World Vision, Inc.

Saving Mothers and Babies in India Through Clean Health Facilities

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To learn more about – or provide significant funding to – this project, please contact Lever for Change.

Project Summary

Each year, 4 million babies die before the they reach their first birthday, with 800,000 of these deaths occurring in India. Additionally, 300,000 mothers die annually from complications related to childbirth, with 45,000 in India. Many of these deaths are preventable, caused by poor hygiene conditions in healthcare facilities (HCFs), which lack basic water, sanitation and hygiene (WASH) services and essential workforce skills required for safe childbirth.With the global drive toward delivering babies in HCFs and the elevated importance of WASH in HCFs, the time to support critical conditions for safe child delivery is now. World Vision, MAMTA, and Emory University are leading this change. They will leverage their experience, expertise, and extensive networks to improve infant and maternal survival through collaboration with the Indian government. Using practical, measurable, and impactful steps to improve quality care, this project will enable women and babies to live longer, healthier lives.

Problem Statement

One-fifth of the world’s infant deaths and one-sixth of maternal deaths occur in India. The government adopted policies and interventions to increase access to quality maternal and child healthcare services, which contributed to a decline in maternal and child deaths over the last two decades. However, the burden of mother and child survival remains exceptionally high, with India still having the highest number of infant deaths and second-highest number of maternal deaths globally. Maternal and child death disproportionately impact families living in extreme poverty, with social and cultural factors affecting accessibility to healthcare. While the Indian government has been successful at increasing childbirth in healthcare facilities, these efforts have not had the desired effect of significantly increasing maternal and infant survival, due to continued poor WASH conditions and practices at HCFs. At the most fundamental level, maternal and child survival in India remain a serious issue because healthcare providers need technical capacity building in safe hygiene as well as infection prevention and control standards and practices. Further, HCFs lack basic WASH infrastructure, including water systems, sanitation and hand-washing facilities, and proper medical waste disposal. While the national government has been proactive in making policies and standards, there is a lack of transparency and accountability to standards; evidence-based tools to address the problem; mechanisms for coordination; and effective governance at the state level, where implementation occurs. By strengthening coordination and accountability between levels of government, this project will achieve impactful change through improvements to the current system.

Solution Overview

The project will strengthen WASH standards, services, and practices in Indian HCFs to improve maternal and child health and save lives. Efforts will focus on strengthening fundamental WASH governance, infrastructure, and practices among HCFs and workers. By focusing on nine of the worst-performing districts in India and building an evidence-based framework for replication, we seek to catalyze change throughout the country and stir other countries to action, creating global momentum for WASH in HCFs. Our priority districts were selected from states with the highest infant and maternal mortality rates: Rajasthan, Madhya Pradesh, and Uttar Pradesh. By covering all HCFs in three districts in each state, we will reach 485 government HCFs with improved WASH coverage. These HCFs welcome over 164,820 babies into the world each year and will likely welcome many more as improved conditions and worker training build demand for more facility births. These nine districts will serve as the gold standard for other districts.We will strengthen government capacity to ensure systems are in place for large-scale impact. A technical specialist will be placed at the national level to advocate with the Ministry of Health and influence policy. Technical hubs will be established at the state level to coordinate work between district teams to ensure HCFs reach Kayakalp standards. Building technical expertise within the government to expand work to new districts and new states will result in rapid improvements that could impact 9,435 facilities in the three states, and nearly 45,000 facilities across the country.

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