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

June 3, 2015 updated by: Unity Health Toronto

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

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.

Study Overview

Status

Unknown

Conditions

Intervention / Treatment

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 Type

Interventional

Enrollment (Actual)

594

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Canada
    • Ontario
      • Toronto, Ontario, Canada, M5C 1N8
        • Centre for Global Health Research, St. Michael's Hospital
  • India
    • Karnataka
      • Bangalore, Karnataka, India, 560034
        • St. John's Research Institute

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child
  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

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

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Health Services Research
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
No Intervention: No Intervention
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

What is the study measuring?

Primary Outcome Measures

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

Secondary Outcome Measures

Outcome Measure
Time Frame
Percentage last child >3 yrs breast fed within 1 hr of birth
Time Frame: Five years
Five years
Percentage women given advice on breastfeeding and newborn thermal care during antenatal care
Time Frame: Five years
Five years
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
Five years
Percentage community health centres with at least 1 surgeon or ob/gyn
Time Frame: Five years
Five years
Percentage public health centres with reagents, light microscope and lab technician for malaria blood smear
Time Frame: Five years
Five years

Other Outcome Measures

Outcome Measure
Time Frame
Differences in any of primary and secondary outcomes between Empowered Action Group and Assam (EAGA) states and non-EAGA states
Time Frame: Five years
Five years
Differences in any of primary and secondary outcomes between measles-focus states and non-measles-focus states
Time Frame: Five years
Five years

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Unity Health Toronto

Collaborators

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

Investigators

  • Principal Investigator: Onil Bhattacharyya, MD, PhD, Unity Health Toronto
  • Principal Investigator: Prabhat Jha, MD, PhD, Unity Health Toronto

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

July 1, 2009

Primary Completion (Anticipated)

March 1, 2016

Study Completion (Anticipated)

July 1, 2016

Study Registration Dates

First Submitted

October 28, 2009

First Submitted That Met QC Criteria

October 28, 2009

First Posted (Estimate)

October 29, 2009

Study Record Updates

Last Update Posted (Estimate)

June 4, 2015

Last Update Submitted That Met QC Criteria

June 3, 2015

Last Verified

June 1, 2015

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • SMH 09-049

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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