Bihar, India: Measurement Learning and Evaluation for the Family Health Initiative

Prepared for
Bill & Melinda Gates Foundation
India Bihar Ananya In 2010, the Bill & Melinda Gates Foundation launched the Family Health Initiative (now called Ananya) in Bihar, India. The program seeks to reduce maternal, neonatal, and child mortality; malnutrition; fertility; and morbidity from infectious diseases by developing and implementing innovative, integrated health solutions that involve both the public and private sectors. To achieve these goals, the foundation is addressing both supply- and demand-side barriers to improving family health in Bihar. Through a set of six complementary grants, the program seeks to increase the coverage and quality of family health interventions in the state. The program will be implemented in eight focal districts by 2012-2013 and scaled up to the rest of Bihar by 2015.

Mathematica is working with the Public Health Foundation of India and Sambodhi Research and Communications to lead the measurement, learning, and evaluation (MLE) component of the Ananya program. The MLE has three components: 
  • Impact Analysis of the Ananya Program and of Select Innovative Solutions: Our team will examine the effects of the overall package of interventions implemented by the grantees in the eight focal districts over a two-period, and examine changes in key coverage and impact indicators across the state over a five-year period. In addition, using a randomized design, we will rigorously test the effectiveness of two innovative solutions in enhancing the quality of household interactions with frontline workers and in improving key coverage indicators.
  • Process and Scale-Up Analysis: We will conduct an implementation study to provide a comprehensive picture of what interventions are being implemented, how they are being implemented, and key implementation successes and failures. This will help inform program improvement and course correction by the foundation and grantees, and also assist in the interpretation of the impact analysis findings. The process analysis will also focus on how successful the program was in scaling up and will measure the extent to which scale-up occurred, understand and document the scale-up process, and identify the factors that facilitate and inhibit scale-up are all critical components of the MLE effort.
  • Cost and Cost-Effectiveness Analysis: Although evidence of effectiveness is critical to persuading development partners to adopt a new approach to family health, the costs of doing so will influence replication and scale-up decisions. The cost analysis will generate estimates of overall program costs, the costs of major program components, replication costs, and the key cost drivers. In addition, we will attempt to determine the cost-effectiveness of both the program and the value-added solutions.