Evaluation of the Safe Care, Saving Lives (SCSL) quality improvement collaborative for neonatal health in Telangana and Andhra Pradesh, India: a study protocol.

BACKGROUND: The collaborative quality improvement approach proposed by the Institute for Healthcare Improvement has the potential to improve coverage of evidence-based maternal and newborn health practices. The Safe Care, Saving Lives initiative supported the implementation of 20 evidence-based maternal and newborn care practices, targeting labour wards and neonatal care units in 85 public and private hospitals in Telangana and Andhra Pradesh, India. OBJECTIVE: We present a protocol for the evaluation of this programme which aims to (a) estimate the effect of the initiative on evidence-based care practices and mortality; (b) evaluate the mechanisms leading to changes in adherence to evidence-based practices, and their relationship with contextual factors; (c) explore the feasibility of scaling-up the approach. METHODS: The mixed-method evaluation is based on a plausibility design nested within a phased implementation. The 29 non-randomly selected hospitals comprising wave II of the programme were compared to the 31 remaining hospitals where the quality improvement approach started later. We assessed mortality and adherence to evidence-based practices at baseline and endline using abstraction of registers, checklists, observations and interviews in intervention and comparison hospitals. We also explored the mechanisms and drivers of change in adherence to evidence-based practices. Qualitative methods investigated the mechanisms of change in purposefully selected case study hospitals. A readiness assessment complemented the analysis of what works and why. We used a difference-in-difference approach to estimate the effects of the intervention on mortality and coverage. Thematic analysis was used for the qualitative data. DISCUSSION: This is the first quality improvement collaborative targeting neonatal health in secondary and tertiary hospitals in a middle-income country linked to a government health insurance scheme. Our process evaluation is theory driven and will refine hypotheses about how this quality improvement approach contributes to institutionalization of evidence-based practices

Preparedness and Response to COVID-19 Outbreak in Assam: An Experience from the Field

The world is now fighting against a new deadly virus disease, novel coronavirus disease (COVID-19), which is first declared as public health emergency and later declared as Pandemic by WHO. As COVID-19 spread around the world, governments, companies, international organizations announced measures to help contain the spread. Assam with 36 cases and the other north eastern (NE) states have been able to control the number of cases quite well compared to other states in India. To contain coronavirus spread in Assam, government leveraged nine projects implemented by Piramal Swasthya Management and Research Institute (PSMRI), in addition to other activities. This paper gives the elaborative listings of activities done by PSMRI in respond to COVID-19 outbreak to support the government respond to this pandemic. Activities are- Inbound calling, out bound calling, contact tracing, Visit and follow up of quarantined patients, data entry and updating Integrated Disease Surveillance Project (IDSP) portal and door step delivery of medicines. As on 26th April, 1,25,566 COVID-19 related calls received in 104-Health Helpline (HIHL). In addition, 37,886 beneficiaries called for quarantine follow up. Field staffs also visited households of home quarantined patients and screened more than 9000 people for COVID-19. PSMRI also supported in activities of Assam Cares Financial scheme and Dhanwantri Scheme.The above activities helped in mitigating the risk of coronavirus infection and also ‘helped in timely respond to the reported cases