DESH: Promoting Evidence-Based Decision-Making in India: District Evaluation Study on Health

Sponsor

Unity Health Toronto (Other)

Overall Status

Unknown status

CT.gov ID

NCT01003587

Collaborator

Canadian International Development Agency (Other), Lombard Insurance Global Poverty Action Lab (Other), St. John's Research Institute (Other)

594

Enrollment

Locations

Arms

Duration (Months)

297

Patients Per Site

3.5

Patients Per Site Per Month

Study Details

Study Description

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.

Condition or Disease	Intervention/Treatment	Phase
Infectious Disease Cardiovascular Disease	Behavioral: District health information package	N/A

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.

Study Design

Study Type:

Interventional

Actual Enrollment :

594 participants

Allocation:

Randomized

Intervention Model:

Parallel Assignment

Masking:

Single (Outcomes Assessor)

Primary Purpose:

Health Services Research

Official Title:

Improving Use of Evidence in Policy: District Evaluation Study on Health

Study Start Date :

Jul 1, 2009

Anticipated Primary Completion Date :

Mar 1, 2016

Anticipated Study Completion Date :

Jul 1, 2016

Arms and Interventions

Arm	Intervention/Treatment
Experimental: District health information package	Behavioral: District 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
No Intervention: No Intervention

Arm

Intervention/Treatment

Experimental: District health information package

Behavioral: District 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

No Intervention: No Intervention

Outcome Measures

Primary Outcome Measures

Percentage children 12-23 months vaccinated against measles [Five years]
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]

Secondary Outcome Measures

Percentage last child >3 yrs breast fed within 1 hr of birth [Five years]
Percentage women given advice on breastfeeding and newborn thermal care during antenatal care [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 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 Outcome Measures

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]

Eligibility Criteria

Criteria

Ages Eligible for Study:

N/A and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

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

Exclusion Criteria (District Officials):

MPs who sit in the Rajya Sabha (Upper House of Parliament), Lok Sabha MPs who represent constituencies not contained within or overlapping study districts, Lok Sabha MPs who represent constituencies that overlap both experimental and control study districts
MLAs who represent constituencies not contained within study districts
DCs who administrate non-study districts
ZPCEOs who administrate non-study districts
DHOs who work in non-study districts