title: Effectiveness of a multiple-strategy community intervention to reduce maternal and child health inequalities in Haryana, North India: a mixed-methods study protocol.
abstract: BACKGROUND
  A multiple-strategy community intervention, known as National Rural Health Mission (NRHM), launched in India to improve the availability of and access to better-quality healthcare, especially for rural, poor mothers and children. The final goal of the intervention is to reduce maternal and child health inequalities across geographical areas, socioeconomic status groups, and sex of the child. Extensive, in-depth research is necessary to assess the effectiveness of NRHM, on multiple outcome dimensions. This paper presents the design of a new study, able to overcome the shortcomings of previous research.
  
  
  OBJECTIVE
  To propose a comprehensive, methodologically sound protocol to assess the extent of implementation and the effectiveness of NRHM measures to improve maternal and child health outcomes and reduce maternal and child health inequalities.
  
  
  METHODS
  A mixed-methods approach (quantitative and qualitative) is proposed for this study in Haryana, a state in North India. NRHM's health sector plans included health system strengthening, specific maternal and child healthcare strategies, and communitization. Mission documents and reports on progress, financial monitoring, and common and joint review will be reviewed in-depth to assess the extent of the implementation of plans. Data on maternal and child health indicators will be obtained from demographic health surveys held before, during, and after the implementation of the first phase of the NRHM (2005-2012) and compared over time. Differences in maternal and child health indicators will be used to measure maternal and child health inequalities; these will be compared pre- and post-NRHM. Focus group discussions (FGDs) with service providers and in-depth interviews with program managers, community representatives, and mothers will be conducted until data saturation is achieved, in two districts of Haryana. Using Nvivo software, an inductive qualitative content analysis will be performed to search for the broader themes across the interviews and FGDs. Ethical approval was obtained from the Ethics Committee of the Post Graduate Institute of Medical Education and Research.
authors: Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India; madhugupta21@gmail.com.
authors: Madhu
authors: M
authors: Gupta
authors: Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, The Netherlands.
authors: Federica
authors: F
authors: Angeli
authors: Department of Family Practice, CAPHRI, Maastricht University, Maastricht, The Netherlands.
authors: Onno C P
authors: OC
authors: van Schayck
authors: Department of Social Medicine, CAPHRI, Maastricht University, Maastricht, The Netherlands.
authors: Hans
authors: H
authors: Bosma
mesh_terms: D057191:Capacity Building / Q000458:organization & administration; D002648:Child; D002662:Child Health Services / Q000458:organization & administration*; D006297:Health Services Accessibility / Q000458:organization & administration; D054624:Health Status Disparities; D006280:Health Workforce; D006801:Humans; D007194:India; D008427:Maternal Health Services / Q000458:organization & administration*; D011203:Poverty; D019984:Quality Indicators, Health Care; D012107:Research Design; D019035:Rural Health Services / Q000458:organization & administration*; D063507:Sexism; D012959:Socioeconomic Factors
keywords: India; National Rural Health Mission; child health; health indicators; health inequalities; maternal health; mixed-methods approach