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Cycle 5 (2015 Deadline)

Cluster-controlled implementation science trial of integrated maternal newborn child healthcare delivery in group settings

PI: Pushpa Chaudhary (, Nepal Ministry of Health & Possible (formerly known as Nyaya Health)
U.S. Partner: Duncan Maru, Brigham and Women's Hospital

Project Overview:

This research team will conduct a cluster-controlled, stepped wedge implementation science trial of a bundled maternal healthcare delivery intervention in rural communities in Nepal. Nepal represents an ideal setting to pilot this study based on its robust national community health worker network, progressive national healthcare priorities, and the team's personal experience in delivering healthcare in a district public healthcare setting since 2008. The intervention integrates three evidence-based approaches for maternal, newborn, and child health: (1) group antenatal and postnatal care to improve the institutional birth rate and reduce mortality among children under age two; (2) a Community Health Worker (CHW) model of home-based care to monitor and increase utilization of services, maternal and neonatal health knowledge, self-efficacy, social support, and emergency planning among mothers; and (3) a mentoring approach to quality improvement targeted at government clinic providers in the study population. This intervention will be implemented and tested in the district of Achham, Far-West Nepal, within a district population of 260,000. Achham is one of 20 priority districts under USAID’s development strategy in Nepal.

The study aims to analyze the impact of the integrated care package on institutional birth rates and under-two mortality using community household survey data. The researchers will assess the mechanisms of the impact of group integrated care and assess the efficacy of targeted CHW protocols for a home-based model of care delivery to address maternal, neonatal, and child care, in addition to chronic disease care, continuous surveillance, and mortality assessment. They will describe key aspects of the implementation process, including costs, human resources, logistics, and fidelity of the group integrated care program to model content and processes. Finally, they will produce a cost-effectivness analysis to determine affordability for national government adoption and Possible’s care delivery model. It is expected that the interventions should decrease infant mortality and morbidity, increase the percent of births that occur in a monitored setting, and increase subsequent contraceptive use.

Summary of Recent Activities
As of March 2017, the study team in partnership with Possible deployed the continuous population health surveillance system in a new population of 16,000 people in Achham District. This expansion brings the total population directly targeted for this Reproductive, Maternal, Neonatal, and Child Health (RMNCH) study to 50,000 people in Achham District. In Dolakha District, the second study site, Possible’s team has begun to implement the continuous population health surveillance system. Possible’s team formally opened recruitment for the Community Health Worker network that collects household-level data for this RMNCH intervention. Qualified candidates have been identified and selected for hire. Unique household IDs will be placed and the Community Health Worker network will begin collecting baseline data at each household in a population of 21,000 people. Possible’s team additionally presented two oral presentations and one poster on aspects of the integrated care model that informs the RMNCH intervention at the National Rural Healthcare Workers Conference and National Population Health Conference in Nepal.

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