Background & rationale: While India has made significant strides in reducing child mortality, nearly 5 lakh newborns continue to die each year, mostly due to preventable causes. Further, newborn survival is a field with a well-established evidence base of impactful interventions that have also been integrated into the national policy, but with persistent challenges in last-mile delivery. This “know-do” gap between evidence-based practices and how to implement them to achieve high coverage and quality at scale can be bridged through implementation research (IR) in close partnership with the health system. There are wide inter-state, inter-district, and potentially even intra-district variations in the neonatal mortality rate (NMR). Prematurity, birth asphyxia and infections are the main causes of neonatal deaths, but their relative distribution may vary with the NMR and local context across regions. Therefore, this multi-state multi-district IR study has been designed to develop effective implementation strategies for a package of evidence-based interventions that are contextualized to different state/regional contexts with the goal of achieving single-digit NMR in each study district.

Research question: How to achieve a single-digit neonatal mortality rate (NMR) in selected high-NMR districts of India by developing and optimizing an implementation model for delivering evidence-based practices to pregnant women and newborns?

Objectives:

1. To co-develop and optimize context-specific/ contextualized implementation strategies for achieving high and equitable coverage and quality of evidence-based practices (EBP) for reducing neonatal mortality.

2. To document the process of evolution (adaptation and fidelity) of the implementation model.

3. To evaluate the effect of the optimized and contextualized implementation model on the neonatal mortality rate.