Another strategy that has a salutary effect on both the Infant Mortality Rate and Maternal Mortality Rate (MMR) is encouraging birth in a medical institution. While this seems like an easy and an obvious strategy to implement, there are significant challenges in executing it especially in rural India, not the least of which is access to an effective and efficient institution when the child is ready to be born. PHCs have an important role in successfully encouraging institutional delivery. Karuna Trust managed PHCs have been showing consistent and stellar performance in these health outcome indicators.