Cardiovascular Disease, Infectious Disease
Conditions
Keywords
India, evidence-based policy, knowledge translation, disease control priorities, decision-makers, health spending, health services delivery, maternal and child health, policy making, delivery of health care
Brief summary
The purpose of this study is to assess the impact of disseminating information on comparative performance, along with actionable messages on how to improve health outcomes, to district-level decision-makers in India using a randomized, controlled design. This information should improve prioritization of health services by district health officers, budget allocation for health, and implementation of priority health services at the district level.
Detailed description
Use of evidence in policy is uneven, leading to frequent waste of resources. However, the best way to promote evidence uptake in policy formulation and implementation is unclear. Information on disease control priorities based on India's disease burden and health system capacity has been produced to help focus government efforts during a period of increased spending and decentralization. This study tests the impact of sending information on comparative performance (using district report cards) and actionable messages (on how to reduce disease burden) to district-level decision-makers on uptake of disease control priority recommendations in India. Using a cluster-randomized design, districts will be randomized to receive either the mailed information package or no intervention. The sample includes all 594 Indian districts in existence in 2001. The intervention will target key district level decision-makers: parliamentarians (Members of Parliament, Members of Legislative Assembly), bureaucrats (District Collectors), technocrats (District Health Officers), and local government officials (Zilla Parishad CEOs). Study outcome data will be collected using sequential national surveys of health service availability and utilization, including relevant rounds of the District Level Health and Facility Surveys and the Annual Health Surveys. This study tests an inexpensive, pragmatic strategy on a large scale and will provide information on effective methods of knowledge translation to policy-makers.
Interventions
BEHAVIORALDistrict health information package
The intervention package consists of: * A report on disease burden, disease control priorities and health system performance in India * Condensed fact sheet based on the report * District health report cards (DRCs) comparing performance on key health indicators with other districts, information on causes of death in each district, and actionable messages to reduce deaths in the district * Customized speech for district level officials detailing key actions to reduce deaths * Reminder materials including poster version of the DRCs and video on key points and actionable messages
Sponsors
Canadian International Development Agency
Lombard Insurance Global Poverty Action Lab
St. John's Research Institute
Unity Health Toronto
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
(Districts): * All districts in India in existence in 2001
Exclusion criteria
(Districts): * All districts in India created after 2001 Inclusion Criteria (District Officials): * Members of Parliament (MPs) who sit in the Lok Sabha (Lower House of Parliament) and represent constituencies that are contained within or overlap study districts * Members of Legislative Assembly (MLAs) who represent constituencies that are contained within study districts * District Collectors (DCs) who administrate study districts * Zilla Parishad Chief Executive Officers (ZPCEOs) who administrate study districts * District Health Officers (DHOs) who work in study districts
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Percentage children <3 yrs with diarrhea in past 2 weeks given oral rehydration solution | Five years |
| Percentage facility-based births for the last child since 2007 | Five years |
| Percentage children 12-23 months vaccinated against measles | Five years |
Secondary
| Measure | Time frame |
|---|---|
| Percentage last child >3 yrs breast fed within 1 hr of birth | Five years |
| Percentage subcenters with oral rehydration solution available on day of survey and no stockouts for more than 10 days in last month | Five years |
| Percentage women given advice on breastfeeding and newborn thermal care during antenatal care | Five years |
| Percentage community health centres with at least 1 surgeon or ob/gyn | Five years |
| Percentage public health centres with reagents, light microscope and lab technician for malaria blood smear | Five years |
Other
| Measure | Time frame |
|---|---|
| Differences in any of primary and secondary outcomes between Empowered Action Group and Assam (EAGA) states and non-EAGA states | Five years |
| Differences in any of primary and secondary outcomes between measles-focus states and non-measles-focus states | Five years |
Countries
Canada, India
Outcome results
None listed