Quality of Care and the Bypassing of Primary Health Centers in India-Implications for Ayushman Bharat

NCAER hosted a seminar on “Quality of Care and the Bypassing of Primary Health Centers in India—Implications for Ayushman Bharat” with Krishna Dipankar Rao, Johns Hopkins University. Shailender Swaminathan, Principal Economist, Leveraging Evidence for Access and Development (LEAD), KREA University, was the discussant. The seminar was attended by members of the NCAER Research Team, and invited guests from various eminent institutions including, Bill & Melinda Gates Foundation, Integrated Research and Action for Development, Federation of Indian Chambers of Commerce and Industry, International Food Policy Research Institute, and IDinsight.

Dr Rao pointed out that India is among many low- and middle-income countries that have invested substantial resources for strengthening facility-based and community-based primary health care services to provide affordable care for improving population health. Yet, patients in India often bypass the nearest government health centres offering free or subsidised services and seek more expensive care, often from private service providers. Dr Rao focused on the quality of care (clinical and structural) and its implications for new efforts to strengthen primary care through the Government of India’s recently launched Ayushman Bharat initiative. While tracing the genesis of the primary health care system in the country, he highlighted various issues that have brought this sector into recent focus, including the predominantly informal nature of primary health care and non-availability of certain crucial services at the primary centres; lessons from the National Rural Health Mission; the role of Accredited Social Health Activists (ASHAs) in the health care system, particularly in rural areas; and wide variations in competencies for health care across the country.

The discussant, Dr Swaminathan stressed the need to mould the primary health care system to align with the goals of Ayushman Bharat. He also suggested the introduction of competency scores for various health centres to assess the quality of services delivered by them and to determine the actual drivers of health-seeking behaviour among patients, especially the factors motivating them to veer towards private health care providers.

Krishna Dipankar Rao is an Associate Professor in the Health Systems Program, Department of International Health, Johns Hopkins University. He is also Research Advisor, National Health Systems Resource Center, Ministry of Health and Family Welfare, Government of India. His research interests lie in the areas of health systems, primary health care, human resources for health, health financing, and economic evaluation. He teaches two graduate courses at Johns Hopkins– economic evaluation, and health financing in low- and middle-income countries.

Workshop on Tourism Satellite Accounts for India and Indian States & Union Territories

NCAER has recently completed a seminal study on Tourism Satellite Accounts for 2015-16 for India and Indian States and UTs for the Union Ministry of Tourism. In this context, a one-day workshop was organised to launch NCAER’s Tourism Satellite Account (TSA) and to study and discuss its findings. The workshop commenced with a welcome address by Dr Shekhar Shah. Shri Yogendra Tripathi, Secretary, Ministry of Tourism, delivered the keynote address. The workshop was attended by officials from Department of Economics and Statistics of several states of India; representatives of travel and tourism training institutes; officials from Central Statistics Office (CSO), Ministry of Tourism, faculty members from NCAER and several researchers and academicians. The Senior Director, Research Planning & Monitoring Department of Nepal Tourism Board also attended the workshop.

A TSA is a powerful tool for understanding and assessing the economics of tourism. It is a framework designed to measure the value addition of goods and services associated with tourism in line with internationally agreed standard concepts and definitions. A TSA is vital to assess the size and contribution of tourism to the economy. State-level TSAs are particularly useful for improving the optimal allocation of local resources to tourism because they measure and reveal the economic impact of tourism on the State’s economy.  Resources can then be deployed where their impact on value addition from tourism is likely to be the greatest, thus ensuring the best use of scarce public resources and ensuring the highest return to private investment in tourism. In this workshop, Dr Poonam Munjal presented the important highlights, methodology and estimation of India’s Third Tourism Satellite Account. This was followed by a presentation by Mr S.V. Ramana Murthy, DDG, CSO who discussed the change in methodology in estimating the Services Sector GDP in the new series which has resulted in falling share of services sector and consequently of tourism sector in GDP. The post-lunch sessions included a presentation on the Regional or State-level TSAs in India by Dr Poonam Munjal and a presentation on Data Sources used in the compilation of TSAs by Dr Palash Baruah and Mr Asrar Alam. A snapshot of the TSA Dashboard was also showcased. The workshop concluded with a vote of thanks by the NCAER study team.

NCAER has led the way since 2006 in preparing India’s regular, five-year TSAs. NCAER pioneered India’s first TSA for 2002-03 for the Ministry of Tourism. Thereafter, it prepared India’s second TSA for 2009-10, and is now completing the third TSA for 2015-16. In 2009-10, NCAER also prepared the first regional TSAs for all Indian States and UTs. This latest NCAER study continues with work on regional TSAs.

 

Request for Proposals (RFP) on Methodological Innovations to Improve Data Quality

RFP launch date: July 22, 2019

The last date for submission of proposals has lapsed

Background:

The National Council of Applied Economic Research (NCAER) is one of India’s oldest and largest independent, non-profit, economic and social research institutes. It undertakes grant-funded research and commissioned studies for governments and industry, and is one of the few think tanks globally that also collects primary data. NCAER has set up a National Data Innovation Centre (NDIC) to serve as a laboratory for experiments in data collection, interfacing with partners in think tanks, Indian and international universities, and government. NDIC forms an important core of NCAER’s long-standing data collection activities. NCAER, has partnered with the Universities of Maryland and Michigan for the NDIC. Initial funding for NDIC is being provided by the Bill & Melinda Gates Foundation.

Current Request for Proposals: 

The focus on data-oriented research and the dynamic policy environment impose a great demand for rapid, high-quality, and policy-relevant data. Changing socio-economic conditions and technological innovations necessitate rethinking of both the kind of data being collected and how they are collected. In that context, quality assurance mechanisms play an important role in influencing the credibility of the data being collected.

Therefore, the focus of the current RFP is to seek proposals on methods to improve data quality across the following themes: gender equity, women’s time use, health system, health insurance and healthcare expenditure, employment and unemployment, family planning, and financial inclusion.

The proposals on these themes should ideally focus on generating evidence pertaining to the following specific areas relevant to data quality:

Sampling frame for selection of ultimate sampling units: The list of sampling units or the sampling frame plays an important role in probability sampling and the accuracy and completeness of the frame dictate the magnitude of the coverage bias in survey estimates. Often the sampling frame for the ultimate sampling units is not readily available. Although house listing has traditionally been used for the selection of households, it can be quite resource-intensive.

This RFP seeks to identify alternative ways of constructing sampling frames for different modes of data collection and of validating the quality of the frames for its potential use in surveys. The proposals on these themes should ideally focus on the following specific areas relevant to the following themes:

Use of paradata as a quality assurance mechanism: In the case of surveys based on computer-assisted personal interviewing (CAPI), a lot of process data (paradata) are being generated, almost real-time, throughout the survey. This may include interviewer productivity indicators, call records, number of attempts made per interview to interview the targeted respondent, interview length, question-level time stamp data based on key strokes, use of question-specific remarks, GPS coordinates, and, audio recording of interviews. The RFP is soliciting proposals for innovative ways of using such data for monitoring data collection activities and intervening as per the findings of such a monitoring mechanism. Can remote monitoring based on paradata provide an alternative to field-based monitoring and supervision as traditionally used in surveys in India? Is this targeted monitoring and supervision method more effective as compared to the random back checks method?

Controlling interviewer bias and variability in outcomes: Computer-assisted modes of data collection ensure the availability of survey data on a real-time basis. This RFP also seeks to promote innovative assessments of such data in order to reduce interviewer bias and variability. Examples include measuring interviewer effort based on different indicators, such as household roster size, number of cases having zero value in consumption expenditure items, number of illnesses or hospitalisation episodes recorded, and number of formal and informal loans taken by the household, and comparing them across interviewers, identifying interviewers opting for more negative screening in order to reduce their burden of the interview relative to other interviewers or having a conceptual misunderstanding about specific questions. How can one use such early signs to minimise interviewer bias and variability in the outcome of interest?

Real time survey data and consistency checks: Real-time survey data can be used to identify intentional or unintentional mistakes in data collection and to take necessary actions for preventing such errors going forward. The RFP looks for demonstration of consistency checks based on a single variable or multiple variables in order to identify errors at the nascent stage of data collection, and to determine how regular tracking can reduce errors in the long run. In this context, it also seeks an answer to the following question: What is the most effective mode and hierarchy of communication that makes it a feasible quality assurance mechanism?

Use of machine learning techniques to identify patterns automatically: Depending on the extent and coverage of the survey, and the CAPI software used for data collection, the volume of paradata generated can be so huge that traditional methods of analysing data may not work. Examples of such paradata include key stroke data, and audio files generated in surveys recording the interviews. In such a situation, the following questions need to be addressed: How can one use machine learning techniques to identify interviewers not performing up-to-the mark? Can this process be automated? How can one evaluate machine learning techniques for achieving this objective?

Secondary data analysis to quantify variability between interviewers: This RFP also looks for application of statistical/econometric modelling in existing survey data for quantifying variability among interviewers across different outcomes, such as, sensitive versus non-sensitive data; straightforward versus complicated questions; and questions leading to a substantial skip versus questions without any skip patterns. It is also important to identify ways of interpreting the results, and the potential explanations behind the various findings.

Eligibility 

Applicants affiliated to any academic or research institutes, non-profit organisations, and private companies that have experience in primary data collection and work out of offices located within India are eligible to apply. We hope that the successful applicants will be able to collaborate with NCAER researchers in future activities, allowing NCAER and the Centre to expand both its network as well as the skill sets of professionals associated with it.

Funding

The Centre will support a budget of up to Rs. 20,00,000/- (inclusive of all applicable taxes) for a period of 12 months. The budget should clearly indicate the actual needs and modes of utilisation of the funding for the proposed project. There is a provision for two such grants of up to Rs. 20,00,000/- (inclusive of all applicable taxes). However, only one grant for each applicant will be considered for funding.

Application Procedure 

All applications must be emailed to Ms. Arpita Kayal, Program Manager, NDIC (akayal@ncaer.org) in a single PDF document (font ‘Georgia’, size 12) with the following components:

A) The proposal (no longer than 6 pages in single space) on research work falling under the focus areas outlined above. The proposal should include the following sections:

1. Project Summary

2. Specific Aim(s)

3. Research Strategy, which would further specify:

a. Significance

b. Innovation

c. Approach and Implementation Plan

4. Expected Outcomes

5. Potential Challenges and Alternative Strategies

6. Timeline

7. Budget and Budget Justification

8. Institutional Background

(The page limit for the proposal is exclusive of details on the budget and applicant’s institutional background.)

B) Curriculum Vitae of the key research staff who will undertake the proposed work.

Expression of interest

Applicants interested in participating in this RFP may inform Ms. Arpita Kayal (akayal@ncaer.org) of their interest. We expect to set up an information sharing phone call with potential applicants during early August 2019.

Selection Criteria

The selection of proposals will be based on the merit of the proposal and the CVs of members of the respective research teams. And, the merit of the proposal will be judged on the basis of the following criteria:

  • Alignment of the proposal with the RFP;
  • Innovativeness in methods outlined in the proposal;
  • Rigour and feasibility of approach;
  • Clarity of thought; and
  • Clarity in writing.

Expected Output

The grantees will be expected to submit a report on the methodology and results to the Centre, which will be posted on NCAER’s website. Successful applicants will be encouraged to submit their results for publications in journals. The study instruments and anonymised data sets will also be placed in the public domain, allowing for free online downloads.

Key dates

Proposal submission due date: 31st August, 2019.

Announcement of the successful candidates: 1st October, 2019.

Contract signing: 1st November, 2019.

Project period: 1st November, 2019 to 31st October, 2020.

Request for Proposals (RFP) on Methodological Innovations to Improve Data Quality

RFP launch date: July 22, 2019

The last date for submission of proposals has lapsed

Background:

The National Council of Applied Economic Research (NCAER) is one of India’s oldest and largest independent, non-profit, economic and social research institutes. It undertakes grant-funded research and commissioned studies for governments and industry, and is one of the few think tanks globally that also collects primary data. NCAER has set up a National Data Innovation Centre (NDIC) to serve as a laboratory for experiments in data collection, interfacing with partners in think tanks, Indian and international universities, and government. NDIC forms an important core of NCAER’s long-standing data collection activities. NCAER, has partnered with the Universities of Maryland and Michigan for the NDIC. Initial funding for NDIC is being provided by the Bill & Melinda Gates Foundation.

Current Request for Proposals: 

The focus on data-oriented research and the dynamic policy environment impose a great demand for rapid, high-quality, and policy-relevant data. Changing socio-economic conditions and technological innovations necessitate rethinking of both the kind of data being collected and how they are collected. In that context, quality assurance mechanisms play an important role in influencing the credibility of the data being collected.

Therefore, the focus of the current RFP is to seek proposals on methods to improve data quality across the following themes: gender equity, women’s time use, health system, health insurance and healthcare expenditure, employment and unemployment, family planning, and financial inclusion.

The proposals on these themes should ideally focus on generating evidence pertaining to the following specific areas relevant to data quality:

Sampling frame for selection of ultimate sampling units: The list of sampling units or the sampling frame plays an important role in probability sampling and the accuracy and completeness of the frame dictate the magnitude of the coverage bias in survey estimates. Often the sampling frame for the ultimate sampling units is not readily available. Although house listing has traditionally been used for the selection of households, it can be quite resource-intensive.

This RFP seeks to identify alternative ways of constructing sampling frames for different modes of data collection and of validating the quality of the frames for its potential use in surveys. The proposals on these themes should ideally focus on the following specific areas relevant to the following themes:

Use of paradata as a quality assurance mechanism: In the case of surveys based on computer-assisted personal interviewing (CAPI), a lot of process data (paradata) are being generated, almost real-time, throughout the survey. This may include interviewer productivity indicators, call records, number of attempts made per interview to interview the targeted respondent, interview length, question-level time stamp data based on key strokes, use of question-specific remarks, GPS coordinates, and, audio recording of interviews. The RFP is soliciting proposals for innovative ways of using such data for monitoring data collection activities and intervening as per the findings of such a monitoring mechanism. Can remote monitoring based on paradata provide an alternative to field-based monitoring and supervision as traditionally used in surveys in India? Is this targeted monitoring and supervision method more effective as compared to the random back checks method?

Controlling interviewer bias and variability in outcomes: Computer-assisted modes of data collection ensure the availability of survey data on a real-time basis. This RFP also seeks to promote innovative assessments of such data in order to reduce interviewer bias and variability. Examples include measuring interviewer effort based on different indicators, such as household roster size, number of cases having zero value in consumption expenditure items, number of illnesses or hospitalisation episodes recorded, and number of formal and informal loans taken by the household, and comparing them across interviewers, identifying interviewers opting for more negative screening in order to reduce their burden of the interview relative to other interviewers or having a conceptual misunderstanding about specific questions. How can one use such early signs to minimise interviewer bias and variability in the outcome of interest?

Real time survey data and consistency checks: Real-time survey data can be used to identify intentional or unintentional mistakes in data collection and to take necessary actions for preventing such errors going forward. The RFP looks for demonstration of consistency checks based on a single variable or multiple variables in order to identify errors at the nascent stage of data collection, and to determine how regular tracking can reduce errors in the long run. In this context, it also seeks an answer to the following question: What is the most effective mode and hierarchy of communication that makes it a feasible quality assurance mechanism?

Use of machine learning techniques to identify patterns automatically: Depending on the extent and coverage of the survey, and the CAPI software used for data collection, the volume of paradata generated can be so huge that traditional methods of analysing data may not work. Examples of such paradata include key stroke data, and audio files generated in surveys recording the interviews. In such a situation, the following questions need to be addressed: How can one use machine learning techniques to identify interviewers not performing up-to-the mark? Can this process be automated? How can one evaluate machine learning techniques for achieving this objective?

Secondary data analysis to quantify variability between interviewers: This RFP also looks for application of statistical/econometric modelling in existing survey data for quantifying variability among interviewers across different outcomes, such as, sensitive versus non-sensitive data; straightforward versus complicated questions; and questions leading to a substantial skip versus questions without any skip patterns. It is also important to identify ways of interpreting the results, and the potential explanations behind the various findings.

Eligibility 

Applicants affiliated to any academic or research institutes, non-profit organisations, and private companies that have experience in primary data collection and work out of offices located within India are eligible to apply. We hope that the successful applicants will be able to collaborate with NCAER researchers in future activities, allowing NCAER and the Centre to expand both its network as well as the skill sets of professionals associated with it.

Funding

The Centre will support a budget of up to Rs. 20,00,000/- (inclusive of all applicable taxes) for a period of 12 months. The budget should clearly indicate the actual needs and modes of utilisation of the funding for the proposed project. There is a provision for two such grants of up to Rs. 20,00,000/- (inclusive of all applicable taxes). However, only one grant for each applicant will be considered for funding.

Application Procedure 

All applications must be emailed to Ms. Arpita Kayal, Program Manager, NDIC (akayal@ncaer.org) in a single PDF document (font ‘Georgia’, size 12) with the following components:

A) The proposal (no longer than 6 pages in single space) on research work falling under the focus areas outlined above. The proposal should include the following sections:

1. Project Summary

2. Specific Aim(s)

3. Research Strategy, which would further specify:

a. Significance

b. Innovation

c. Approach and Implementation Plan

4. Expected Outcomes

5. Potential Challenges and Alternative Strategies

6. Timeline

7. Budget and Budget Justification

8. Institutional Background

(The page limit for the proposal is exclusive of details on the budget and applicant’s institutional background.)

B) Curriculum Vitae of the key research staff who will undertake the proposed work.

Expression of interest

Applicants interested in participating in this RFP may inform Ms. Arpita Kayal (akayal@ncaer.org) of their interest. We expect to set up an information sharing phone call with potential applicants during early August 2019.

Selection Criteria

The selection of proposals will be based on the merit of the proposal and the CVs of members of the respective research teams. And, the merit of the proposal will be judged on the basis of the following criteria:

  • Alignment of the proposal with the RFP;
  • Innovativeness in methods outlined in the proposal;
  • Rigour and feasibility of approach;
  • Clarity of thought; and
  • Clarity in writing.

Expected Output

The grantees will be expected to submit a report on the methodology and results to the Centre, which will be posted on NCAER’s website. Successful applicants will be encouraged to submit their results for publications in journals. The study instruments and anonymised data sets will also be placed in the public domain, allowing for free online downloads.

 

Key dates

Proposal submission due date: 31st August, 2019.

Announcement of the successful candidates: 1st October, 2019.

Contract signing: 1st November, 2019.

Project period: 1st November, 2019 to 31st October, 2020.

NCAER, Brookings India, and Business Standard pay tribute to their former colleague, Subir Gokarn (1959-2019)

It is with deep sadness that many of Subir Gokarn’s friends and former colleagues heard about his tragic passing away in Washington DC on July 30th after a brief illness: Dr Gokarn was just 59. Since November 2015, Subir Gokarn had been the IMF Executive Director for India, Bangladesh, Sri Lanka and Bhutan. More than that, he was a professional and personal friend to many in India and overseas, known for his wry, keen sense of humour.

To celebrate the life and work of Dr Subir Gokarn, three New Delhi institutions—NCAER, Brookings India, and the Business Standard—came together on Wednesday, August 7, 2019 for a joint memorial meeting. Over 120 guests joined the meeting, held at the new T2 Conference Centre at NCAER. This 74-minute video of the memorial meeting contains tributes from the three institutions—delivered by Shekhar Shah, T N Ninan, and Shamika Ravi—and from a number of Subir’s colleagues and friends from his time at the Delhi School of Economics, IGIDR, NCAER, CRISIL, RBI, Brookings India, and the IMF.

Dr Gokarn started his professional career at the Indira Gandhi Institute of Development Research (IGIDR) in Mumbai, becoming an Associate Professor over 1991-2000. During this time, he also spent an academic year at the Economic Growth Center at Yale on a Fulbright Fellowship. From IGIDR Subir came to NCAER as Chief Economist and IFCI Chair during 1999-2002. In that role, he ran the first three NCAER-NBER Neemrana Conferences, working closely with NBER Research Associate Raghuram Rajan. His association with NCAER continued over the years as an active member of the India Policy Forum Research Panel, co-editor on the India Policy Forum journal for two years, and a regular at the NCAER Neemrana Conferences.

From NCAER, Gokarn went on to become the Chief Economist of CRISIL from 2002 to 2007, and then Chief Economist of Standard & Poor Asia-Pacific during 2007-09. At 49, Gokarn became the RBI’s youngest Deputy Governor responsible for Monetary Policy, Research, Financial Markets, Communications and Deposit Insurance, staying at RBI from 2009-12. From 2012 to 2015, Gokarn was the first Director of Research at Brookings India, building a vibrant institution while overcoming many teething problems. In recent years, Subir Gokarn was a regular columnist with the Business Standard and a frequent participant at its editorial meetings.

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