The document presents a monitoring and evaluation framework for Mothers' Absolute Affection (MAA), a nationwide Indian government program to promote breastfeeding. It outlines the program's goals of increasing rates of early initiation of breastfeeding and exclusive breastfeeding. It describes the program's implementation at community, health center, and national levels. It proposes monitoring indicators related to inputs, processes, outputs, outcomes and impact. Key evaluation methods include analyzing health surveys and administrative data using statistical techniques to assess the program's progress toward nutrition and health targets.

1. Monitoring and Evaluation Framework
for MAA: Mothers’ Absolute Affection
Presented by:
Nand Lal Mishra & Bishwajeet Besra

2.  Introduction and Background
 Goals and Objectives
 Components & Implementation levels
 Logical Framework
 Monitoring of Input and Process
 Evaluation of Process, Output, Outcome and Impact
 SWOT Analysis
 Conclusion
Contents

3.  Prevents 20% of newborn deaths
 Prevents 13% of under-five deaths
 11 times lesser chance of diarrheal mortality
 15 times lesser chance of Pneumonia related mortality
 Benefits on raising I.Q.
 Prevention of non-communicable diseases
 Lesser hospital stay of newborns
 Maternal benefits (cancer prevention)
Sources: UNICEF, WHO and Lancet series on child nutrition and maternal
cares, 2003, ’08 & ’12)
Breastfeeding…

4. Current Scenario
24.5
46
42
55
0
10
20
30
40
50
60
Early initiation of
breastfeeding (within one
hour of birth)
Exclusive Breastfeeding
Early & Exclusive Breastfeeding (in %)
NFHS3 NFHS4
24.4
29.6
0
5
10
15
20
25
30
35
Median Duration of
Breastfeeding (in months)
NFHS3 NFHS4

5.  SDG 2.2: By 2030, end all forms of malnutrition, including achieving…
the internationally agreed targets on stunting and wasting in children
under 5 years of age (Poshan Abhiyan: -2% to -3% annually)
 SDG 3.2: By 2030, reduce NMR to 12 per 1,000 live births and
U5MR to 25 per 1,000 live births
 SDG 3.4: By 2030, reduce by one third premature mortality from non-
communicable diseases through prevention and treatment and promote
mental health and well-being (including breast cancer)
Relevant SDG Targets

6. Mothers’ Absolute Affection (MAA): A Nationwide programme
of the Ministry of Health and Family Welfare, Government of India
initiated in August 2016 (NHMIYCFMAA)
Aims: Promotion of breastfeeding (early initiation of breastfeeding
within one hour of birth & exclusive breastfeeding for the first six months)
and provision of counselling services for supporting breastfeeding
through health systems
Covering: All States & UTs; Around 3.9 crore pregnant & lactating
mothers; 8.8 lakh ASHAs; 1.5 lakhs Sub-centers & 17,000 Birthing
Facilities/Delivery Points
About

7. Goal: To revitalize efforts towards promotion, protection and
support of breastfeeding practices through health systems to achieve
higher breastfeeding rates.
Objectives:
 Build an enabling environment for breastfeeding through awareness
generation activities, targeting pregnant and lactating mothers, family
members and society in order to promote optimal breastfeeding
practices.
 Reinforce lactation support services at public health facilities through
trained healthcare providers and through skilled community health
workers.
 To incentivize and recognize those health facilities that show high rates
of breastfeeding along with processes in place for lactation management.
Goal & Objectives

8. Components
1
• Enabling Environment and demand generation through mass
media, mid media and community
2
• Community level activities: Community dialogues through
mothers meeting & Providing skilled care in the communities
3
• Capacity building of healthcare providers: At all delivery
points & lactation support services
4
• Awards: Recognition for best performing baby friendly facilities

9. Implementation Levels
Micro Level:
At village and
community
level (ANM’s,
AWW’s &
ASHA)
Meso Level:
At health centres
(Doctor’s & Nurses)
Macro Level:
Through mass media
(Print & Electronic)

10. Logical Framework
Input: Budget (NHM fund + 4.3 lakhs per dist.), mass media content
and training of healthcare providers
Process: General awareness (mass media campaigning), community
level intervention and health facilities strengthening
Output: Promotion of initial and exclusive breastfeeding, awareness
and breaking taboos
Outcome: Decline in early childhood mortality, improvement in
nutritional status of children and reduction in prevalence of diseases
such as diarrhoea, pneumonia etc.
Impact: Better child and maternal health

11. Monitoring Provisions
Monitoring and impact assessment is an integral part of
MAA programme.
Key indicators to measure progress: availability of skilled
persons at delivery points for counselling, improvement in
breastfeeding practices and number of accredited health facilities
Monitoring agencies: UNICEF and Reproductive, Maternal,
Newborn, Child, and Adolescent Health (RMNCH+A) lead
development partners
Provision of reporting by ASHA in prescribed monitoring form and a
state wide evaluation survey after one year of implementation.

12. Inbuilt Monitoring Indicators
Number and % of ASHAs for whom sensitization on IYCF was conducted in block meetings
Number of districts conducted launch of MAA programme
Number of Mothers’ meetings held
Number and % of Pregnant & lactating mothers who attended mother’s meetings
Number and % of ASHAs having IYCF infokit
Number and % of ASHAs provided incentive for mothers’ meetings
Number and % of ANMs for whom one day sensitization was undertaken
Number & % of ANMs & nurses trained on 4 day trainings.
Number and % of delivery points, where healthcare providers have been oriented using one
day sensitization module
Number of Facilities received MAA awards (at State level)

13. Key Themes of M&E
Relevance
Effectiveness
Efficiency
Sustainability
Photo: NHM Website

14. Monitoring of Input
Inputs: Budget
Mass media
content
Training of
healthcare
providers
Dimensions/
Indicators:
Amount of budget
per pregnant
women registered
Quantity and
quality of content
Number of
participants and
training sessions
Data sources: HMIS MAA Website Training records
Methods: Financial auditing Vignette & PPDT
KI & In-depth
Interviews

15. Monitoring of Process
Process:
General
awareness
(mass media)
Community
level
intervention
Health facilities
strengthening
Dimensions/
Indicators:
Frequency of
publications and
broadcasts
Community
engagements and
activities
Different facilities
available at health
centers
Data sources:
DAVP &
BARC
Reporting by
healthcare
providers
HMIS
Methods:
Descriptive
statistics
Geotagged photo
analysis
Health facility
index & dashboard

16. Evaluation of Process
Process:
General
awareness
(mass media)
Community
level
intervention
Health facilities
strengthening
Dimensions/
Indicators:
Outreach of
publications and
broadcasts
Impact of
community
engagements
Different facilities
available at health
centers
Data sources:
DAVP, BARC
& NFHS
KI & In-depth
Interviews/NFHS
Feedback collected
Methods:
Statistics and
Propensity score
matching (PSM)
Qualitative
analysis/PSM
Feedback analysis

17. Evaluation of Output
Output:
Promotion of
early initiation of
breastfeeding
Promotion of
Exclusive breastfeeding
up to 6 months
Dimensions/
Indicators:
Percent children under
age 3 breastfed within
one hour of birth
Percent children
under age 6 months
exclusively breastfed
Data sources: NFHS & HMIS
Methods: Percent growth and Multiple Classification Analysis

18. Evaluation of Outcome
Outcome:
Decline in early
childhood
mortality
Improvement
in nutritional
status of
children
Reduction in
prevalence of
diarrhoea,
pneumonia etc.
Dimensions/
Indicators:
NMR, IMR
& U5MR
Percent children
stunted, wasted &
underweight
Prevalence of
diarrhoea,
pneumonia etc.
Data sources: NFHS & SRS
Methods:
Percent decline, Multiple classification analysis
& Two-stage least square methods

19. Evaluation of Impact
Impact: Better child and maternal health
Dimensions/Indicators: Relevant
SDG/NHM/NNM targets and indicators
Data sources: NFHS, SRS, HMIS etc.
Methods: Target oriented analytical
approach & Various statistical methods and
analysis
Photo: Mukesh Kumar

20. SWOT Analysis: Strength
 Vast Coverage to the public through
mass media
 Strong policy support from government
 Human resource friendly
 Financial resource friendly
 Doesn’t require extra infrastructure

21. SWOT Analysis: Weakness
 Traditional beliefs and practices
 Lack of funds
 Improper functioning of health centers
 Additional burden on health workers
 Less baby friendly facilities
 Low female literacy & media exposure
 Corruption or improper implementation

22. SWOT Analysis: Opportunity
 Capacity building of health workers
 Focus on complementary feedings
 Community & NGO engagements
 Social media coverage
 Adult education at AWC
 More incentives and lack of motivations for ASHAs

23. SWOT Analysis: Threat
 Pre-existing taboos & refusal of community
 Effect of societal gatekeepers
 Limited access to social media
 Extra burden of adult literacy on AWW
 Inadequate working environment for
health care workers

24. Conclusion
1. MAA was initiated recently in august 2016 and hence only baseline
report can be generated at present.
2. Monitoring is a default part of Mothers’ Absolute Affection
programme. So there is no need of separate monitoring system.
3. Also there is no need of separate or specific evaluation survey for the
same as various statistical methods can be applied to NFHS, HMIS and
SRS data in order to assess the program's output and impact.
4. Or evaluation of this program can be merged with the evaluation of
policies and programs such as NHM, ICDS, Poshan Abhiyan etc.

25. References
 http://nhm.gov.in/nrhm-updates/536-maa-programme.html
 http://unicef.in/AddNewPage/PreView/19
 http://vikaspedia.in/health/health-campaigns/mothers-absolute-
affection#section-1
 http://nhm.gov.in/MAA/Operational_Guidelines.pdf
 https://www.unicef.org/about/annualreport/files/India_2016_COAR.pdf
 http://rchiips.org/nfhs/report.shtml
 https://nrhm-mis.nic.in/SitePages/Home.aspx

26. THANK YOU !