Evaluation Period: April 2015 – July 2019
Total Awarded: $11,516,000
Total Number of Grants: 28
Geographic Focus: India



For more than 20 years, we have supported work to improve population and reproductive health in India. After making significant progress in this field, particularly in the areas of maternal health and rights, we are preparing to exit the population and reproductive health field in India and are supporting a concluding round of grantmaking focused on maternal health quality of care.


What We Evaluated

Our grantmaking strategy was designed to advance three mutually reinforcing sub-strategies, or areas of work: (1) strengthening the supply of quality maternal health services, (2) building the demand for quality services through accountability mechanisms, and (3) building an evidence base and support for maternal health quality of care. Our evaluation partner, Mathematica Policy Research, previously assessed the strategy’s landscape, early and midline progress. This is the fourth and final evaluation report that synthesizes evidence collected over the course of the entire Maternal Health Quality of Care strategy (2015-2019) and surfaces the learnings we have gathered along the way.


What We Learned

This report represents the culminating review of the strategy, highlighting key learnings that other donors, practitioners, and policymakers can use to continue and inform efforts to improve maternal health quality of care in India.

  • The strategy made important gains in strengthening the supply of quality care: developing standards and guidelines that have gained both state- and national-level traction, providing trainings and curricula for large numbers of providers, introducing facility-level quality improvement and certification, and generating preliminary interest in state-level adoption of promising quality improvement policies. However, it remains to be seen whether these quality improvements will ultimately lead to better maternal health outcomes such as a reduction in morbidity or mortality. Findings to date reveal several cross-cutting next steps that could strengthen the supply of quality maternal health care: scaling up and sustaining clinical and quality management standards to promote consistent quality of care across the country; measuring and documenting the impact of improvements to quality of care on health outcomes; and looking beyond the focal areas of the strategy to address other critical gaps in the quality of care health ecosystem.
  • The strategy has largely succeeded at catalyzing action on and interest in accountability mechanisms to improve the availability of quality maternal health care. Much of the accountability work started under the strategy goes on today, with several organizations continuing to implement community accountability programs and seeking opportunities to refine or expand this work. Continued testing, implementation, and scaling of accountability work will be necessary to keep advancing this field. In particular, lessons learned from the strategy have highlighted these necessary next steps: emphasize sustaining and deepening community engagement in community accountability; deliver the National Health Mission’s stated commitment to encouraging communities to lead health planning and monitoring;  document the impact of community accountability on health care utilization and health outcomes; and continue to support legal strategies to promote accountability when other methods fall short.
  • As the Foundation prepares to exit the field, continued advocacy by communities and coalitions will help keep maternal health quality of care a state and national priority, especially as other goals, such as universal health coverage, gain momentum. Key areas for continued advocacy activities include: fulfilling policymakers’ appetite for evidence by documenting the results and strategically positioning maternal health quality of care within the broader health landscape, including attention to the growing pressure to achieve universal health coverage.
  • Sustaining the Maternal Health Quality of Care strategy’s work will take various forms depending on the stage of the intervention for a specific grant. For grants providing proof of concept, sustainability will involve further adoption and maintenance to show consistent value when an intervention is attempted again. Interventions already showing this value will need to demonstrate their transferability to various settings—ultimately, that stakeholders can replicate and scale up core components of the intervention. Finally, widely applicable and relevant interventions could be at the stage that warrants institutionalization through policy.

The strategy has provided information on a wide-ranging menu of supply, demand, and advocacy interventions—some evidence-based and others emergent—that, if scaled up, could have far-reaching impacts on maternal health. To move the field forward, the effect of combined approaches within and across the sub-strategies needs more exploration to understand how multipronged approaches might amplify outcomes. This information can convince stakeholders of the value of adoption and collaboration.


Download the full report ›

Midline Evaluation of Maternal Health Quality of Care Strategy in India ›

Evaluation and Learning for the Maternal Health Quality of Care Strategy in India ›

Landscape Evaluation of Maternal Health Quality of Care in India ›