Full Report - Research for Development - Department for ...

Background
Cross-sectional surveys such as the Demographic and Health Surveys (DHS),
National Family Health Survey (NFHS) in India, and Multiple Indicator Cluster
Surveys (MICS) are an important source of data that allow disaggregation, for
example, by wealth quintile of urban populations. These sorts of analyses have
driven much of the bulk of descriptive evidence that exists about the health of the
urban poor (Hazarika, 2009; Antai and Morad, 2010; Matthews et al., 2010).
Whilst an important source of disaggregated information for those settings where
there are no other data sources, this sort of approach is not without its critics.
Montgomery (2009) outlines three major shortcomings of reliance on these sorts of
datasets and analyses: low reliability of estimates of health among the poor in any
given city; insufficient spatial information to identify small- and medium-sized
cities; and, over-reliance on proxy variables to construct measures of living
standards due to the absence of information on income or consumption
expenditures.
There are calls (Harpham, 2009) for greater investment in longitudinal, prospective
studies that deal specifically with the urban poor. Demographic Surveillance
Systems (DSS) such as those covered by the In-Depth network 3 are one such source,
and in Africa include sites such as the Nairobi Urban Health and Demographic
Surveillance System 4 in Kenya and Bandim Health Project 5 in Guinea Bissau, which
are fully established and producing data and research. A new DSS site in
Ouagadougou 6 has started to collect data which are not yet available for analyses.
Emergent research agendas focusing on health in LICs include the Urban Health
Resource Centre in India 7 (Urban Health Resource Centre, 2006). Specific online
foci for gathering relevant research have recently been developed, including the
Measurement, Learning and Evaluation Project for the Urban Reproductive Health
Initiative. 8
1.3 Policy and practice background
1.3.1 What are models of service delivery?
Models of service delivery are concerned with how interventions are delivered.
They specify the component intervention package, target groups and means of
distribution (Campbell and Graham 2006). Their impact depends not only on the
effectiveness of the package of interventions, but also on the coverage achieved by
the means of distribution, its uptake by the target population, and quality
(Campbell and Graham 2006). Furthermore, models of service delivery are
influenced enormously by context and must consider the local epidemiology;
economic, geographical and cultural barriers; and the local health system’s
infrastructural and human resource capacity (Lawn et al., 2009).
Whilst the medical solutions for preventing maternal and infant mortality are
known, delivering these solutions is a considerable challenge. Despite variation
across regions, most maternal deaths in LICs and LMCs are due to a handful of
causes, including haemorrhage, hypertensive disorders, sepsis/infections,
3 http://www.indepth-network.org/ (accessed 17 January 2012)
4 http://www.aphrc.org/insidepage/?articleid=470 (accessed 17 January 2012)
5 http://www.bandim.org/ (accessed 17 January 2012)
6 http://www.issp.bf/OPO/ (accessed 17 January 2012)
7 http://www.uhrc.in/ (accessed 17 January 2012)
8 http://www.urbanreproductivehealth.org/ (accessed 17 January 2012)
What are the effects of different models of delivery for improving maternal and infant
health outcomes for poor people in urban areas in low income and lower middle income
countries? 7