India has among the highest maternal mortality ratios and infant mortality rates in the world, at 178 maternal deaths per 100,000 live births and 42 infant deaths per 1,000 live births (Sample Registration System, 2013). Among all Indian states, Uttar Pradesh, with one sixth of India’s population (200 million) has the highest maternal mortality ratio (292 per 100,000 births), and the highest infant mortality (53 per 1,000 live births). One of the main underlying causes of high morbidity and mortality among women and children is the health risk associated with early childbearing, short birth intervals and high parity, often higher than desired.Given this, the Government of India (GoI) has launched a renewed campaign to improve RMNCH+A performance across India, and the GoUP has followed up the national launch with its own show of commitment through the state RMNCH+A effort, and the launch of the ‘Hausla’ campaign to save mothers and children across the state. A major emphasis of the Government of Uttar Pradesh (GoUP) has been investment in health and development focused on reproductive, maternal, newborn and child health, along with adolescent health (RMNCH+A) through the National Health Mission. To support this, the GoUP recognized that enhancement of the state’s execution capacity through better planning and implementation could improve the efficiency, effectiveness and equity of RMNCH+A services, and thereby improve health and development outcomes.

Given this, the GoUP approached the Bill & Melinda Gates Foundation (the Foundation) to provide techno-managerial assistance through the establishment of a comprehensive Technical Support Unit (TSU) focused on supporting the GoUP to reach its goals in RMNCH+A.


In November 2013, IHAT established a TSU to support the government of UP to increase the efficiency, effectiveness and equity of its execution vis-à-vis the three platforms identified in the Foundation’s ICO (India Country Office) strategy for integrated delivery: the government, the private sector, and communities.

The objectives are:

  • Support leadership to focus more on outcomes
  • Improve the performance of front-line workers (FLW)
  • Improve facility performance, coverage and quality of care
  • Enhance accountability systems [internal and external] to ensure quality of service delivery at scale
  • Improve overall planning, policy formulation and coordination


RMNCH+A project aims to support GoUP in improving the quality and quantity of frontline worker interactions at the community level and within households to drive the priority RMNCH+A behaviors. It also focuses on improving quality of RMNCH+A services at health facilities including supporting critical health systems level improvements.

The project leverages across three platforms of community, facility and systems to provide the necessary support to the functionaries for bringing in a holistic change in acceptance of health-promoting behaviours for RMNCH+A. At each level, techno-managerial support is provided to not only understand the bottlenecks but also undertake hand holding of the necessary intervention.


The RMCNH+A project is supporting in strengthening integrated-service delivery platform called Village Health & Nutrition Day (VHND), where women and their children could access key nutrition and RMNCH+A services from frontline workers.

The CRP provides support on logistics, community mobilization, and quality of services being offered at the VHNDs. TSU’s support has been instrumental in shaping the quality of VHND sessions with a large majority of them now having improved infrastructural provisions and service availability, thereby emerging as the single most important and easily accessible platform for receiving integrated health and nutrition services for pregnant women and children.