Evaluation of Nurse Mentoring Program for Emergency Obstetric Care in Bihar, India
The student will take part in an on-going program evaluation of the Integrated Family Health Initiative (IFHI) led by CARE in partnership with the Government of Bihar and funded by the Bill and Melinda Gates Foundation. Evaluation of this program is being conducted by Oxford Policy Management and JHU is working with them on the evaluation. One of the IFHI programs focuses on improving the quality of delivery care at health facilities. The specific intervention focuses on improving quality of care by mentoring nurses at Primary Health Centers in Basic Emergency Obstetric Care (BEmOC), and at District Hospitals in comprehensive emergency obstetric care (CEmOC).
Global Health Mentor/PI: Krishna Rao, PhD
In the midst of a dusty city, we turned into the quarters of a large gated building complex. A few floors up, we entered the Gates Foundation office, brightly lit, and totally unexpected. The walls were lined with maps of Bihar and draped with fabric from the region. It was stunning. I was shocked to later learn that there were no permanent staff at this location, but it served as the mission office for staff visits. I was at the office to take part in a summit of stakeholders working on a Gates-funded evaluation. In addition to the JHSPH, CARE-India, UCSF, and Pronto International all had on-going research initiatives related to the Gates funded intervention to improve nurse capacity in rural facilities.
Having implemented programs before, I was aware of the important roll that program staff play in informing evaluations. Thus, it was no surprise to me that the people I learned the most from during the summit were the CARE program staff. During the meeting, they questioned our operational definitions and clarified our misunderstandings about the local context. They also seemed shocked to see how many people were invested in researching the intervention they had been instrumental in implementing. Over a team dinner, I chatted with a couple of the young women that served as managers of the intervention. I listened as they described how they had bravely told their parents they would be working in the field in Bihar, known to be one of the worst states in India to travel as a woman. Two of the three women were also engaged and had left behind their fiancés to continue their intensive work in the field, something almost unheard of in many parts of India. It was their stories that truly had the largest impact on me as a young woman. To hear their passion for their work, their investment in the program success, I was blown away.
While on a site-visit at one facility, I sat down with a faculty member and an enumerator (a female data collector) to hear about her experience conducting the evaluation. One component of the evaluation included conducting direct observations of delivery. The enumerator told us that in some rare cases, the nurse to be evaluated would tell mothers to reject consent to be observed, out of fear of being reprimanded for her performance. No matter how much you can anticipate in the training and pre-testing phases of the instrument, the experience of enumerators will shed light on new unforeseen challenges with implementation of the evaluation. While there were many lessons I learned from this trip, I always value talking to people directly engaged with the fieldwork and learning from their insight. It is a reminder that global health is far more than p-values and writing papers. Rather, both program implementation and program evaluation are the product of the hard-work of the young men and women that are passionate about their work. Without capturing and recognizing their knowledge and contribution, we are ignoring those at the heart of the work.