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Implementation Science and Health Systems Research

Uttar Pradesh Health Systems Strenghthening Project

What do we do in UP?

The Johns Hopkins Uttar Pradesh Health Systems Strengthening Support Project (HSSSP) team at BSPH provides technical and advisory support in collaboration with UP-TSU partners in the areas of health systems strengthening, analytics and capacity building. As specific analyses or field studies are identified, the HSSSP team plays roles ranging from facilitation and training to oversight of study implementation, analysis, and communication. 

Our team comprises of faculty, staff, and students who are based in Lucknow, Gorakhpur, and Baltimore. 

About Uttar Pradesh

Lucknow is the capital as well as one of the 75 districts that comprise Uttar Pradesh (UP). 


largest state in land-size in the north-central part of India.


million people were estimated to live in UP in the year 2022, making it the most populous state in India.


of the total population of UP is in the age group of 20-59 years.


was the Maternal Mortality Ratio in UP in 2018, which is 45% lower than that in 2009.


of the population in UP resides in rural areas.


of the disease burden is contributed to by Communicable, Maternal, Neonatal, and Nutritional Diseases (CMNND).


of DALYs are contributed by the NCDs, out of which injuries contribute to 11.6%

Why do we work in UP?

While health indicators in UP have been improving in recent years, maternal, neonatal, infant and child mortality rates remain substantially higher in UP than in most of the rest of India. Measures of acute and chronic malnutrition are also among the poorest in the country.  The drivers of these poor health indicators of UP are complex and multifaceted. Addressing the challenges within the health system requires a holistic approach which considers the linkages between health systems processes, institutions, regulations, and governance. There is an urgent need to enhance the overall capacity of health system through a system strengthening approach to improve reproductive, maternal, child health, and nutrition as well as various communicable and non-communicable diseases.  

Who are our partners?

The Bill & Melinda Gates Foundation signed a memorandum of understanding with the Government of UP (GoUP) to provide technical assistance toward addressing many of these challenges and improving health indicators in the state. The Uttar Pradesh Technical Support Unit (UP TSU) was established by the University of Manitoba (UM) to provide a platform for this support to the state government. The Department of International Health at the Johns Hopkins Bloomberg School of Public Health (BSPH) is one of several organizations comprising the UP TSU and leads several health systems strengthening components. 

BSPH has also collaborated with local partners to undertake a range of project activities, with the aim to transition many of the functions to them. Engaging with these partners is critically important for building and strengthening institutions, systems, and capabilities for improving health outcomes. In the current phase of our project, BSPH is continuing to build on these relationships and develop new collaborations across all proposed project areas. Working together with local partners will help to ensure that local capacity is further strengthened thereby supporting the long-term sustainability of project activities. Our local partners include the All India Institute for Medical Sciences (AIIMS) in Gorakhpur and the State Institute of Health and Family Welfare (SIHFW) in Lucknow. 

Our Approach

The overall approach of the HSSSP team is to provide a platform for collaborative learning and action for strengthening health systems in UP. Understanding our role as global health practitioners – the philosophy of our project is to embrace a decolonized approach to improving lives millions at a time – through capacity building, moving for local buy-in, and centering our activities around local priorities.

Health Systems Components

During the initial phase of our project, health systems experts from BSPH worked closely with the GoUP co-developing strategies to improve human resources for health across the state, developing a plan for strengthening government health institutions, and improving the use of data for decision making. In the current phase of our project, the HSSP team continues to provide technical assistance in these areas while also building capacity for implementation research within the state and overall strengthening public health institutions.

Public Health Training and Capacity Building

GoUP has acknowledged the need to strengthen public health training institutions and enhance core competencies of public health workforce, as a key to improve public health outcomes of Uttar Pradesh. A wide array of activities has been conducted by BSPH under the UPHSSS project to strengthen the public health training ecosystem in the state at individual, organizational and systemic levels. BSPH has been working closely with the SIHFW to strengthen its organizational capacity to adequately train and support various cadres with public health and management responsibilities.  Recently, BSPH has also initiated partnership with AIIMS, Gorakhpur to support health research, education and training. 

Health Systems Governance

The Directorate of Medical and Health Services (DOMH) is the executive public health agency in UP. Upon request from the GOUP leadership, JHU is supporting organizational strengthening efforts focused on the DOMH. The HSSSP team has conducted detailed organizational assessments to identify various factors affecting organizational performance in the DOMH. Based on these assessments, the HSSSP team along with UP TSU partners is now working closely with DOMH leadership to facilitate development of the Mission, Vision and Core values of the DOMH. Further, efforts to strengthen delivery of the identified core and support functions of the DOMH through organizational design and organizational behavior interventions are underway.  

HRH Policy Strengthening

The following overarching objectives guide the strategy for addressing the HRH issues in UP.  

  1. Increase overall availability of health workers in the state.  

  1. Promote distribution of health workers to rural and underserved areas.  

  1. Improve skill-mix of health workers at all levels of the system.  

  1. Strengthen health worker competencies to deliver core health services and functions.  

  1. Build health worker motivation for service provision.  

  1. Support individual and team performance of health workers.  


Bhandari, Sudip, Brian Wahl, Sara Bennett, Cyrus Y. Engineer, Pooja Pandey, and David H. Peters. “Identifying Core Competencies for Practicing Public Health Professionals: Results from a Delphi Exercise in Uttar Pradesh, India.” BMC Public Health 20, no. 1 (November 17, 2020): 1737.


Meghani, Ankita, Daniela C. Rodríguez, Huzaifa Bilal, Anand B. Tripathi, Vasanthakumar Namasivayam, Ravi Prakash, David H. Peters, and Sara Bennett. “Examining Policy Intentions and Actual Implementation Practices: How Organizational Factors Influence Health Management Information Systems in Uttar Pradesh, India.” Social Science & Medicine 286 (October 1, 2021): 114291.


Sonderegger, Serena, Sara Bennett, Veena Sriram, Ummekulsoom Lalani, Shreya Hariyani, and Timothy Roberton. “Visualizing the Drivers of an Effective Health Workforce: A Detailed, Interactive Logic Model.” Human Resources for Health 19, no. 1 (March 12, 2021): 32.


Sriram, Veena, Shreya Hariyani, Ummekulsoom Lalani, Ravi Teja Buddhiraju, Pooja Pandey, and Sara Bennett. “Stakeholder Perspectives on Proposed Policies to Improve Distribution and Retention of Doctors in Rural Areas of Uttar Pradesh, India.” BMC Health Services Research 21, no. 1 (September 29, 2021): 1027.

Employment Opportunities

We are not currently in search for new members to join our team. However, be on the lookout - we will post new opportunities to join our project here!

Learn More

Are you interested in learning more about our team and their work supporting the health system in Uttar Pradesh? Are you interested in collaborating with us? We would love to hear from you.