From Evidence to Action: Co-Designed Implementation Strategies to Improve Neonatal Outcomes in a Rural District of India
1
Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Despite progress in maternal and newborn health (MNH), India continues to face challenges in achieving the Sustainable Development Goal of single-digit neonatal mortality rate (NMR), especially in rural areas. Implementation research (IR) offers an opportunity to bridge the gap between evidence-based practices (EBPs) and their effective delivery in real-world health systems. This project “SANKALP” (collective resolution) was undertaken in Ambala, to develop and optimize a contextualized implementation model to strengthen MNH systems and improve neonatal survival.
METHODS:
A formative, mixed-methods assessment was undertaken across district, facilities, and community. Data collection included quantitative reviews of facility records, case files, facility assessments, skill assessments of healthcare providers, alongside in-depth interviews (n=65) with administrators, healthcare providers at facilities and focus group discussions (n=22) with grass root workers and communities. Findings were presented in a multi-stakeholder co-design workshop, where prioritization matrices guided selection of feasible and sustainable strategies.
RESULTS:
Key gaps were identified in antenatal care quality, high-risk pregnancy (HRP) tracking, facility readiness, and inter-departmental coordination. Through participatory prioritization, stakeholders co-developed actionable innovations, including: strengthening perinatal death reviews; digital HRP tracking; standardized triage and referral SOPs; enhanced post-discharge care for preterm/LBW newborns; motivational, need-based capacity building; and quality improvement initiatives at delivery and newborn care points.
CONCLUSIONS:
This IR project demonstrates how participatory, system-oriented approaches can contextualize global EBPs to local health systems. By integrating stakeholder-driven solutions, optimizing service delivery, and strengthening accountability, the project aspires to establish a scalable implementation model to achieve single-digit NMR in Ambala and inform similar efforts nationwide.
Despite progress in maternal and newborn health (MNH), India continues to face challenges in achieving the Sustainable Development Goal of single-digit neonatal mortality rate (NMR), especially in rural areas. Implementation research (IR) offers an opportunity to bridge the gap between evidence-based practices (EBPs) and their effective delivery in real-world health systems. This project “SANKALP” (collective resolution) was undertaken in Ambala, to develop and optimize a contextualized implementation model to strengthen MNH systems and improve neonatal survival.
METHODS:
A formative, mixed-methods assessment was undertaken across district, facilities, and community. Data collection included quantitative reviews of facility records, case files, facility assessments, skill assessments of healthcare providers, alongside in-depth interviews (n=65) with administrators, healthcare providers at facilities and focus group discussions (n=22) with grass root workers and communities. Findings were presented in a multi-stakeholder co-design workshop, where prioritization matrices guided selection of feasible and sustainable strategies.
RESULTS:
Key gaps were identified in antenatal care quality, high-risk pregnancy (HRP) tracking, facility readiness, and inter-departmental coordination. Through participatory prioritization, stakeholders co-developed actionable innovations, including: strengthening perinatal death reviews; digital HRP tracking; standardized triage and referral SOPs; enhanced post-discharge care for preterm/LBW newborns; motivational, need-based capacity building; and quality improvement initiatives at delivery and newborn care points.
CONCLUSIONS:
This IR project demonstrates how participatory, system-oriented approaches can contextualize global EBPs to local health systems. By integrating stakeholder-driven solutions, optimizing service delivery, and strengthening accountability, the project aspires to establish a scalable implementation model to achieve single-digit NMR in Ambala and inform similar efforts nationwide.
| eISSN: | 2654-1459 |
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