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United Arab Emirates is seeking to become self-sufficient in gas supply by 2030. This has led the country to initiate several exploratory and appraisal projects to achieve this goal. This study covers one such pilot project targeting production from tight gas reservoirs in three wells through coiled tubing (CT) underbalanced drilling (UBD) project in ADNOC Onshore. CT pressure control equipment was rigged up on top of production trees with wells already completed and cemented. A CT tower was used to accommodate the drilling bottomhole assembly (BHA) and eliminate risks related to its deployment. CT strings were designed to reach target intervals with sufficient weight on bit (WOB), suitable for sour environment, and able to withstand high pumping rates with mild circulating pressures. To address the hazards of H2S handling at surface, a custom-fit closed-loop system was deployed. The recovered water was treated on surface and reused for drilling to decrease the water consumption throughout the operations. The plan was to drill three 3/4-in. horizontal laterals in all candidate wells. Each well was completed with a combination of a 4 1/2-in. and a 5 1/2-in. tubing and a 7-in. liner. Five laterals were drilled across the three candidate wells targeting carbonate reservoirs with each lateral having an average length of ∼4,000 ft. The achieved rates of penetration varied significantly from 15 ft/min to 30 ft/min while drilling through the various formations. Over the course of the pilot project, several challenges had to be addressed, such as material accretion on the CT string during wiper trips, treatment of return fluids having high H2S content and rock cuttings and ensuring integrity of the CT pipe while operating in severe downhole environments. Solutions and lessons learnt from each well were implemented subsequently in the campaign, such as the use of increased concentrations of H2S inhibitor to coat the CT string, use of nitrified fluids based on changing well parameters to maintain underbalance, thorough pipe management through real-time CT inspection, and adding a fixed quantity of fresh water to the drilling system every day to avoid chemical reactions between the drilling fluid additives and hydrocarbons. The wells completed with this method exceeded production expectations by 35 to 50% across the project, while reconfirming the value of the technology. The use of CT for UBD is still considered a challenging intervention worldwide. Such cases in high H2S environments are rare. This study outlines best practices for a CT UBD and a setup that can be replicated in other locations to implement this methodology with high H2S and when rig sourcing is a concern.

ObjectivesWe undertook assessment of quality of antenatal care (ANC) services in public sector facilities in the Indian state of Bihar state delivered under the national ANC programme (Pradhan Mantri Surakshit Matritva Abhiyan, PMSMA).SettingThree community health centres and one subdistrict hospital each in two randomly selected districts of Bihar.ParticipantsPregnant women who sought ANC services under PMSMA irrespective of the pregnancy trimester.Primary and secondary measuresQuality ANC services were considered if a woman received all of these services in that visit—weight, blood pressure and abdomen check, urine and blood sample taken, and were given iron and folic acid and calcium tablets. The process of ANC service provision was documented.ResultsEight hundred and fourteen (94.5% participation) women participated. Coverage of quality ANC services was 30.4% (95% CI 27.3% to 33.7%) irrespective of pregnancy trimester, and was similar in both districts and ranged 3%–83.1% across the facilities. Quality ANC service coverage was significantly lower for women in the first trimester of pregnancy (6.8%, 95% CI 3.3% to 13.6%) as compared with those in the second (34.4%, 95% CI 29.9% to 39.1%) and third (32.9%, 95% CI 27.9% to 38.3%) trimester of pregnancy. Individually, the coverage of weight and blood pressure check-up, receipt of iron folic acid (IFA) and calcium tablets, and blood sample collection was >85%. The coverage of urine sample collection was 46.3% (95% CI 42.9% to 49.7%) and of abdomen check-up was 62% (95% CI 58.6% to 65.3%). Poor information sharing post check-up was done with the pregnant women. Varied implementation of ANC service provision was seen in the facilities as compared with the PMSMA guidelines, in particular with laboratory diagnostics and doctor consultation. Task shifting from doctors to ANMs was observed in all facilities.ConclusionsGrossly inadequate quality ANC services under the PMSMA needs urgent attention to improve maternal and neonatal health outcomes.

Technical assistance is provided to country governments as part of international development programmes to support policymaking or strengthen state capability. This article presents the conceptual evolution of ‘technical assistance’ linked to capacity development, starting with programmes aiming exclusively to enhance individual capacity in the 1950s to 1970s and progressing to complex systems approaches in the past ten years. It also presents some of the frequent challenges in designing and implementing technical assistance, drawing from the existing literature and the authors’ experience in international development. The article summarises the latest thinking about delivering more effective development, including the adaptive management practices and the initiatives to strengthen evidence about what works. Finally, we complement this article with a follow-up open letter reflecting on the current policy options and opportunities for change.

Background Self-help group (SHG) interventions have been widely studied in low and middle income countries. However, there is little data on specific impacts of health layering, or adding health education modules upon existing SHGs which were formed primarily for economic empowerment. We examined three SHG interventions from 2012-2017 in Bihar, India to test the hypothesis that health-layering of SHGs would lead to improved health-related behaviours of women in SHGs. Methods A model for health layering of SHGs – Parivartan – was developed by the non-governmental organisation (NGO), Project Concern International, in 64 blocks of eight districts. Layering included health modules, community events and review mechanisms. The health layering model was adapted for use with government-led SHGs, called JEEViKA+HL, in 37 other blocks of Bihar. Scale-up of government-led SHGs without health layering (JEEViKA) occurred contemporaneously in 433 other blocks, providing a natural comparison group. Using Community-based Household Surveys (CHS, rounds 6-9) by CARE India, 62 reproductive, maternal, newborn and child health and nutrition (RMNCHN) and sanitation indicators were examined for SHGs with health layering (Pavivartan SHGs and JEEViKA+HL SHGs) compared to those without. We calculated mean, standard deviation and odds ratios of indicators using surveymeans and survey logistic regression. Results In 2014, 64% of indicators were significantly higher in Parivartan members compared to non-members residing in the same blocks. During scale up, from 2015-17, half (50%) of indicators had significantly higher odds in health layered SHG members (Parivartan or JEEViKA+HL) in 101 blocks compared to SHG members without health layering (JEEViKA) in 433 blocks. Conclusions Health layering of SHGs was demonstrated by an NGO-led model (Parivartan), adapted and scaled up by a government model (JEEViKA+HL), and associated with significant improvements in health compared to non-health-layered SHGs (JEEViKA). These results strengthen the evidence base for further layering of health onto the SHG platform for scale-level health change. Study registration ClinicalTrials.gov number NCT02726230

Background The Government of Bihar (GoB) in India, the Bill and Melinda Gates Foundation and several non-governmental organisations launched the Ananya program aimed to support the GoB to improve reproductive, maternal, newborn and child health and nutrition (RMNCHN) statewide. Here we summarise changes in indicators attained during the initial two-year pilot phase (2012-2013) of implementation in eight focus districts of approximately 28 million population, aimed to inform subsequent scale-up. Methods The quasi-experimental impact evaluation included statewide household surveys at two time points during the pilot phase: January-April 2012 (“baseline”) including an initial cohort of beneficiaries and January-April 2014 (“midline”) with a new cohort. The two arms were: 1) eight intervention districts, and 2) a comparison arm comprised of the remaining 30 districts in Bihar where Ananya interventions were not implemented. We analysed changes in indicators across the RMNCHN continuum of care from baseline to midline in intervention and comparison districts using a difference-in-difference analysis. Results Indicators in the two arms were similar at baseline. Overall, 40% of indicators (20 of 51) changed significantly from baseline to midline in the comparison districts unrelated to Ananya; two-thirds (n = 13) of secular indicator changes were in a direction expected to promote health. Statistically significant impact attributable to the Ananya program was found for 10% (five of 51) of RMNCHN indicators. Positive impacts were most prominent for mother’s behaviours in contraceptive utilisation. Conclusions The Ananya program had limited impact in improving health-related outcomes during the first two-year period covered by this evaluation. The program’s theories of change and action were not powered to observe statistically significant differences in RMNCHN indicators within two years, but rather aimed to help inform program improvements and scale-up. Evaluation of large-scale programs such as Ananya using theory-informed, equity-sensitive (including gender), mixed-methods approaches can help elucidate causality and better explain pathways through which supply- and demand-side interventions contribute to changes in behaviour among the actors involved in the production of population-level health outcomes. Evidence from Bihar indicates that deep structural constraints in health system organisation and delivery of interventions pose substantial limitations on behaviour change among health care providers and beneficiaries. Study registration ClinicalTrials.gov number NCT02726230.

Background Unacceptably high rate of childhood stunting for decades remained a puzzle in the eastern Indian state of Bihar. Despite various programmatic interventions, nearly half of the under-five children (numerically about 10 million) are still stunted in this resource-constrained state. Data and methods Using four successive rounds of National Family Health Survey (NFHS) data spread over more than two decades and by employing unconditional quantile regressions and counterfactual decomposition (QR-CD), the present study aims to assess effects of various endowments as well as returns to those endowments in disparities in childhood stunting over the period. Results The results show that although the child’s height-for-age Z-scores (HAZ) disparity largely accounted for differing levels of endowments during the earlier decades, in the later periods, inadequate access to the benefits from various development programmes was also found responsible for HAZ disparities. Moreover, effects of endowments and their returns varied across quantiles. We argue that apart from equalizing endowments, ensuring adequate access to different nutrition-centric programmes is essential to lessen the burden of childhood stunting. Conclusion The state must focus on intersectoral convergence of different schemes in the form of state nutrition mission, and, strengthen nutrition-centric policy processes and their political underpinnings to harness better dividend.

BackgroundUnacceptably high rate of childhood stunting for decades remained a puzzle in the eastern Indian state of Bihar. Despite various programmatic interventions, nearly half of the under-five children (numerically about 10 million) are still stunted in this resource-constrained state. Data and MethodsUsing four successive rounds of National Family Health Survey (NFHS) data spread over more than two decades and by employing quantile regressions and counterfactual decomposition (QR-CD), the present study aims to assess effects of various endowments as well as returns to those endowments in disparities in childhood stunting over the period. Results The results show that although child’s height-for-age Z-scores (HAZ) disparity was largely accounted for differing levels of endowments during earlier decade, in the later periods, inadequate access to the benefits from various development programmes was also found responsible for HAZ disparities. Moreover, effects of endowments and their returns vary across quantiles. We argue that apart from equalizing endowments, ensuring adequate access to different nutrition-centric programmes are essential to lessen the burden of childhood stunting. ConclusionThe state must focus on intersectoral convergence of different schemes in the form of state nutrition mission, and, strengthen nutrition-centric policy processes and their political underpinnings to harness better dividend.

Background Unacceptably high rate of childhood stunting for decades remained a puzzle in the Indian state of Bihar, located in the eastern part of the country. Despite various programmatic interventions, nearly half of the under-five children (numerically about 10 million) are still stunted in this resource-constrained state. Data and Methods Using four successive rounds of National Family Health Survey (NFHS) data spread over more than two decades and employing quantile regressions and counterfactual decomposition (QR-CD), the present study aims to assess effects of various endowments as well as returns to those endowments in disparities in childhood stunting over the period. Results The results show that although child’s height-for-age Z-scores (HAZ) disparity was largely accounted for differing levels of endowments during earlier decade, in the later periods, inadequate access to the benefits from various development programmes was also found responsible for HAZ disparities. Moreover, effects of endowments and their returns vary across quantiles. We argue that apart from equalizing endowments, ensuring adequate access to different nutrition-centric programmes are essential to lessen the burden of childhood stunting. Conclusion The state must focus on intersectoral convergence of different schemes in the form of state nutrition mission, and, strengthen nutrition-centric policy processes and their political underpinnings to harness better dividend.

Background mHealth technology holds promise for improving the effectiveness of frontline health workers (FLWs), who provide most health-related primary care services, especially reproductive, maternal, newborn, child health and nutrition services (RMNCHN), in low-resource - especially hard-to-reach - settings. Data are lacking, however, from rigorous evaluations of mHealth interventions on delivery of health services or on health-related behaviors and outcomes. Methods The Information Communication Technology-Continuum of Care Service (ICT-CCS) tool was designed for use by community-based FLWs to increase the coverage, quality and coordination of services they provide in Bihar, India. It consisted of numerous mobile phone-based job aids aimed to improve key RMNCHN-related behaviors and outcomes. ICT-CCS was implemented in Saharsa district, with cluster randomization at the health sub-center level. In total, evaluation surveys were conducted with approximately 1100 FLWs and 3000 beneficiaries who had delivered an infant in the previous year in the catchment areas of intervention and control health sub-centers, about half before implementation (mid-2012) and half two years afterward (mid-2014). Analyses included bivariate and difference-in-difference analyses across study groups. Results The ICT-CCS intervention was associated with more frequent coordination of AWWs with ASHAs on home visits and greater job confidence among ASHAs. The intervention resulted in an 11 percentage point increase in FLW antenatal home visits during the third trimester (P = 0.04). In the post-implementation period, postnatal home visits during the first week were increased in the intervention (72%) vs the control (60%) group (P

IntroductionWe evaluated the impact of a ‘Team-Based Goals and Incentives’ (TBGI) intervention in Bihar, India, designed to improve front-line (community health) worker (FLW) performance and health-promoting behaviours related to reproductive, maternal, newborn and child health and nutrition.MethodsThis study used a cluster randomised controlled trial design and difference-in-difference analyses of improvements in maternal health-related behaviours related to the intervention’s team-based goals (primary), and interactions of FLWs with each other and with maternal beneficiaries (secondary). Evaluation participants included approximately 1300 FLWs and 3600 mothers at baseline (May to June 2012) and after 2.5 years of implementation (November to December 2014) who had delivered an infant in the previous year.ResultsThe TBGI intervention resulted in significant increases in the frequency of antenatal home visits (15 absolute percentage points (PP), p=0.03) and receipt of iron-folic acid (IFA) tablets (7 PP, p=0.02), but non-significant changes in other health behaviours related to the trial’s goals. Improvements were seen in selected attitudes related to coordination and teamwork among FLWs, and in the provision of advice to beneficiaries (ranging from 8 to 14 PP) related to IFA, cord care, breast feeding, complementary feeding and family planning.ConclusionResults suggest that combining an integrated set of team-based coverage goals and targets, small non-cash incentives for teams who meet targets and team building to motivate FLWs resulted in improvements in FLW coordination and teamwork, and in the quality and quantity of FLW–beneficiary interactions. These improvements represent programmatically meaningful steps towards improving health behaviours and outcomes.Trial registration numberNCT03406221

Technical assistance has been at the heart of development assistance provided to country governments by donor agencies over the past several decades. The current debates on reimagining technical assistance focus on the existing challenges of the different types of technical assistance, and the (re)construction of an ideal model for delivering this type of support, with little discussion about the dilemmas involved in making day-to-day decisions and trade-offs in implementation. This article presents technical assistance as a policy option for governments and details the existing models of delivering technical assistance, as well as their limitations and the required enabling conditions. The models presented focus on the type of role for the technical advisers- as doers (performing government functions), partners (working with the government to perform a specific role) and facilitators (enabling and facilitating change programmes to address wicked problems). As part of the programmes, the team of technical advisers can play one or more roles. The authors also discuss how problem-solving or solution implementation can be the focus of a technical assistance programme or how large programmes combine these two approaches. The paper provides a practical account of the implications of the programme design that would ideally help governments and donors to design more effective technical assistance programmes.

Technical assistance is provided to strengthen state capability as part of international development programmes. This article presents the conceptual evolution of the technical assistance linked to capacity development, starting from a single unit of analysis, that of individual capacity to complex systems theories. It presents some of the frequent challenges in designing and implementing technical assistance, with a focus on the challenges common across government-funded and externally funded technical assistance, as well as the challenges unique to externally funded technical assistance. The article reviews the recent thinking on the practice in technical assistance from locally-driven technical assistance to positive deviance as a method to identify what works. It discusses change management as an adaptive and iterative process, and technical advisers acting as enablers of change rather than as change-makers and relying on adaptive and flexible approaches to programme management.

Table S5. Results of multiple logistic regression for association of stillbirth for sub-group analysis for referred deliveries with select risk factors in the Indian state of Bihar. (DOCX 12 kb)

Figure S1. Distribution of illness symptoms (not mutually exclusive) and treatment sought for that symptom among newborns who survived 3â days or more in the Indian state of Bihar. (DOCX 23 kb)

Table S3. Distribution of the health provider who delivered the baby for all births, and for facility births based on referral between January and December 2016 in the Indian state of Bihar. (DOCX 13 kb)

Table S1. Basic descriptive for risk factors during labour and delivery for all births including stillbirths by the place of delivery between January and December 2016 in the Indian state of Bihar. (DOCX 16 kb)

Table S2. Results of multiple logistic regression for association of stillbirth for sub-group analysis for deferred deliveries with select risk factors in the Indian state of Bihar. (DOCX 12 kb)

Figure S2. Distribution of causes of death using verbal autopsy interviews by place of delivery for the three age sub-groups in the Indian state of Bihar. (DOCX 66 kb)

Table S1. Basic descriptive during labour and delivery for all live births between January and December 2016 and for neonatal deaths in 0–2, 3–7, and 8–27 days by the place of delivery for those who participated in the detailed interview. (DOCX 37 kb)

Table S4. Results of sequential multiple logistic regression models for association of stillbirths in facility deliveries with inclusion of referred delivery as a risk factor along with other risk factors in the Indian state of Bihar. Statistically significant odds ratios are shown in bold in the final model 5. (DOCX 16 kb)

Table S2. Survival status at discharge post-birth and mean days of facility stay for neonates born at a facility in the Indian state of Bihar. (DOCX 22 kb)

Background: The Indian government has adopted a target of 28 weeks wherein the fetus did not show any sign of life. We investigated the association of stillbirth with a variety of socio-demographic, maternal, pregnancy, labour and delivery related risk factors among all births using a hierarchical logistic regression model approach. Findings: A total of 23,940 births including 338 stillbirths were identified giving the state stillbirth rate (SBR) of 15.4 (95% CI 13.2-17.9) per 1,000 births, with no difference in SBR by sex. Antepartum and intrapartum SBR was 5.6 (95% CI 4.3-7.2) and 4.5 (95% CI 3.3-6.1) per 1,000 births, respectively. In the final logistic regression model, significantly higher odds of stillbirth were documented for deliveries with gestation period of 30 years (OR 3.20, 95% CI 1.52-6.74), pregnancies with multiple foetuses (OR 2.82, 95% CI 1.49-5.33), breech presentation of the baby (OR 2.70, 95% CI 1.75-4.18), and births in private facilities and home (OR 2.23, 95% CI 1.67-2.99). Varied risk factors were associated with antepartum and intrapartum stillbirths. Among the facility deliveries, the referred deliveries had significantly high odds of stillbirth (OR 3.32, 95% CI 2.03-5.43). Interpretation: This study finds increased risk of stillbirths in deferred and referred deliveries in addition to identifying demographic and clinical risk factors for antepartum and intrapartum stillbirths from population-based data, highlighting aspects of health care that need attention in addition to improving skills of health providers to reduce stillbirths. The INAP could utilise the findings of this study to further strengthen its approach to meet the stillbirth reduction target by 2030. Funding Statement: This work was supported by the Bill & Melinda Gates Foundation. Declaration of Interests: PN and DB are employees of the Bill & Melinda Gates Foundation, India Country Office, New Delhi. The other authors have no conflict of interest. Ethics Approval Statement: This study was approved by the Institutional Ethics Committee of the Public Health Foundation of India. All participants provided written informed consent, and for those who could not read or write, the participant information sheet and consent form were explained by the trained interviewer and a thumb impression obtained.

This paper aims to show overall position of the process of IFRS adoption worldwide as well as in India to harmonize the global financial accounting and reporting system. Worldwide homogeneous accounting standards have been set out by the IASB in form of IFRS. It is generally expected that worldwide adoption of IFRS will be beneficial to investors and other users of financial statements. Out of worldwide 140 jurisdictions as developed by IFRS Foundation, 116 jurisdictions require IFRS for all or most domestic publicly accountable entities in their capital markets. Of the 24 jurisdictions that do not require IFRS for all or most domestic publicly accountable entities, 14 already permit or require IFRS for at least some domestic publicly accountable entities. Only 10 jurisdictions currently do not require or permit IFRS for any domestic publicly accountable entities. One of those (Thailand) is in the process of adopting IFRS in full, and another (Indonesia) is in the process of convergence of its national standards with IFRS. The remaining eight that use national or regional standards are Bolivia, China, Egypt, Guinea-Bissau, Macao, Niger, the United States and Vietnam. Out of the 14 countries that have adopted IFRS for at least some (but not all) domestic publicly accountable entities, India is one of them.