Learning from success through subnational mixed-methods equity analysis


August 23, 2023: National report dissemination of the 'Maternal and Newborn Health in India Global Exemplar Study'. Pictured here from Left to Right: Dr. K. Madan Gopal, Dr. Pawan Kumar, Dr. Usha Ram, Ms. L.S. Changsan, Dr. Vinod K. Paul, Dr. P. Ashok Babu, Dr. Ties Boerma

Maternal and newborn health: learning from success

Over the last few decades, India made substantial progress in improving reproductive, maternal, newborn and child health. The India maternal and newborn health Exemplars study conducted from 2020-2023 focused on understanding the drivers of the major national and subnational progress in reducing maternal and neonatal mortality through analyses of changes in two clusters of states (lower and higher mortality), as well as in-depth studies in six states (Maharashtra and Tamil Nadu among the lower mortality state cluster; Madhya Pradesh, Odisha, Rajasthan, and Uttar Pradesh among the higher mortality state cluster). A critical dimension of that analytical approach was learning from success: the ability to identify positive outliers and the associated drivers of change.

Taking the positive public health approach further

To continue learning from success in other related priority areas of reproductive, maternal, newborn and child health within India, work has started by the National Health Systems Resource Centre (NHSRC), the International Institute for Population Sciences (IIPS Mumbai), India Health Action Trust (IHAT) and the University of Manitoba, with engagement of the Ministry of Health and Family Welfare, Government of India. It will examine trends in reproductive, maternal and child health outcomes at more granular level. The focus is on intervention coverage and equity at sub-state and district levels. Another study looks at urban populations, identifying more successful cities and the most important drivers of their progress. These studies will examine how state, district and/or city policy and health systems contributed to improving outcomes more equitably. The approach emphasizes ‘positive public health’ as a way to learn from past success, and inform future policy making and programs in states and districts to accelerate progress towards India’s ambitious targets for universal health coverage by 2030.

Achievements for 2020-2022

During 2020-2022, Countdown worked in India and six other countries to understand the drivers of the major declines in maternal and newborn mortality over the past decades, as part of the Global Health Exemplars studies of Gates Ventures. The Countdown Exemplar study in India was a partnership between International Institute for Population Sciences (IIPS), National Health Systems Resource Centre (NHSRC), the India Health Action Trust (IHAT), and the University of Manitoba, with support from the Bill & Melinda Gates Foundation country office. All the Exemplar studies had a similar mixed methods design.



India Countdown Collaboration Team

Shajy K. Isac
Reynold Washington
Ritu Agrawal
Thirumalai Narayanan
Usha Ram
Manoj Alagarajan
Andrea Blanchard
BM Ramesh
Kerry Scott
Ties Boerma
James Blanchard
Arpita Aggarwal
Maj. Gen. (Prof) Atul Kotwal
K. Madan Gopal