Monitoring, Learning, and Evaluation of the Uttar Pradesh Technical Support Unit
The Bill and Melinda Gates Foundation (BMGF) entered into a Memorandum of Cooperation with the Government of Uttar Pradesh (GoUP) in December 2012 to provide techno-managerial assistance by establishing a Technical Support Unit (TSU) to implement the Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A) strategy. The TSU planned on supporting the GoUP by improving the execution capacity at the block, district, divisional, and state levels. The overall objective was to increase uptake, enhance the quality of maternal and child health services in the state, and accelerate progress against critical health and other key development indicators.
Sambodhi was asked to evaluate the TSU’s performance and outcomes through an external Monitoring, Learning, and Evaluation (MLE) process. The key objectives of MLE were:
- to evaluate the contribution of the UP-TSU Phase 2 initiatives in decreasing Neonatal Mortality Rate (NMR), improving RMNCH+A and Nutrition outcomes at the community level, and improving the Quality of Care (QoC) at public health facilities through using rigorous evaluation study designs and appropriate methodologies,
- to assess the contribution of UP-TSU’s efforts in building health system facilities, and
- to facilitate knowledge sharing, including documentation and dissemination of best practices.
Sambodhi conducted the following actions to evaluate the performance and outcomes of the TSU:
- Neonatal Mortality Rate (NMR) estimation study: To assess whether the reductions in NMR in UP can be attributed to TSU interventions in Phase 1 and 2.
- Household study for MNCH and Nutrition outcomes: To assess TSU’s contribution to improving the community’s RMNCH+A & Nutrition outcomes.
- Quality of Care study: To assess the quality of care, infrastructure, standard treatment protocols, direct observation, checklists, patient satisfaction surveys, and medical audits. The supply of medicine, stock, equipment and infrastructure, and human resources was also observed through 162 facility visits and 810 deliveries.
- Health System Assessment study: To study the extent of TSU’s support in building the health system.
- Process evaluation studies (Progress Assessment + Investigative Deep-dive): For identifying ways to leverage contextual drivers and optimize impacts. Four rounds of process evaluation, each extending to over four months, were done over two years.
- Continuum of Care study: To assess the continuum of care experienced by clients across Antenatal care (ANC), Labor and Delivery, and postnatal care (PNC) until 42 days after delivery. This nine-month-long study mapped client expectations from health services across the continuum of care.