and capacity, logistics, drugs & equipment, referral & follow-up, recording and reporting, supervision, governance, information, co-ordination quality assurance, guidance and financial modalities.

• AMS was commissioned to undertake the study with the following objectives: -
• 1. To benchmark key output indicators in respect of the following—
• Use of Modern Family Planning methods (Modern method contraceptive prevalence rate : mCPR)—
• Male & female Sterilization; IUCD / PPIUCD; Oral Pills & Condom
• Complete ANC (3 ANC check-up + 2 doses of TT and 100 IFA); 3 ANC checkups; Distribution and consumption of IFA tables; 2 doses of TT; Age at Marriage; and Age at first birth.
• 2. To identify key restraining and facilitating factors responsible for the particular nature of family planning & maternal health indicators among currently married women (15-45 years);
• 3. To recommend suitable measures for improving the family planning & maternal health indicators at the grassroots level.

• The Rashtriya Swasthya Beema Yojana was launched by the Government to provide health insurance to the workers engaged in unorganized sector, particularly those belonging to BPL category. AMS was commissioned to undertake its evaluation in the state. The objective of the study was to evaluate and analyse the following aspects of the scheme--
• Need & justification for study.
• Action taken by State Nodal Agency on the survey conducted for the scheme.
• Adequacy of empanelled Govt. and Private hospitals under the scheme.
• Inclination of BPL families towards the scheme.
• Process of registration of BPL families under the scheme and the hurdles faced.
• Understanding how the target groups are being benefited and adequacy of provisions.
• Publicity & awareness.
• Adequacy & sufficiency of facilities extended to patients.
• Process of settlement of claims and amount released to hospitals, including time involved in the process.
• Payment of premium to Insurance Companies.
• Status of lower interest w.r.t. scheme among BPL families.
• Difficulties faced during implementation of scheme and suggestions to overcome them.
• Efficacy of implementation and benefits accrued to BPL families as against scheme’s mandate.

• The Government of Jharkhand in partnership with MOST (India), the USAID Micronutrient Program took up initiatives to address anemia in Jharkhand. The primary goal of this initiative was to improve the health status of pregnant women, lactating mothers and adolescent girls in these areas by reducing the prevalence of anemia in these target groups. An evaluation was undertaken to assess the overall effectiveness of the existing program, its impact on behaviors of the community, and on the capacity of the NGOs to deliver program services.
• AMS was commissioned to conduct this evaluation with the specific objectives to —(a) identify the strengths and weaknesses of the project; (b) review communication materials created; (c) study the supervision structure and its effectiveness; (d) study the monitoring process undertaken and monitoring tools created; (e) review the management structure of the Project; (f) review the ability of the Project to link itself with the community; (g) evaluate how this anemia program package could be used as a means of building capacity of the NGOs to deliver other types of health services; and (h) evaluate how the NGOs’ involvement in the community had contributed to the program success.

• Merry Gold Health Network (MGHN) is a three-tier health service delivery model in 35 districts of Uttar Pradesh. The first level, L1, is known as Merry Gold Hospitals located at the district level with 15 - 20 bedded facilities providing maternal and child health services and reasonably equipped to handle emergency obstetric care and critical issues. At the second level, the L2 facilities are called Merry Silver clinics which provide basic obstetric care, family planning services and counseling and immunization services. Merry Tarang (L3) is the third tier of the network and serves as the referral network at the community level and provides health-counseling and socially marketed health products like condoms, oral contraceptives, Oral Rehydration Salts and Iron and Folic Acid tablets. This innovative franchisee network consists of 70 fully franchised Merry gold (L1) facilities, 371 fractional franchised Merry Silver (L2) facilities and 10,814 Merry Tarang (L3) field-workers as a referral network which includes two fully franchisor owned facilities, known as L0 which serve as the demo sites model hospital for testing out elements of the franchising package spread in 36 districts of Uttar Pradesh.
• The overall aim of MGHN was to gain scale and increased demand/ patient loads that would allow profitable franchisees to provide various services at 30 - 50% below the prevailing market price.
• AMS undertook the assessment of Social Franchising Project in 35 districts of Uttar Pradesh. The study included the following components:
• i. Beneficiaries exit interview at facilities L1 & L2,
• ii. Facility (L1, L2 & L3) assessment.

• AMS was contracted to undertake a comprehensive social assessment study to ascertain community’s healthcare needs and problems faced in fulfilling them, their perceptions of the Government healthcare delivery system and preferences. The CAPI based survey also focused on maternal and reproductive health of women between 15-49 years of age. Collection of both quantitative and qualitative data related to hygiene and sanitation formed an integral part of the survey.
• The overarching goal of this study was to generate baseline estimates for various healthcare performance indicators to help the authorities understand the current status of the sampled villages. The findings generated out of this study would serve as a crucial input for designing social accountability strategies and interventions for bringing about quality improvements in the health service delivery.

• To alleviate the health scenario of the State, NRHM mandated the establishment of a State Health Resource Centre (SHRC) as a ‘think-tank’ for facilitating implementation of NRHM interventions besides providing technical assistance for improving the public health delivery systems.
• The SPHRI was proposed to be established over a period of five years (2012-17) in a phased manner under the auspices of State Institute of Health and Family Welfare. For the institute to get established and become fully functional, it required a long gestation period. However, for the institute to start delivering on its mandate effectively right from its inception, it required support from external sources. It was therefore proposed to engage a Technical Assistance Provider (TAP), who would not only systematically assist in establishing the resource centre/institute but also offer the intended services to the directorates on behalf of SPHRI while still being established. As a Technical Assistance Provider, it was proposed to offer services under two broad categories —
• Provide managerial and administrative support towards the establishment of SPHRI.
• Provide technical support to SPMU (NRHM) and the Directorates of Medical Health and Family Welfare enabling informed decision making.
• TAP sought to offer the support to the SPHRI for the entire project duration (2012-17), after which it left, leaving the organization self-sustained and independent.

• AMS undertook in-depth evaluation and process monitoring of 102 NAS and 108 Samajwadi Swasthya Seva (2014-15) schemes in U.P. The specific objectives of the study involving desk appraisal were to—
• Assess and evaluate patterns of utilization of services in all 75 districts of U.P. in order to understand the present and potential demand for these services and the effectiveness of response to this.
• Review the operational aspects of 102 and 108 services, including the operational efficiency of GVK-EMRI, financial management, and management of contractual obligations.
• Examine the design aspect and the framework of the EMRI model, in the context of larger health systems issues and ERS requirements, including equity issues and institutional frameworks including governance and accountability issues

• AMS undertook in-depth evaluation and process monitoring of 102 NAS and 108 Samajwadi Swasthya Seva (2014-15) schemes in U.P. The specific objectives of the study involving desk appraisal were to—
• Assess and evaluate patterns of utilization of services in all 75 districts of U.P. to understand the present and potential demand for these services and the effectiveness of response to this.
• Review the operational aspects of 102 and 108 services, including the operational efficiency of GVK-EMRI, financial management, and management of contractual obligations.
• Examine the design aspect and the framework of the EMRI model, in the context of larger health systems issues and ERS requirements, including equity issues and institutional frameworks including governance and accountability issues

• The UN-World Food Program (WFP), in collaboration with the Department of Women and Child Development, Government of Uttarakhand, had initiated a joint project, aimed at empowering adolescents for health promotion and prevention of HIV/AIDS. AMS was commissioned by the UN-World Food Program to conduct a baseline & end-line assessment study to get an in-depth understanding of the level of awareness among adolescent girls with respect to reproductive and child health, HIV/AIDS and RTI/STI, besides assessing their health seeking behaviour and the issue of accessibility to the healthcare services. The Study was conducted in both, urban and rural areas of the State. The assessment study involved in-depth interviews and focus group discussions with adolescent girls, the frontline health functionaries (ANMs and AWWs) and the in-charges of the Government health facilities. The study findings enabled the program managers not only to design area specific strategies but also in benchmarking the key indicators against which to measure the impact of the program.

• AMS has conducted the annual monitoring of the U.P. Health Systems Development Project (UPHSDP). As a component of the above task, AMS has conducted regular Patients’ Satisfaction Survey for assessing the patients’ perception on various parameters. AMS has been conducting this survey right since the inception of the World Bank assisted Health Systems Development Project in the State. During the survey, the patients’ satisfaction was judged on four key aspects, namely, (i) availability of services — medicines and diagnostic services, (ii) behaviour of the paramedical staff, (iii) behaviour and competence rating of doctors and (iv) physical facilities and environment. Based on these aspects, overall satisfaction ratings were determined and these were crosschecked with a “Value for Money” index. Based upon the findings, key strategies were developed for ensuring more effective implementation of these schemes in the State

• The Directorate of Family Welfare, Govt. of U.P. had commissioned AMS to undertake a comprehensive pilot study on resource mapping of all public and private health facilities in the four districts of U.P., namely Lakhimpur Kheri, Deoria, Mainpuri and Sonbhadra. The objective of this exercise was to study the availability of various resources such as equipment, infrastructure, manpower, etc., at various health facilities and to identify the critical gaps and resource mismatches for strengthening the health facilities. Based upon the findings, key strategies were developed for strengthening the health facilities and ensuring its effective implementation in the state.
• On successful execution of the pilot study, AMS was retained to upscale the project in the remaining 66 districts of the state. Keeping in mind the key issues under the study, a sampling plan was developed along with a set of qualitative and quantitative research tools for collection of primary data. The quantitative data was analyzed using various statistical tools for collection of primary data. The quantitative data was analyzed using various statistical tools and the qualitative data was suitably synthesized. Besides generating facility-wise reports on the availability of various resources, AMS also developed a GIS software which could be used for rationalizing the location of sub-centers in the state.

• The World Bank had commissioned AMS to conduct the study ‘Averting Preventive Maternal Mortality— Delays and Barriers to the Utilization of Emergency Obstetric Care in India’. The purpose of this study was — to provide an understanding of the delays and barriers to emergency obstetric care utilization; to identify the maternal health intervention strategies most likely to improve emergency obstetric care utilization; and ultimately to reduce maternal mortality and morbidity levels. The study consisted of both qualitative and quantitative components examining the delays and barriers to the utilization of emergency obstetric care using available data and collecting additional primary data. It also aimed to assess the relative contributions of demand (social, economic and household/family), barriers and supply (service access and quality) factors in determining women’s utilization of emergency obstetric care.

• The Integrated Child Development Services (ICDS) is a flagship programme of Govt. of India to fight malnutrition, morbidity, mortality, low learning capacity among children. Although ICDS has an evolving monitoring system for collecting data at Anganwadi Centers (AWCs) on processes of implementation, such as type of food distributed and its utilisation, stock position, supplementary feeding records for pregnant & lactating women and children up to six years of age, immunization, vitamin A supplementation, delivery outcomes, etc. There is a dearth of reliable and timely data for situation analysis on nutrition, anaemia, child mortality, birth registration, etc.
• The Ministry of Women and Child Development (MWCD) entered into collaboration with UNICEF to support the setting up of a Rapid Survey Based Information System (RSI) for providing reliable data with regards to quick assessment of situation of children, lactating & pregnant women and status of implementation of ICDS, through AWC on a regular basis. Towards this end, UNICEF commissioned AMS for undertaking a survey of children with two broad objectives—
• To measure the levels of identified indicators, based on the household and personal information of mothers for children below 6 years of age, and currently pregnant & lactating mothers.
• To assess the situation of implementation of ICDS Project in terms of its facilities and utilization of services for different target groups.
• The fieldwork for the survey was carried out through the Computer Aided Personal Interview (CAPI) system involving data collection directly onto the mini-laptops preloaded with customized software, rather than the traditional paper-pencil format. Overall, the survey involved undertaking the following— (i) survey of household members; (ii) anthropometric measurement of children below 5 years of age and of adolescent girls aged between 10 and 19 years; (iii) testing of salt, being used by the households, for its iodine content; and (iv) facility survey of AWCs.

• Save the Children (SC) is a global organization committed to help India reach MDG-4 related to reduction of child mortality. The objectives of SC’s Newborn & Child Survival programs are— to increase the chances of survival of children aged 0-5 years; to reduce the levels of malnutrition among children; and to improve newborn and maternal health.
• The project aimed to strengthen MNCHN services and practices through interventions in capacity building, governance and accountability in project areas. In this project, SC proposed to improve the quality & coverage of MNCHN services in three strategic ways—
• i. Enhancing the capacity of frontline health workers to deliver effective preventive, promotional and basic curative services;
• ii. Promoting good governance through community-based accountability mechanisms and advocacy; and
• iii. Increasing the quantity, quality and availability of empirical data related to the provision of MNCHN care through research activities.
• iii. Increasing the quantity, quality and availability of empirical data related to the provision of MNCHN care through research activities.

• Save the Children, India (Bal Raksha Bharat) commissioned AMS to undertake a study for assessing neonatal deaths in its MNCHN project implementation areas. The core objective of the study was to assess the rates and causes of neonatal deaths, along with the role of local healthcare practitioners in averting the same. The sample was spread across 6 project implementation districts from three states – Churu & Tonk in Rajasthan, Sitamarhi & Gaya in Bihar, and Kandhamal & Nuapada in Odisha.
• In order to explore the causes of deaths, verbal autopsies were conducted for neonatal deaths reported in the sampled areas between January 1st and December 31st, 2012. The verbal autopsies primarily aimed at understanding the events preceding the death of the baby and the symptoms observed by family members which might have caused it. Further, to understand the role of local healthcare providers in preventing these deaths, in-depth interviews were conducted with public and private health care practitioners working in the sampled areas. During the course of study the prevalent IYCF practices in the project districts were also assessed as improper feeding practices may lead to malnourishment and ultimately an increase in infant mortality.
• The findings generated from the study would help the organization devise strategic interventions for averting neonatal deaths in these areas.

• Providing basic health services at the doorstep, especially to the far flung and remote inaccessible hilly villages, forms the mandate of the core health policy of the Government of Uttarakhand. Besides institutional service delivery mechanism, supplementary services are identified as crucial arena in order to achieve the milestones set in the health sector. The state government is already operating well equipped mobile health vans (Arogya Raths) under the ambit of NRHM, staffed with doctors, specialists &assistants, besides medicines and consumables, across the length and breadth of the state. While route mapping of such vehicles is carried out in a pre-defined frequency across the strategic locations, such support essentially include OPD and diagnostic services on the scheduled camp sites.
• Experience gained during initial years of such operations called for inclusion of a wide array of services, maintaining affordability especially for the economically backward sections of the society, increasing the frequency of organization of camps and minimizing distance from the remote & underserved locations. Besides other factors such as logistics support for free of cost medicines, wider coverage and overall quality aspects, were simultaneously recognized to be important for up-scaling the present coverage. Therefore, in order to ensure adequate coverage of the service and according weight of the aforementioned aspects, the state had further decided to operate externally funded additional mobile clinics in all the 13 districts at the state’s own operational expense. The services were subsequently introduced and entailed linkage to professional agencies deployed as operators. In order to gauge the level of performance of the aforesaid mobile health service as against the stipulated mandates, the State Planning Commission of Uttarakhand, had awarded a prestigious evaluation study to AMS as an independent third party. Accordingly the performance of all the qualitative and quantitative aspects of the mobile health van service in the state was assessed in a systematic manner. Semi-structured schedules were prepared in consultation with the client and thereafter requisite feedbacks were obtained from multiple stakeholders covering all the sampled locations. Logical analysis of data & findings, preparation of report & presentation of the

• With the goal to increase accessibility of preventive, diagnostic and curative services for people living in remote areas and an emphasis on reproductive health services, UKHFWS implemented a pilot project towards improving access to health care at the household level and supplement the primary health care services as also to provide referral service to the needy through the Mobile Health Clinics.
• However, a number of barriers were identified in the effective utilization of these mobile clinics. The major barriers include knowledge issues around the van & its services followed by conservative community attitudes and beliefs, thereby hindering desired utilization level of mobile health clinics. There are also misconceptions that are spread by those who had visited the vans and had not been able to understand the processes inside. In the absence of required counselling to dispel doubts and garner knowledge, they came back with incorrect ideas and spread them in the community. Further, cost barrier had also contributed to the low utilization level of the mobile health clinics. People were not quite aware that something more is to be paid and how much.
• In the light of the aforementioned issues UKHFWS had commissioned AMS to undertake BCC campaign design for mobile health clinics. The overall program objective was to improve access to RCH services in difficult remote areas by way of increasing utilization of the Mobile Van services. The assignment involved conducting a Household Survey for assessing the healthcare seeking behaviour of the people, their communication needs and levels of awareness regarding the services of mobile health vans. Based on the same, the barriers in communication were identified among various respondent groups and it formed the basis of designing a responsive and local need specific BCC strategy for the MHVs. During the course of the assignment various BCC materials were also developed like, Signpost, Paper Airplane for Propaganda, Leaflets, Registration Kits, Booklets, etc.

• The provision of assured and credible primary health services of acceptable quality in urban areas has emerged as a priority for both the central and the state governments in view of the increasing urbanization along with the growth of slums and low-income populations in the cities. AMS was commissioned by Health & Family Welfare Society (UKH & FWS) to conduct a Baseline Survey to develop key baseline Reproductive & Child Health indicators prior to launching the urban health program in these two cities.
• The baseline survey used a two-stage, 30-cluster sampling design, with slums as the Primary Sampling Unit (PSU) and women who have delivered in the past two years within the sample PSU as the secondary sampling unit. Total of 1500 women were covered across 60 slums (30 slums each in Dehradun and Roorkee districts).

• The key objective of the survey was to evaluate the impact of the Health Systems 20/20 Mission Convergence Health Project interventions. The pilot intervention was designed to increase access to and use of essential maternal and child health services and Rashtriya Swasthya Bima Yojna (RSBY), and to reduce out-of-pocket expenditures for drugs and medical consultations via a clinic model. For the same, two cross-sectional surveys were conducted across the slums of Delhi, categorised as the Intervention and Control Slums.
• The survey sought to assess the access to primary health care services, prevalence of chronic/critical ailments, healthcare seeking behaviour, coverage under RSBY and other health insurance plans, pattern of the most recent OPD and IPD treatment in the past 30 days and 365 days, respectively through household survey. Besides, the surveys also sought to assess the key maternal & child health indicators through MCH Survey. Further, it also sought to assess the changes in key indicators between the baseline and the endline of the project. The quantitative data was analyzed using various statistical tools like difference-in-differences (DID) analysis, ANOVA, etc. and the qualitative data was suitably synthesized.

• The core objective of this assignment was to carry out a baseline survey in the slums of Delhi for the purpose of evaluating Delhi Mission Convergence Health Insurance Project. The baseline survey sought to assess the quality of primary health care services, prevalence of chronic/critical ailments, health seeking behavior, coverage under Rashtriya Swasthya Bima Yojana (RSBY) and other health insurance plans, pattern of the most recent OPD and IPD treatment in the past 30 days and 365 days, respectively through the household schedules.
• Besides, the baseline survey also sought to assess the key Maternal & Child Health indicators through 'MCH Survey'. Keeping in mind the key issues under study, a sampling plan was developed, besides designing a set of quantitative and qualitative research tools for the collection of primary data. The quantitative data was analyzed using various statistical tools and the qualitative data was synthesized suitably. Based on the analysis, final report was prepared and presented to the client.

• AMS undertook the Annual Performance Survey of the World Bank assisted Health Systems Development Projects in the State of Uttar Pradesh. The major objectives of the assignment were: — (a) To assess the performance of the Project at various levels; (b) To measure the improvement in services, both in terms of quantity & quality and to generate measurable outcomes, such as, increase in outpatient & inpatient visits, increased bed occupancy, greater use of diagnostic facility and greater patient satisfaction for all the project facilities; (c) To assess the impact of secondary-level strengthening on CHCs and Block PHCs and functioning of the referral system; (d) To analyze the use of facilities by disadvantaged groups and women; and (e) To assess the status of motivation & behavior of employees, with special reference to absenteeism.

• The National Rural Health Mission (NRHM) was launched by the Government of India in April, 2005 for providing accessible, affordable and equitable healthcare to the rural people with a special focus on 18 states that have weak public health indicators and/or weak infrastructure. AMS was commissioned by the Ministry of Health & Family Welfare, Government of India to assess the impact of the NRHM interventions in the states of Uttar Pradesh and Jharkhand.
• The key objectives of the assignment were to survey and identify the gaps and constraints in programme implementation; and to provide suggestions for overcoming the constraints and improving the implementation of the programme with reference to functioning of health facilities and accountability in the delivery of health services. The assignment included probing issues related to institutional and monitoring systems; consistency, feasibility and effectiveness of programme design with respect to the goals of NRHM; making the program elements of NRHM operational and identifying managerial and design constraints; identification of the available capacities and the adequacy building efforts; and outcomes of the programme as regards the phase of the programme in each State.

• The National Rural Health Mission (NRHM) was launched by the Government of India in April, 2005 for providing accessible, affordable and equitable healthcare to the rural people with a special focus on 18 states that have weak public health indicators and/or weak infrastructure. AMS was commissioned by the Ministry of Health & Family Welfare, Government of India to assess the impact of the NRHM interventions in the states of Uttar Pradesh and Jharkhand.
• The key objectives of the assignment were to survey and identify the gaps and constraints in programme implementation; and to provide suggestions for overcoming the constraints and improving the implementation of the programme with reference to functioning of health facilities and accountability in the delivery of health services. The assignment included probing issues related to institutional and monitoring systems; consistency, feasibility and effectiveness of programme design with respect to the goals of NRHM; making the program elements of NRHM operational and identifying managerial and design constraints; identification of the available capacities and the adequacy building efforts; and outcomes of the programme as regards the phase of the programme in each State.

• Strengthening of CHCs/Round-the-clock (24x7) PHCs to provide emergency obstetric care and newborn care in rural areas as first referral units (FRUs) is a key initiative under the NRHM policy framework and annual action plan for Govt. of UP. In the State, 45 districts have been identified as high focus districts. Unicef had commissioned AMS to develop detailed action plans for making the selected health facilities (122 across various levels) functional as FRUs in 5 out of these 45 districts. In addition, quite aptly, the study also mandated to facilitate the implementation of these plans by providing technical support through follow-up visits. It is envisaged that this will serve as a model, which can be scaled up and extended to rest of the high focus districts by the Government.

• Effective communication with target groups forms one of the essential components in any programme for generation of awareness and behaviour change. Communication inputs significantly increase people’s awareness and concern over matters relating to health & hygiene. Research has proved that communication can indeed be used as an input for achievement of programme goals. Accordingly, Information, Education and Communication (IEC) is an intrinsic component of the NPCB programme for improving health & hygiene indicators related to eye care. IEC activities under NPCB are undertaken at Central, State and District levels.
• Periodic evaluation to keep track of the program performance is an essential ingredient for successful implementation of any development program. This allows the program managers to consolidate the program strengths and minimize the shortcomings. Information, education and communication (IEC) is a crucial component of NPCB having a direct influence on the goals and objectives of this health initiative of National importance. Accordingly, AMS was commissioned by the Ministry of Health & Family Welfare, Government of India to conduct an evaluation of IEC activities under the National Program for Control of Blindness.

• As a preparatory activity for the National Urban Health Mission (NUHM), the Directorate of Family Welfare, Govt. of Uttar Pradesh had commissioned AMS to conduct a baseline survey of Health Facilities & urban slums (listed and unlisted) across the 14 cities of Uttar Pradesh to benchmark the various reproductive & child health (RCH) and family planning indicators.
• The baseline study was aimed at gathering all relevant information from households and facilities by executing the following sets of activities—
• Household level interviews with the heads of the respective households
• Individual interviews with married women of reproductive age (15-49 years) within the same households.
• Facility audits of Service Delivery Points (public & private health facilities, pharmacies, retail outlets and RMPs).
• AMS had conducted the study and submitted its report as per protocol. All activities, including field planning, induction training of research investigators, data collection, data entry, programming, data sheet generation, data interpretation and report writing were duly carried out.

• The Ministry of Health & Family Welfare, Govt. of India, gets conducted a District Level Household Survey (DLHS) for generating district-level indicators on Reproductive & Child Health (RCH) in all the States and Union Territories of the country. AMS was commissioned to conduct the Round-3 of this survey in the States of Uttarakhand and Himachal Pradesh. The assignment involved carrying out the field survey and generating relevant RCH indicators. The sample size in each state was determined considering the population size. Apart from household survey, public health facilities, such as, Sub-Centres (SCs) and Primary Health Centres (PHCs), falling under the jurisdiction of the sample PSUs, were also covered. Further, all Community Health Centres (CHCs) and District Hospitals were surveyed under the project. Thus, a very large volume of data was collected from the field which was then duly edited, coded and entered into the computer using customized software.
• A double entry system with 100 percent verification was followed to ensure accuracy of data entry. Data editing included range checks, structure checks and selected checks for internal consistency. Thus, an in-house robust control system was put in place to ensure accuracy and reliability of data for generation of data tables and reports.

• The Ministry of Health & Family Welfare, Govt. of India, gets conducted a District Level Household Survey (DLHS) for generating district-level indicators on Reproductive & Child Health (RCH) in all the States and Union Territories of the country. AMS was commissioned to conduct the Round-3 of this survey in the States of Jharkand. The assignment involved carrying out the field survey and generating relevant RCH indicators.
• The sample size in each state was determined considering the population size. Apart from household survey, public health facilities, such as, Sub-Centres (SCs) and Primary Health Centres (PHCs), falling under the jurisdiction of the sample PSUs, were also covered. Further, all Community Health Centres (CHCs) and District Hospitals were surveyed under the project. Thus, a very large volume of data was collected from the field which was then duly edited, coded and entered into the computer using customized software.
• A double entry system with 100 percent verification was followed to ensure accuracy of data entry. Data editing included range checks, structure checks and selected checks for internal consistency. Thus, an in-house robust control system was put in place to ensure accuracy and reliability of data for generation of data tables and reports.