This research is collecting empirical data considered as the “gold standard” through direct observations of healthcare in six facilities across three countries, Bangladesh, Tanzania and Nepal, for the selected interventions and comparing this data with matched health records. The overall purpose is to use this and other linked research to rapidly move to feasibility assessment of different indicators in a wider group of countries and health care contexts.

Data collection tools

Following wide multi-stakeholder consultation through the Windsor workshop in April 2016 and formative research phase, data collection tools were finalised and data are collected on tablets using a software application developed specially for this purpose by the expert team at ICDDR,B.

The Labour ward observer checklist and KMC ward observer checklist were developed, along with a neonatal infection data verification tool and ACS data verification tool.

Further data is being collected to facilitate the comparison of health worker reports and maternal recall at the time of discharge with a health matched record through a Maternal recall pre-discharge survey.

Filming is being used to answer specific questions for measuring quality of resuscitation, and potentially for KMC in Nepal and Tanzania.

In addition, birthweight, gestational age, birth certificate notification and registration, perinatal audit and service readiness intervention for small and sick newborns are being integrated into the facility based research as other essential health systems work.


Formative phase, June 2016 to May 2017: During the formative phase of the research, the study incorporated essential components of conducting health facility assessment (HFA), data flow assessment (DFA), interviews and focus groups pre-piloting data collection tools and training of observers in each of the country sites prior to the facility based testing work. Research site visits were completed in Bangladesh, Nepal and Tanzania, and a Research Implementation Planning Workshop was held in Tanzania in December 2016. The information gathered informed the data collection phase and specifically refined the observer’s checklists, the data collection tools and processes.

Data collection phase, June 2017 to Beginning of 2018: During the data collection phase, 5,000 births will observed in one health facility site in Nepal, across three health facility sites in Bangladesh and in each of the two health facility sites in Tanzania for a total of 20,000 observed births. In addition, mixed methods research involving both qualitative and quantitative data will be collected to identify barriers and enablers of health workers’ recording alongside a time in motion study, as well as to identify birth registration and birth weight recording barriers and enablers and quality improvement initiatives.

Analysis and planning for feasibility study, 2018: Throughout the data collection phase, data will be analysed with final results shared widely in peer reviewed papers and the feasibility study will be planned.