Table 2 Description of the multi-faceted implementation strategy for Helping Babies Breathe (HBB) Quality Improvement Cycle (QIC)

HBB training

Two-day training: First day on HBB knowledge and skills as per standard package and second day on components of HBB QIC standards, training of trainers on how to conduct weekly review meeting, how to fill self-evaluation checklists and conduct peer evaluations.

Facilitators: HBB trainers

Participants: Staff of the delivery units

Setting up HBB QIC standards

At each unit: Development of QIC goals and objectives, development of a place for daily bag-and-mask skill checks, QIC weekly review meetings, use of self-evaluation checklists and peer reviews after each resuscitation.

Facilitators: Study team

Participants: Staff of the delivery units

QIC Weekly review meeting

At each unit, the unit in-charge facilitates the weekly review meetings on the progress of implementation of HBB QIC standards.

Facilitators: HBB trainers

Participants: Staff of the delivery units

Daily bag-and-mask skill check

At each unit, each staff does a bag-and-mask skill check on a mannequin before starting duty.

Facilitators: Unit in-charge

Participants: Staff of the delivery units

Self-evaluation checklist after each delivery

A self-evaluation checklist, which consists of a list of steps for immediate newborn care and neonatal resuscitation as per HBB protocol with checkboxes. After completing care of each newborn, the nurse midwife will fill up the self-evaluation checklist based on the steps completed as per the HBB protocol.

Facilitators: Unit in-charge

Participants: Staff of the delivery units

Peer review after each resuscitation

A mounted poster with the steps of the HBB protocol will be attached at each resuscitation table, so that peers can review with the colleague completing resuscitation on whether the steps were followed.

Facilitators: Unit in-charge

Participants: Staff of the delivery units