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BMJ Glob Health. 2017 Sep 29;2(3):e000497. doi: 10.1136/bmjgh-2017-000497. eCollection 2017.

Scaling up quality improvement intervention for perinatal care in Nepal (NePeriQIP); study protocol of a cluster randomised trial.

Author information

International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Health Section, UNICEF, UN House, Lalitpur, Nepal.
Institute for Global Health, University College London, London, UK.
Lifeline Nepal, Kathmandu, Nepal.
Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
Health Economic Forum, Uppsala University, Uppsala, Sweden.
Department of Economics, Uppsala University, Uppsala, Sweden.
Department of Health Services, Ministry of Health, Nepal.



Nepal Perinatal Quality Improvement Project (NePeriQIP) intends to scale up a quality improvement (QI) intervention for perinatal care according to WHO/National guidelines in hospitals of Nepal using the existing health system structures. The intervention builds on previous research on the implementation of Helping Babies Breathe-quality improvement cycle in a tertiary healthcare setting in Nepal. The objective of this study is to evaluate the effect of this scaled-up intervention on perinatal health outcomes.


Cluster-randomised controlled trial using a stepped wedged design with 3 months delay between wedges will be conducted in 12 public hospitals with a total annual delivery rate of 60 000. Each wedge will consist of 3 hospitals. Impact will be evaluated on intrapartum-related mortality (primary outcome), overall neonatal mortality and morbidity and health worker's performance on neonatal care (secondary outcomes). A process evaluation and a cost-effectiveness analysis will be performed to understand the functionality of the intervention and to further guide health system investments will also be performed.


In contexts where resources are limited, there is a need to find scalable and sustainable implementation strategies for improved care delivery. The proposed study will add to the scarce evidence base on how to scale up interventions within existing health systems. If successful, the NePeriQIP model can provide a replicable solution in similar settings where support and investment from the health system is poor, and national governments have made a global pledge to reduce perinatal mortality.



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