1. Strengthen enumeration and mapping of areas to ensure reach of front line workers (FLWs: auxiliary nurse midwives- ANMs; community health workers- ASHAs; anganwadi workers- AWWs).
2. Convene monthly FLW meetings to build skills and get trained in job kits to increase the quantity and quality of household visits.
3. Train FLWs on communication skills and use of mobile kunji, a job-aid tool, to improve FLWs' communication with households.
4. A mass media campaign inclusive of street theatre, tv and radio, and a mobile van.
5. Community mobilization linking mass media efforts with self-help groups.
6. Quality improvement activities at public health facilities.
7. Facility-based skills training to staff delivering infants to improve quality of care

standard of care public health services in India

The Ananya program was developed and implemented via a partnership of the Bill and Melinda Gates Foundation and the Government of Bihar as a means of improving reproductive, maternal, newborn and child health (RMNCH) outcomes in the state, in particular focusing on improving health behaviors and service utilization in the final trimester of pregnancy and early postpartum period. Ananya was designed as a series of supply- and demand-side efforts to improve health. Efforts were focused on strengthening outreach services in quantity and quality, improving quality of facility services, and mobilizing communities to improve health behaviors. The Ananya program included training, mobilizing, and monitoring of government frontline health workers (FLWs, including anganwadi workers- AWWS, auxiliary nurse midwives- ANMs, and community health workers-ASHAs) to increase quantity and quality of home visits for RMNH screenings and services, and media messages to increase demand for services.

Assessed via self-report from representative sample of mothers of children aged 0-11 months; item created for Ananya Survey

Assessed via self-report from representative sample of mothers of children aged 0-11 months; items created for Ananya Survey

Postnatal care practices [Nothing applied to cord or umbilicus; Health worker placed child unclothed on mother's chest/abdomen in skin-to-skin contact; First bath delayed by two or more days; Breastfed child within one hour of birth] assessed via self-report using a single item for each behavior from representative sample of mothers of children aged 0-11 months; items from demographic and health surveys

a survey item was used to assesse complementary feeding of infants as reported by mothers of infants aged 0-11 months; items taken from the Demographic and Health Survey

data from immunization cards or from self-reports when women did not have cards; approximately 50-60% of participants did not have immunization cards