PT - JOURNAL ARTICLE AU - Ashish KC AU - Anna Bergström AU - Dipak Chaulagain AU - Olivia Brunell AU - Uwe Ewald AU - Abhishek Gurung AU - Leif Eriksson AU - Helena Litorp AU - Johan Wrammert AU - Erik Grönqvist AU - Per-Anders Edin AU - Claire Le Grange AU - Bikash Lamichhane AU - Parashuram Shrestha AU - Amrit Pokharel AU - Asha Pun AU - Chahana Singh AU - Mats Målqvist TI - Scaling up quality improvement intervention for perinatal care in Nepal (NePeriQIP); study protocol of a cluster randomised trial AID - 10.1136/bmjgh-2017-000497 DP - 2017 Sep 01 TA - BMJ Global Health PG - e000497 VI - 2 IP - 3 4099 - http://gh.bmj.com/content/2/3/e000497.short 4100 - http://gh.bmj.com/content/2/3/e000497.full AB - Introduction Nepal Perinatal Quality Improvement Project (NePeriQIP) intends to scale up a quality improvement (QI) intervention for perinatal care according to WHO/National guidelines in hospitals of Nepal using the existing health system structures. The intervention builds on previous research on the implementation of Helping Babies Breathe-quality improvement cycle in a tertiary healthcare setting in Nepal. The objective of this study is to evaluate the effect of this scaled-up intervention on perinatal health outcomes.Methods/design Cluster-randomised controlled trial using a stepped wedged design with 3 months delay between wedges will be conducted in 12 public hospitals with a total annual delivery rate of 60 000. Each wedge will consist of 3 hospitals. Impact will be evaluated on intrapartum-related mortality (primary outcome), overall neonatal mortality and morbidity and health worker’s performance on neonatal care (secondary outcomes). A process evaluation and a cost-effectiveness analysis will be performed to understand the functionality of the intervention and to further guide health system investments will also be performed.Discussion In contexts where resources are limited, there is a need to find scalable and sustainable implementation strategies for improved care delivery. The proposed study will add to the scarce evidence base on how to scale up interventions within existing health systems. If successful, the NePeriQIP model can provide a replicable solution in similar settings where support and investment from the health system is poor, and national governments have made a global pledge to reduce perinatal mortality.Trial registration number ISRCTN30829654.