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Study of Innovative Health Program in India Supported by Gates Foundation

The study, led by Duke assistant professor Manoj Mohanan,

A large-scale evaluation of an innovative health care program in the
Indian state of Bihar has been awarded a $3 million grant by the Bill & Melinda Gates Foundation.

The Bihar Evaluation of Social Franchising and Telemedicine (BEST) study
will be led by Manoj Mohanan, an assistant professor of public policy and
global health at Duke University.

Mohanan and his co-principal investigators at COHESIVE-India, a
multi-institution research collaboration, will assess the impact of the World Health Partners
(WHP) telemedicine and social franchising program. Specifically, they will
assess the program’s impact on health outcomes associated with four priority
diseases in 12 districts in Bihar: childhood diarrhea, childhood pneumonia,
tuberculosis and visceral leishmaniasis, the second-largest parasitic killer in
the world after malaria. Their study will assess program results based on data
collected from more than 100,000 households over the next four years.

In addition to the grant from the Gates Foundation, Mohanan anticipates
receiving supplemental funding of $1.3 million for the BEST study from other

The goals of the WHP program, which is also funded by Gates Foundation,
are to improve the quality and sustainability of rural health care services
delivered by the private sector and to standardize service delivery through the
creation of affordable local franchisee networks. These networks of
private-sector practitioners treat and refer cases, but because they may have
minimal medical training, they are able to consult with formally trained
physicians through the use of cell phones and telemedicine facilities.

A telemedicine facility allows a practitioner to use Internet-connected
computers to share patient data such as blood pressure or heart rate with a
consulting physician. The physician also can be consulted via webcam on the
diagnosis and treatment of a patient. Patients often can purchase prescribed
medicines on site.

The study also will estimate the costs associated with the target
diseases and the benefits from the program intervention. It will address
specific policy-relevant questions about the program’s sustainability,
affordability, scalability and future government support.

"Social franchising has received a lot of attention as a potential
service delivery mechanism in the health sector," Mohanan said. "However, due
to factors such as challenges with design issues and funding limitations, there
have been no large-scale experimental evaluations of these programs.

"We plan to collect information from more than 100,000 households during
three waves of data collection. In addition, we plan to undertake research on
households' choice of providers to estimate the demand for higher quality of
care and to study how provider incentives could help to improve quality of

The evaluation research will be implemented by collaborators in India:
Sambodhi, a leading evaluation research consulting firm in Delhi, and Institute
for Social and Economic Research on Development and Democracy, or ISERDD, which
has extensive experience with implementing provider quality assessment studies
in various states in India.

COHESIVE-India, based at the Duke Global Health Institute, was
established in response to the need for rigorous impact evaluation studies in
India's health sector that can help guide policymakers. The collaboration was
established by Mohanan along with Grant Miller of Stanford University, Marcos
Vera-Hernandez of University College London and Jerry La Forgia of the World

Other researchers involved in the BEST study are Jeremy
Goldhaber-Fiebert (Stanford), Manish Kakkar (Public Health Foundation of
India), Sunil Raj (Public Health Foundation of India), and Veena Das (ISERDD
and Johns Hopkins) in addition to experts from Duke, Yale, the University of
Edinburgh and the World Health Organization.