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CHARACTERISTICS OF RESEARCH PROJECTS TO BE DEVELOPED

• Undertake formative research on ACS administration to identify barriers to uptake of ACS in the specific local context. Formative research over 3 months timeframe will include facilities and communities and key populations such as health care providers, community leaders, families, and the mother-infant dyad. A key part of this effort is user-centric design focused on the needs, motivations, and influencers of the mother-infant dyad. Formative research will include both supply issues (through the health system and providers) and demand issues (primarily through the mother and family). Subsequently the formative research team will function as the program learning team to improve the model and its implementation

• Phase 1 (2.5 years): Each study team will design one or more scalable models for ACS administration based on formative research and user-centric design. This will include ACS guidelines, protocols, communication materials, training materials, and tools needed for implementing the delivery model in facilities and in the community. ACS delivery models will be designed such that they could be effectively scaled-up through the existing health system, taking into account system barriers and constraints identified in formative research.

• Phase 2 (2.5 years): Each study team will evaluate the impact of the scale up of the optimized model, on coverage, safety and impact outcomes in a stepped-wedge cluster randomized controlled trial in 6 administrative clusters with a network of health facilities. Women at high risk of preterm birth between 26- less than 34 weeks gestation will be the target of the ACS package and, together with their babies, will also be subjects for outcome assessment. Health providers will be the target of facility and provider level components of the implementation model. The impact on neonatal mortality rate, ACS coverage and safety outcomes (proportion of women who received ACS and delivered at term and maternal infection) will be evaluated.

• The research studies will be implemented in full partnership with the MoNHSR&C and provincial Departments of Health, including at the provincial and district levels. Implementation activities will include guideline dissemination; health care provider training (including community health care workers if part of the model); early registration of pregnancy; early dating scans; identification of pregnant women at risk of preterm delivery; care seeking at appropriate health facilities; demand generation/communication; community mobilization; incentive structures for health care providers, mothers, and families; establishing referral and supervision systems; monitoring; and continuous feedback loops and adaptation. Grantees will work closely with the provincial Departments of Health or other institutions that are accountable for service delivery to pilot the delivery model(s). Grantees will be responsible for the evaluation component.

• Collaborate with fellow grantees to coordinate evaluation methodologies, to share information, and to disseminate results from this initiative.

• Applied implementation research methods will be included as part of applications. Mixed methods (qualitative/ quantitative) will be required to understand what is working and why different components of the model work or do not work. Cluster RCT in a stepped-wedge design is part of Phase 2 of this implementation research.

• ACS package must be implemented as an integral aspect of maternal and child health programs and other effective interventions should be linked. ACS package must be implemented within the existing health service delivery and not as a vertical program.