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

Primary Purpose

Infectious Disease, Cardiovascular Disease

Status
Unknown status
Phase
Not Applicable
Locations
International
Study Type
Interventional
Intervention
District health information package
Sponsored by
Unity Health Toronto
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional health services research trial for Infectious Disease focused on measuring 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

Eligibility Criteria

undefined - undefined (Child, Adult, Older Adult)All SexesDoes not accept 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

Sites / Locations

  • Centre for Global Health Research, St. Michael's Hospital
  • St. John's Research Institute

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

No Intervention

Arm Label

District health information package

No Intervention

Arm Description

Outcomes

Primary Outcome Measures

Percentage children 12-23 months vaccinated against measles
Percentage children <3 yrs with diarrhea in past 2 weeks given oral rehydration solution
Percentage facility-based births for the last child since 2007

Secondary Outcome Measures

Percentage last child >3 yrs breast fed within 1 hr of birth
Percentage women given advice on breastfeeding and newborn thermal care during antenatal care
Percentage subcenters with oral rehydration solution available on day of survey and no stockouts for more than 10 days in last month
Percentage community health centres with at least 1 surgeon or ob/gyn
Percentage public health centres with reagents, light microscope and lab technician for malaria blood smear

Full Information

First Posted
October 28, 2009
Last Updated
June 3, 2015
Sponsor
Unity Health Toronto
Collaborators
Canadian International Development Agency, Lombard Insurance Global Poverty Action Lab, St. John's Research Institute
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1. Study Identification

Unique Protocol Identification Number
NCT01003587
Brief Title
Promoting Evidence-Based Decision-Making in India: District Evaluation Study on Health
Acronym
DESH
Official Title
Improving Use of Evidence in Policy: District Evaluation Study on Health
Study Type
Interventional

2. Study Status

Record Verification Date
June 2015
Overall Recruitment Status
Unknown status
Study Start Date
July 2009 (undefined)
Primary Completion Date
March 2016 (Anticipated)
Study Completion Date
July 2016 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Unity Health Toronto
Collaborators
Canadian International Development Agency, Lombard Insurance Global Poverty Action Lab, St. John's Research Institute

4. Oversight

Data Monitoring Committee
No

5. 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.
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.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Infectious Disease, Cardiovascular Disease
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

7. Study Design

Primary Purpose
Health Services Research
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
Outcomes Assessor
Allocation
Randomized
Enrollment
594 (Actual)

8. Arms, Groups, and Interventions

Arm Title
District health information package
Arm Type
Experimental
Arm Title
No Intervention
Arm Type
No Intervention
Intervention Type
Behavioral
Intervention Name(s)
District health information package
Intervention Description
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
Primary Outcome Measure Information:
Title
Percentage children 12-23 months vaccinated against measles
Time Frame
Five years
Title
Percentage children <3 yrs with diarrhea in past 2 weeks given oral rehydration solution
Time Frame
Five years
Title
Percentage facility-based births for the last child since 2007
Time Frame
Five years
Secondary Outcome Measure Information:
Title
Percentage last child >3 yrs breast fed within 1 hr of birth
Time Frame
Five years
Title
Percentage women given advice on breastfeeding and newborn thermal care during antenatal care
Time Frame
Five years
Title
Percentage subcenters with oral rehydration solution available on day of survey and no stockouts for more than 10 days in last month
Time Frame
Five years
Title
Percentage community health centres with at least 1 surgeon or ob/gyn
Time Frame
Five years
Title
Percentage public health centres with reagents, light microscope and lab technician for malaria blood smear
Time Frame
Five years
Other Pre-specified Outcome Measures:
Title
Differences in any of primary and secondary outcomes between Empowered Action Group and Assam (EAGA) states and non-EAGA states
Time Frame
Five years
Title
Differences in any of primary and secondary outcomes between measles-focus states and non-measles-focus states
Time Frame
Five years

10. Eligibility

Sex
All
Accepts Healthy Volunteers
No
Eligibility Criteria
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
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Onil Bhattacharyya, MD, PhD
Organizational Affiliation
Unity Health Toronto
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Prabhat Jha, MD, PhD
Organizational Affiliation
Unity Health Toronto
Official's Role
Principal Investigator
Facility Information:
Facility Name
Centre for Global Health Research, St. Michael's Hospital
City
Toronto
State/Province
Ontario
ZIP/Postal Code
M5C 1N8
Country
Canada
Facility Name
St. John's Research Institute
City
Bangalore
State/Province
Karnataka
ZIP/Postal Code
560034
Country
India

12. IPD Sharing Statement

Links:
URL
http://www.cghr.org
Description
Centre for Global Health Research
URL
http://www.sjri.res.in/
Description
St. John's Research Institute

Learn more about this trial

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

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