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

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ClinicalTrials.gov Identifier: NCT01003587
Recruitment Status : Unknown
Verified June 2015 by St. Michael's Hospital, Toronto.
Recruitment status was:  Active, not recruiting
First Posted : October 29, 2009
Last Update Posted : June 4, 2015
Information provided by (Responsible Party):

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
Infectious Disease Cardiovascular Disease Behavioral: District health information package

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  (Clinical Trial)
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 : July 2009
Estimated Primary Completion Date : March 2016
Estimated Study Completion Date : July 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

Outcome Measures

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

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

Other Outcome Measures:
  1. Differences in any of primary and secondary outcomes between Empowered Action Group and Assam (EAGA) states and non-EAGA states [ Time Frame: Five years ]
  2. Differences in any of primary and secondary outcomes between measles-focus states and non-measles-focus states [ Time Frame: Five years ]

Eligibility Criteria

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Ages Eligible for Study:   Child, Adult, Senior
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

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
Contacts and Locations

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01003587

Canada, Ontario
Centre for Global Health Research, St. Michael's Hospital
Toronto, Ontario, Canada, M5C 1N8
St. John's Research Institute
Bangalore, Karnataka, India, 560034
Sponsors and Collaborators
St. Michael's Hospital, Toronto
Canadian International Development Agency
Lombard Insurance Global Poverty Action Lab
St. John's Research Institute
Principal Investigator: Onil Bhattacharyya, MD, PhD St. Michael's Hospital, Toronto
Principal Investigator: Prabhat Jha, MD, PhD St. Michael's Hospital, Toronto
More Information

Additional Information:
Responsible Party: St. Michael's Hospital, Toronto
ClinicalTrials.gov Identifier: NCT01003587     History of Changes
Other Study ID Numbers: SMH 09-049
First Posted: October 29, 2009    Key Record Dates
Last Update Posted: June 4, 2015
Last Verified: June 2015

Keywords provided by St. Michael's Hospital, Toronto:
evidence-based policy
knowledge translation
disease control priorities
health spending
health services delivery
maternal and child health
policy making
delivery of health care

Additional relevant MeSH terms:
Cardiovascular Diseases
Communicable Diseases