Total Amount Granted: $11,516,000
Total Number of Grants: 28
Evaluation Period: April 2017 – March 2018
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

Through this four-year strategy, we aim to advance maternal health by supporting a shift in the field’s focus from access to quality of maternal health care. To accomplish this goal, the strategy backs three main areas of work or sub strategies: strengthening the supply of quality maternal health services, building the demand for quality services through accountability mechanisms, and building an evidence base and support for maternal health quality of care. The strategy officially launched in June 2015. Our evaluation partner, Mathematica Policy Research, documented early progress of the strategy through March 2017. Building on earlier evaluations of the strategy, this document provides findings from the midline evaluation covering April 2017 to March 2018.

What We Learned

Regarding efforts to strengthen the supply of quality maternal health services:

  • Findings indicate that ongoing mentorship strategies help sustain knowledge and skills, but further examination of these ongoing trainings—the ideal frequency, mode, and value to improving maternal health quality of care—is required to optimize implementation.
  • Over time, management and capacity-building trainings for non-clinical staff, such as facility administrators, have increased, which has influenced quality efforts with other clinical and non-clinical staff and facility-level infrastructure.
  • Strengthening facility-based quality assurance (QA) systems can be complex and time-intensive, requiring ongoing technical assistance and support. Grantees noted the focus required for maintaining QA systems has led to fewer new efforts launched over time.

Regarding efforts to build demand for quality services through accountability mechanisms:

  • Two grantees found that providing information on health rights and entitlements to women led to increased use of maternal health services, lending support for a key hypothesis that women who are educated on their rights will likely seek out and use high quality services.
  • Beyond increasing knowledge about women’s health rights, questions remain about the value of light-touch engagement with women and community leaders in accountability efforts. Questions also remain about how to best identify and support women who might be willing to become more engaged leaders for accountability in their communities.
  • One grantee continues to file and win notable court cases that protect maternal health and, through continued legal trainings, has expanded the number of legal and allied professionals equipped to conduct this work.

Regarding efforts to build an evidence base and support for maternal health quality of care:

  • Policymakers have used evidence generated under the strategy to scale up and advocate for maternal health care quality improvements. However, evidence generated that deviates from accepted norms or reveals flaws in existing policies and programs is often met with great resistance.
  • Advocacy campaigns supported under the strategy address a wide range of maternal health quality of care issues and have achieved successes in key areas, such as labor room and hospital management, to promote patients’ welfare. Moving beyond the start of these campaigns to outcomes of the campaigns, the end line evaluation will include an in-depth assessment of the nature and characteristics of the campaigns associated with achieving results.
  • Sustainability continues to pose a challenge for grantees. The majority of grantees have not yet secured their own funding for this work after the strategy ends. However, there may be other ways to assess sustainability, for example, integrating work into other systems. As maternal mortality declines in India, and as a more comprehensive view of health and care coordination develops further, grantee efforts to improve maternal health have become integrated into primary care, family planning, child health, and other areas. More information is needed to assess long-term sustainability.

Download the full report ›

We will periodically report on the progress of and learnings from the Maternal Health Quality of Care Strategy in India. This is the third in a series of reports that will be issued over time. You can find the first two reports and three related issue briefs here:

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

Landscape Evaluation of Maternal Health Quality of Care in India

Issue Brief: Community Accountability to Improve Quality of Maternal Health Care in India

Issue Brief: Maternal Quality of Care Ecosystem in India

Issue Brief: Building Coalitions to Support Maternal Health Quality of Care in India

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