Investigator(s)
| WHO Technical Officer |
Deepti Agrawal WHO Country office for India Deepti Agrawal 
|
| Principal Investigator |
Dr Shobhna Gupta Ministry of Health and Family Welfare, Government of India Dr Shobhna Gupta
|
| Co-Investigator(s) |
Dr DEEPTI Agrawal WHO Country office for India Dr DEEPTI Agrawal
|
| Co-Investigator(s) |
Dr Archisman Mohapatra GRID Council Dr Archisman Mohapatra
|
Title(s) and abstract
| Scientific title | Evaluation of a Risk-Stratified Home-Based Newborn and Child Care (HBNCC) Pilot Programme: A Mixed-Methods Study in Rajasthan and Odisha, India (2026-2029) |
| Public title | Evaluation of the Pilot Implementation of the Home-Based Newborn and Child Care (HBNCC) Programme in Rajasthan and Odisha, 2026-2029 |
| Background | Recent global evidence highlights the potential of risk-differentiated care to improve child survival and development. While all children require essential services, a subset—such as those born preterm, with low birth weight, congenital conditions, or not breastfed—are biologically vulnerable and need more intensive follow-up. A risk stratification approach enables frontline health workers to tailor care intensity, optimize resource allocation, and strengthen continuity of care without compromising universal coverage. Building on this evidence, the Ministry of Health is integrating Home-Based Newborn Care (2013) and Home-Based Young Child Care (2018) into a unified programme, covering birth to three years. The revised programme incorporates risk stratification as a central strategy, with differentiated follow-up pathways, stronger primary healthcare linkages, and greater emphasis on maternal wellbeing, nutrition, nurturing care, early childhood development, team-based delivery, and digital support. A pilot in four districts of Rajasthan and Odisha will help evaluate feasibility, implementation, costs, sustainability, and scalability to inform NHM-led scale-up. |
| Objectives | 1. To evaluate the performance (feasibility, implementation performance, fidelity, incremental costs, sustainability, and scalability) of the HBNCC programme in improving early identification, risk classification, and follow-up of ‘at-risk’ newborns and children under three years of age. 2. To estimate the incremental costs of implementing the revised Home-Based Newborn and Child Care programme over and above the existing HBNC and HBYC programmes, and, where feasible to conduct cost effectiveness analyses. 3. To document lessons learned and best practices to inform the potential scalability across other states or districts. |
| Study Methods | A multi-phase, mixed-methods evaluation will be undertaken across four pilot districts in Rajasthan and Odisha. The design combines quantitative and qualitative approaches to examine feasibility, implementation, fidelity, costs, sustainability, scalability, and contextual factors influencing delivery and uptake. Phase I (Baseline; ~6 months): A convergent mixed-methods approach will establish readiness and baseline conditions. Quantitative assessments include facility readiness surveys at sub-centres and linked facilities, and cross-sectional surveys of ~1,584 caregivers (≈396 per district) and 264 ASHAs (≈66 per district) to assess service use, care practices, risk perception, and satisfaction. Qualitative inquiry in one selected block per district will use IDIs, FGDs, and KIIs with caregivers, frontline workers (ASHAs, ANMs, CHOs), and programme managers. Phase II (Concurrent Monitoring; ~16–18 months): Routine HMIS and child-tracking data will track adherence to visit protocols, timeliness and completion of referrals, and follow-up outcomes. About 10% of cases will be validated through household visits. Qualitative assessments (FGDs, KIIs, and case-based “stories of change”) will be conducted every six months to capture experiences, acceptability, and emerging challenges. Phase III (Endline; ~6 months): Endline assessments will measure change over time. Surveys of caregivers and ASHAs, facility reassessments, and structured observations will evaluate coverage, quality, and referral outcomes after implementing newer HBNCC components. An incremental cost and cost-effectiveness analysis will use a health system perspective and activity-based costing, linking programme costs to outputs and modelled outcomes (e.g., diarrhoea/ARI cases, DALYs) to estimate cost-efficiency. |
| Expected outcomes and use of results | Key outcome domains include: (i) Implementation/process outcomes: home visit completion, risk identification, protocol adherence, timely escalation, and referral completion. (ii) Intermediate outcomes (household surveys): caregiver knowledge of danger signs, malnutrition screening coverage, exclusive breastfeeding, immunisation, care-seeking, and service satisfaction. (iii) Modelled health outcomes: reductions in diarrhoea and ARI episodes and mortality trends, derived from routine programme data for cost-effectiveness analysis. Mortality and severe morbidity will not be directly surveyed but assessed using ASHA registers, facility records, and HMIS data. Findings will be synthesised into briefs, reports, and presentations to support adaptive programme management. Evidence will guide improvements in implementation, workforce capacity, and service delivery at district and state levels. Cost-effectiveness results will inform resource allocation and value-for-money assessments. Overall, the evaluation will generate actionable evidence on sustainability and scale-up of the HBNCC model under NHM. |
| Keywords | Home-Based Newborn and Child Care, mixed-methods, risk stratification, maternal and child health |
Research Details
| Student research | No |
| Start Date | 06-Jul-2026 |
| End Date | 31-Dec-2029 |
| Key Implementing Institution | WHO Country Office India |
| Multi-country research | No |
| Nationwide research | Yes, with randomly selected geographical areas |
| India, India | |
| Research Domain(s) | Maternal, Reproductive and Child Health |
| Research field(s) | Health Care Seeking/Utilization |
| Involves human subjects | Yes |
| Intervention Evaluation Research | |
| Data Collection | Primary data |
| Proposal reviewed by other Committee | Under Review |