West Bengal Health System Reform Program, Operation

联系信息

Government of West Bengal

Department of Health Family Welfare

Swasthya Bhawan, Sector – V, Salt Lake

Kolkata – 700 091

No. HF/SPSRC/21/2025/ 263 Dated: 10 /07/2025

E-Procurement Notice

INDIA - Proposed West Bengal Health System Reform Program Operation [WBHSRP] – Technical Assistance [TA] Component

CONSULTANCY SERVICES - FIRM SELECTION

REQUEST FOR EXPRESSION OF INTEREST [EOI] for STEP wise approach to Non Communicable Diseases [NCD] risk factor surveillance’ - [STEPS] Survey in West Bengal under Technical Assistance Component of the Proposed West Bengal Health System Reform Program [WBHSRP] Operation

Project ID Number: ****

Loan Number: TBD

Procurement Plan Reference Number: IN-DOHFW, WB-485595-CS-QCBS

NIT no: NIT/161/2025

[a] General Experience: Firms are requested to provide a brief profile and general experience of the Firm along with organizational structure. Documentary Evidence: Registration certificate of the firm [s]; Power of attorney/Board resolution of authorized representative to sign the EOI proposal; Firm’s brochure

[b] Specific Experience: The firm should have successfully completed at least Two [2] similar assignments in health sector within the past ten [10] years in Government or PSU or Multilateral, or Bilateral projects. Documentary evidence: Completion certificate/work order [including project title, duration, nature, total contract value and tenure, total input in terms of staff month, Client with contact details, location of service, and scope of services, etc.]/ Satisfactory work continuation certificate. The experience of a parent company, subsidiary company, group company or associates [whatever the names] of the Applicant shall not be considered in short listing.

[c] Financial capacity of the firm including average annual turnover from survey assignments for the last three financial years [2022-23, 2023-24 and 2024-25] which should not be less than INR 4 Crores. Documentary evidence: Audited financial reports for last three financial years.

[d] Manpower with qualifications and relevant technical and professional competence necessary for implementation of the assignment. Kindly do not provide CVs as these will not be evaluated at short listing stage

While indicating information relating to [b] , it shall be made clear whether the responsibility of the firm was in the capacity of a principal firm [lead partner] or as an associated firm [sub-consultant/JV partner] with detail scope of the service. A short note on similar projects implemented by the firm should be provided.

Key Dates

REOI publication date and time: July 11, 2025 from 10:00 Hours

REOI download start date and time: July 11, 2025 from 10:00 Hours

REOI download end date and time July 25, 2025 from 14:00 Hours

EOI online opening date and time: July 25, 2025 from 14:30 Hours

Strategic Planning and State Reform Cell [SPSRC]

Department of Health and Family Welfare

Government of West Bengal

Shri.Vivek Kumar, Special Secretary and Director SPSRC

Swasthya Bhawan, GN 29, Salt Lake

Kolkata

West Bengal 700091

Telephone number: +91 33 ****7921 / +91 33 ****30609/11

E-mail: wb.****.****@gmail.com

Attachment: Terms of Reference

Sd/-

Spl. Secretary Director SPSRC

GoWB

Indicative Terms of Reference

Hiring of Consultancy Services [Firm] to Conduct ‘STEPwise approach to Non Communicable Diseases [NCD] risk factor surveillance’ - [STEPS] Survey in West Bengal under Technical Assistance Component of the proposed West Bengal Health System Reform Program (WBHSRP) Operation

The proposed West Bengal Health System Reform Program (WBHSRP) Operation (Unnata Susathya West Bengal) is a health systems reforms program of the Department of Health and Family Welfare (DoH FW), Govt. of West Bengal (GoWB). The WBHSRP is proposed to be implemented during 2025-2031, with US$290 million loan from the World Bank and would use a Program for Results (PforR) lending instrument that focuses on result-based outcomes, with a Technical Assistance [TA]/IPF component to ensure focus on results-based outcomes for achieving the Program Development Objectives (PDO). This assignment is under the Technical Assistance component of the WBHSRP.

The Program Development Objective (PDO) of the Proposed WBHSRP is “to improve utilization of health services, enhance quality of care and reduce inequities in maternal and adolescent health in West Bengal”. The program activities are organized around the four Result Areas (RAs) which contribute to the PDO. The activities of the WBHSRP under the four result areas (RAs) principally are such that they either expedite, augment or enhance the existing government program.

RA-1: Strengthened integrated care model for CPHC services: The key focus of this RA is to strengthen the policies and service delivery framework to address the NCD related risk factors, improve input and process quality of the primary healthcare system, strengthen the continuum of care, and streamline protocols for frontline workers and service providers for the provision of quality personalized care. Global evidence suggests that addressing risk factors early on leads to a reduction in the disease burden for NCD and facilitating processes and protocols for the providers has a positive impact on care-seeking among NCD patients, ultimately leads to control of NCD conditions.[1] While the focus of the RA is on hypertension and diabetes, strengthened systems are expected to improve access and quality of services for other NCDs.

RA#2: Reduced health inequalities in maternal and adolescent health: RA#2 will strengthen the delivery of health services to address the challenges of adolescent girls and boys. While several interventions targeting adolescents are operational in the state, gaps remain in their coverage and quality, coordination, and monitoring mechanisms. Addressing the GBV also requires streamlining key interventions within the health system. Thus, the design of RA#2 seeks to (a) strengthen convergence among DoHFW, School Education Department and Women and Child Development Department and track key indicators and progress at the state, district and sub-district levels; (b) expand coverage and quality of RKSK program; and (c) develop and roll out survivor-centric GBV services

RA #3 – Enhanced Governance, Accountability and Resilience: This RA focuses on critical QoC interventions, which are recognized through global evidence to be the ‘best buys’ on governance, accountability and resilience.[2] These include developing a facility- and administrative-level performance measurement framework (PMF) to track progress of health system performance and public ing and facility accreditation for comprehensive emergency obstetric and newborn care (CEmONC) centers.[3] Additionally, this result would focus on strengthening public financial management (PFM) and procurement-related challenges, which are critical to improve governance. Finally, the RA would also focus on extreme weather events and health-related interventions and strengthening the climate resilience of the health system.

RA#4: Alignment of behaviors between people and Providers: RA#4 would strengthen the system to address people and provider behaviors. It will support development and implementation of social and behavior change communication (SBCC) strategies to improve maternal and adolescent health and GBV-related outcomes, especially in priority districts lagging the state averages. The interventions are expected to empower communities with knowledge and awareness about health risks and available services. RA#4 will also support activities to bridge providers’ know-do gap for better clinical effectiveness. These interventions are well defined under several global frameworks[4], and proven to improve quality of services and increase demand.

A key element under Results Area 1 is the control and prevention of NCDs, notably hypertension and diabetes, which account for a growing burden of morbidity and mortality in the state. The Global status on Non-Communicable Diseases by World Health Organization (WHO) has estimated that every year, nearly 28 million people lose their lives to NCDs. In India, NCDs account for 60% of the total deaths. The burden of NCDs and associated risk factors is evident worldwide. This is especially true among those living in poverty. NCDs are increasingly affecting developing countries at a faster rate than in developed nations. NCDs are lifestyle diseases, as the behavioural risk factors like smoking, alcohol consumption, inadequate fruit and vegetables intake and physical inactivity pose an individual at increased risk of developing NCD. Although many lifestyle factors are considered to be modifiable, all individuals, across all strata of society should have sufficient and equal access and support to make healthy lifestyle choices. The WHO global status on non-communicable diseases 2010 ranked the monitoring and surveillance of risk factors as a top priority to tackle growing NCD epidemics in low resource settings. India, as part of Integrated Disease Surveillance Project, conducted a NCD risk factor surveillance using WHO STEPS questionnaire in the year 2007 to provide data on risk factors, which in turn was expecting to help the state health administrators to plan strategies for the control of non-communicable diseases by modifying the risk factors. Though it was planned to include all Indian states in a phased manner, the project ended with the first phase which included seven states namely Andhra Pradesh, Kerala, Madhya Pradesh, Maharashtra, Mizoram, Tamil Nadu and Uttarakhand.

West Bengal has not conducted this survey in the past and having combated the major communicable diseases in West Bengal, it is high time that the resources are invested on fighting non- communicable diseases. To address this, the Department of Health Family Welfare (DoHFW), Government of West Bengal (GoWB) plans to undertake a state-wide STEPwise approach to NCD risk factor surveillance (STEPS)[5] aligned with the WHO’s standardized approach for surveillance of NCD risk factors. This will provide critical baseline data to inform policy, measure program performance, and strengthen the quality of primary care service delivery under WBHSRP.

The overall objective of the assignment is to conduct a comprehensive NCD risk factor survey in West Bengal based on the WHO STEPS methodology targeting adult population (18-69 years), so as to generate population level estimates on key NCD risk factors (behaviorial, physical and biochemical) disaggregated by age, gender and geography, in order to ultimately formulate a baseline for the Program to support design of preventive, diagnostic, and treatment strategies.

Specific tasks under this objective include but may not be limited to the following :

The scope of the assignment includes inception, tool development, fieldwork, data cleaning, analysis, ascertaining the baseline and dissemination of results to key stakeholders of the DoHFW, encompassing the following activities, structured across three main phases of the survey:

A. Preparatory Phase:

B. Data Collection Phase:

C. Analysis and ing Phase:

The duration of the assignment would be twelve (12) months from contract signature.

The selected consultant/firm shall be expected to and deploy sufficient amount of human resource required to successfully deliver the tasks in the defined timelines. The human resource requirement for the project must include key experts of suitable qualifications and experience for the key positions tabulated below:

S. No.	Key Position	Nos.	Minimum Qualification and Professional Experience	Estimated Person Months
K1	Team Leader/Principal Investigator (PI) Lead the Team and provide team management and quality oversight over the assignment and deliverables Plan, supervise and manage timely deliverables of the assignment Point of Contact [POC] for the firm [all communications routed through the Team Leader] represent the firm in meetings with the GoWB Ensure that all documents and reports are reviewed and assessed in a timely manner with a high level of quality	1	Professional Experience: At least 15 years’ of demonstrated experience in managing health and nutrition sector projects (with focus on NCDs) with strong background in analytics, surveys, monitoring, and evaluation in the health sector. Specific Experience: Working as technical expert or Team Leader in at least 2 projects having similar objectives involving quantitative and qualitative data collection, questionnaire design and large-scale surveys and their analysis. Prior experience in similar surveys that includes a module on biomarkers (such as WHO STEPS, National Family Health Survey (NFHS) or UNICEF Comprehensive National Nutrition Survey (CNNS) would be an advantage. Qualifications post-graduate or higher degree in biostatistics/epidemiology/public health/nutrition/ health administration from a recognized University.	12
K2	Public Health Specialist (with Specialization in Epidemiology)/ Epidemiologist - Design survey methodology (sampling techniques, data collection methods) -Create questionnaires or interview guides -Oversee the pilot test and conduct of the survey -Collaborate with stakeholders, government agencies, and NGOs as necessary	2	Professional Experience: At least 10+ years of demonstrated experience in NCD-focused surveys. Must have led sampling design and survey instruments aligned with WHO STEPS. The specialist should also have experience in working with the government health systems, in handling or managing analytical studies on health including experience in assessment and/or evaluation of public health programs Specific Experience: Working as technical expert in at least 2 Public Health/Nutrition/Epidemiology projects having similar objectives involving quantitative data collection, questionnaire design and large-scale surveys and their analysis. Qualifications: Post-graduate or higher degree in public health/nutrition/ health administration from a recognized University.	24 months cumulative for K2
K3	Survey Expert - Ensure the quality of technical and operational aspects of the survey, including sampling, sample size calculations and designing of appropriate weights	1	Professional Experience: Specific Experience: At least 7 years of professional experience in household surveys. Ensures technical quality, sample design, and weight calculations. Demonstrated experience in use of statistical/analysis software such as STATA/Epi/SPSS/SAS. Qualifications: Postgraduate degree in biostatistics, epidemiology or economics.	9
K4	Lab Coordinator/Biochemical Specialist -Oversee all aspects of STEP 3 biochemical sample collection, including planning, cold chain logistics, and compliance with WHO STEPS and NABL protocols. -Coordinate with district laboratory partners to ensure timely and quality-controlled processing of blood samples (e.g., glucose, lipids, thyroid profile). -Ensure availability and calibration of lab equipment, sample transport materials, and lab kits across all districts. -Monitor adherence to pre-analytical protocols, including fasting requirements, informed consent, and proper labeling and tracking of specimens. -Facilitate quality assurance processes, including use of control strips, double-blind sample re-testing, and sample integrity tracking. -Provide technical orientation to field phlebotomists/lab technicians and troubleshoot issues during sample collection.	2	Professional Experience: At least 5 years of relevant experience in laboratory diagnostics, public health surveillance, or managing field-based biomedical sample collection, including logistics and cold chain maintenance. Specific Experience: Experience in venous blood collection protocols, biochemical analysis, and working with NABL-accredited or equivalent lab settings. Familiarity with WHO STEP 3 protocols or equivalent biomarker surveys preferred. Qualifications: Bachelor’s degree in Medical Laboratory Technology. Certification in laboratory quality management or biosafety will be an advantage.	8 months cumulative for K4
K5	Data and IT expert -Develop the CAPI-based field data entry formats and data management strategy, ensure the quality of data entry, and coordinate data entry	2	Professional Experience: At least 3 years of professional experience in managing large household datasets Specific Experience: Experience in developing digital data entry system for health sector survey. Qualifications: B.Tech/BCA/BSc-IT degree from a recognized University; 3+ years building and managing mobile-based tools (ODK/Kobo).	12 months cumulative for K5
K6	Monitoring Evaluation (M E) Specialist - Work with the K2 and K3 in (a) Designing survey methodology (sampling techniques, data collection methods); (b) creating questionnaires or interview guides; and (c) overseeing the pilot test and conduct of the survey - Ensure data integrity through proper data handling, validation, and error-checking procedures. - Use advanced analytics to analyze survey data, identifying trends and correlations.	2	Professional Experience: At least 7 years of relevant experience in health systems and M E with focus on qualitative and quantitative data collection Specific Experience: experience in monitoring evaluation of development programs in areas of health systems strengthening, NCDs, etc. Proficiency in using statistical analysis software, such as SPSS, STATA, and Excel. Qualitative data analysis software (such as QSR) will be preferred. Qualifications: Masters in Economics or Statistics, Epidemiology or Public Health from a recognized University.	18 months cumulative for K6
K7	Writer/Communications Specialist - Compile and analyze survey findings into clear, concise, and actionable reports. -Translate complex data into accessible insights for diverse audiences, including policymakers, researchers, and the general public. -Prepare reports, presentations and other communication materials as per the required template. -Ensure that the reports are professionally formatted and edited as per the GoWB requirements. -Ensure reports and communication materials adhere to public health standards, ethical guidelines, and data privacy laws.	1	Professional Experience: At least 5 years of relevant work experience in writing and documentation. Specific Experience: Worked as Writer/Communications Specialist and has drafted Project reports for at least 3 Public Health projects having similar objectives involving quantitative data collection, questionnaire design and large-scale surveys and their analysis. Qualifications: Master’s degree in English, Journalism, or Mass Communication/MSW/ Public Health/rural management from a recognized University.	4
TOTAL				87

Table 3: Essential Qualification and experience of Non-Key [NK] Experts

Sl.****.	Position	Nos.	Essential Qualification/ Experience	Estimated Person Months
NK1	Field Surveyors	35	Bachelor’s degree in Social Work, Rural Management, or other relevant discipline and more than 3 years’ experience of conducting surveys. Assist in collecting required field data Prior knowledge of surveying and collecting data in skill eco-system will be preferable Proficiency in the local language of the study area is essential Preference will be given to candidates residing in or familiar with the local context	140 person months cumulative for NK1
NK2	Phlebotomist	35	Diploma or certificate course in Phlebotomy or Medical Laboratory Technology. More than 3 years of experience in drawing blood, handling specimens, and working in clinical or diagnostic or field settings. Proficiency in the local language of the study area is essential Preference will be given to candidates residing in or familiar with the local context	140 person months cumulative for NK2
NK3	Field Supervisors	10	Graduate with 3+ years of field team leadership; trained in STEPS methodology, QA, and digital data collection. Proficiency in the local language of the study area is essential Preference will be given to candidates residing in or familiar with the local context	40 person months cumulative for NK3

The consultant/firm shall carry out the assignment under the overall supervision of the DoHFW. However, day-to-day activities shall be coordinated by the nodal for RA#1 under the PMU, WBHSRP and nodal for NCD program in DoHFW.

The PMU shall provide the consultant/firm with relevant documents, data and permissions necessary to complete deliverables under the assignment and shall ensure that the firm has access to all Program sites and locations.

The consultant/firm shall timely submit the following reports to the PMU (the inception and assignment completion reports would be in Word, PDF and printed formats):

Table 4: List of Deliverables

#	Deliverables/Outputs	Tentative Deadline
1.	Inception with proposed survey tools, sampling methodology, indicative questionnaire (s), workplan with key milestones and timelines, deployment of resources, and STEPS plan	T0 + 1 month
2.	Pilot testing of the STEPS tools, incorporating the suggested changes and submission of final assessment tools	T0 + 3 months
3.	Final tools and questionnaire and commencement of STEPS	T0 + 4 months
4.	Midline Progress	T0 + 7 months
4.	Draft with detailed analysis of the findings	T0 + 9 months
5.	Final assessment with detailed analysis of the findings	T0 + 10 months
6.	Dissemination to the stakeholders and creation of knowledge products	T0 + 11 months
7.	Assignment Completion	T0 + 12 months

It may be noted that payments shall be made upon acceptance of the deliverables by the Client.

Give access to all the required documents, correspondence and any other information associated with the project as felt necessary by Client in discussion with the consultant. Facilitate consultation with relevant stakeholders (Departments, Implementation Entities and other institutions), as appropriate.

The consultant firm will protect the confidentiality of those participating in the survey at all stages. All data/material/information collected shall be confidential and the property of the DoHFW, GoWB. No data or other information from this survey will be released to third parties without the written approval of the DoHFW, GoWB The consultant firm will turn over all data and questionnaires to the DoHFW, GoWB and will not destroy information and material at the end of the project and after all data and original documentation has been delivered to the DoHFW, GoWB.

Annexure I: STEPS survey study Protocol– West Bengal

Methods :

1.1 Study design

A state wide cross-sectional survey will be conducted using the WHO STEP wise survey protocol to obtain representative estimates from the adult population, aged 18 to 69 years, in West Bengal. The age will be grouped into 18-29 years, 30-44 years, 45-59 years, 60-69 years. All groups will be measured in both genders.

1.2 Study population

The target population of the study will be adults aged 18 to 69 years old residing in West Bengal.

1.3 Inclusion criteria

All individuals aged 18 to 69 years of age and residing in the address for more than 12 months will be included.

1.4 Exclusion criteria

Individuals who fall into following categories will be excluded from the survey.

1.5 Sample Size:

N = Zα2pqd2

Wherein,

No of household calculation= (no of houeholds in the area) sample size / total no of households

1.6 Sampling Method

A multi stage cluster sampling method will be used to select a state wide representative sample from the total population. A uniform sample design with population proportionate to size allocation in urban and rural area will be adopted in all the districts. In each district, the rural sample will be selected in from each Blocks. In the first stage, a village will be randomly selected followed by the random selection of equal number of households within each selected village. In urban areas of each district, a two-stage procedure will be followed from all the wards. In the first stage, one Census Enumeration Block (CEB) from each ward followed by random selection of equal number of households within each CEB using the systematic random sampling procedure.

The number of population to be covered in each district will be sampled based on the population proportion to sample size with equal allocation in urban and rural areas.

Sl. No.	Name of District	Total Projected Pop 23-24	% of Total Population	District wise sample size	Sample size for rural	No. of Blocks	Sample size for urban	No. of ULBs
1	Alipurduar	****916	1.6%	126	91	6	35	1
2	Bankura	****381	2.7%	206	150	16	56	1
3	Basirhat HD	****447	2.5%	192	139	10	53	2
4	Birbhum	****764	2.2%	170	123	11	47	3
5	Bishnupur HD	****547	1.2%	92	67	6	25	1
6	Cooch Behar	****753	3.1%	236	171	12	65	1
7	Dakhhin Dinajpur	****920	1.8%	137	99	8	38	2
8	Darjiling	****684	2.1%	163	118	9	45	3
9	Diamond Harbour	****696	3.5%	267	194	13	73	1
10	Hooghly	****761	5.8%	447	325	18	122	12
11	Howrah	****838	5.2%	403	293	14	110	3
12	Jalpaiguri	****940	2.1%	164	119	7	45	2
13	Jhargram	****356	1.2%	95	69	8	26	1
14	Kalimpong	338893	0.3%	25	18	3	7	1
15	Kolkata	****755	4.6%	354	0	0	354	1
16	Maldah	****390	4.6%	354	257	15	97	2
17	Murshidabad	****705	8.2%	626	454	26	172	7
18	Nadia	****841	5.6%	427	310	18	117	8
19	Nandigram HD	****696	2.1%	159	115	11	44	1
20	North 24 PGS	****891	8.4%	644	468	12	176	24
21	Paschim Bardhaman	****023	3.1%	236	171	8	65	2
22	Paschim Medinipur	****747	5.3%	404	293	21	111	3
23	Purba Bardhaman	****339	5.2%	401	291	23	110	3
24	Purba Medinipur	****985	3.5%	271	197	14	74	3
25	Purulia	****169	3.2%	248	180	20	68	1
26	Rampurhat HD	****650	1.7%	128	93	8	35	1
27	South 24 PGS	****888	5.7%	436	317	16	119	4
28	Uttar Dinajpur	****885	3.5%	269	195	9	74	3
	Total	****43860		7680	5317	342	2363	97

From each selected PSU (District), the SSU (Block in rural area and ULB in urban area) will be selected proportionately by systematic random sampling (every fifth) starting from a landmark (BDO/ Panchayet samity office area) until the required sample size is achieved. From each selected household, one individual will be selected from those who fall in the 18-69 age range by using KISH method.

Selection of eligible participants at household level:

One eligible participant (aged between 18 and 69 years) in the selected households will be recruited for the survey using the KISH method.

The Kish sampling method will be used to randomly select one eligible member of the household. Using the Kish Method, eligible participants (adults aged 18 to 69 years) in each household will be ranked in order of decreasing age, starting with males then females, then randomly selected.

STEPS INSTRUMENT:

Preparation of STEPS instrument:

All necessary STEPS approved questionnaire and tools of WHO may be re-created in Google Form/ ODK toolkit app for mobile based data collection. Data analysis tools can also be created with the help of department / 3rd party Statistician and I.T team (to be decided by higher authorities).

Community information

Necessary community information for the survey and data collection is an essential step before survey and may be appraised by MPW and ASHA after getting policy approval from the Department.

Data Collection

Data collection will be done by 28 different teams, one team for each district. The data and blood sample collector will be selected engaged by firm which will be selected by tender selection committee.

Data collection will be done after necessary training by selected firm. Each team required be provided with a field kit containing: a carrier bag, letters to the relevant authorities, feedback forms for participants, consent forms, checklist, list of the selected wards and villages and households and village maps, interview tracking forms, operational manual, pens, pencils, clipboards, notebooks, Seca digital weighing Machine, Seca Portable Stadiometer, Seca measuring tape, OMRON digital BP Apparatus, Batteries, Show Cards, Measuring Cups, feedback forms, Clinic Cards). The team will also be supported by the local Sr. PHN/ PHN/ANM/ ASHA to identify the household and elaborating the procedure.

The flow of events will be as follows: STEP 1 and 2 will be conducted at the survey participant's household and STEP 3 will be conducted on the morning of 2nd day of contact by the Laboratory partner.

Data collection will be spread over two phases, namely, initial contact with the participant, completing the questionnaire and taking physical measurements, and collecting blood samples for biochemical measurement. The participants will be requested to give 45–60 minutes of their time for completion of STEPS I and STEP II and an additional 5 minutes for collecting the blood sample.

Data collection from a selected participant will be completed in 2–3 days. On the first day, all eligible participants in the selected household will be listed and one participant will be selected using the Kish method. An interview tracking form will be completed to record brief information about the respondent. If a selected participant is present on that visit, s/he will be requested to participate in the study and asked for consent. Once the consent is obtained, the STEP I and II questionnaire will be completed by the enumerator team. If s/he is not at home, a second visit will be made. After completing STEPS I and II, participants will be given a feedback form. This form will include information on their height, weight, hip and waist circumferences, blood pressure (third reading) and heart rate (third reading). A clinic card will also be given to every participant for biochemical measurement containing fasting instruction. This card will also contain the appointment date, time and place for blood sample collection. Blood sample will be collected by the lab technician at the doorstep. The participants will be called through telephone the previous day evening and oral consent will be obtained to give fasting blood sampling the next day early morning. The lab technician will go to the household the next day early morning to collect the blood sample after obtaining written informed consent. The reports of the biochemical markers will be later communicated to the study participants.

Physical Measurements

Body weight, height, waist and hip circumferences, blood pressure and heart rate will be measured using Seca Digital Floor Scale with High Capacity (Model 813), Seca 217 portable stadiometer, Seca 201 measuring tape and OMRON automatic digital blood pressure monitor respectively.

Height will be measured with a portable Seca stadiometer. For the height measurement, respondents will be asked to remove footwear (shoes, slippers, sandals) and any hat or hair ties. Respondents should stand on a flat surface facing the interviewer with their feet together and heels against the backboard with knees straight. They will be asked to look straight ahead and not tilt their head up, making sure that their eyes were at the same level as their ears. Height measurements will be taken to the nearest 0.1 cm.

Weight will be measured with a pre-calibrated portable digital weighing scale (Seca). The instrument will be placed on a firm, flat surface. Participants will be requested to remove their footwear and socks, wear light clothes, stand on the scale with one foot on each side of the scale, face forward, place arms at their side and wait until asked to step off. Measurements will be taken to the nearest 0.1 kg.

Waist and hip circumference will be measured using a Seca measuring tape. A private area, such as a separate room within the house, will be used and these measurements will be taken over light clothing. The waist circumference measurement will be made at the midpoint between the last palpable rib and the top of the iliac crest. Measurements will be made to the nearest 0.1 cm. Hip measurement will also be made using a Seca measuring tape placed horizontally at the point of maximum circumference over the buttocks. Measurements will be taken to the nearest 0.1 cm.

Blood pressure measurements will be taken using automatic digital blood pressure monitor (OMRON) with universal cuff size. Before taking the measurements, participants will be asked to sit quietly and rest for 15 minutes with legs uncrossed. The sphygmomanometer cuff will be placed on the left arm while the participant rested their forearm on a table with the palm facing upward. Two readings will be taken 10 minutes apart. During the analysis the average of the two readings will be taken. The batteries will be replaced after every 100 measurements.

Biomarker Data Collection Plan

Biochemical measurements will be done in the selected NABL accredited/ Govt. hospital laboratories in each district. On, the day of the survey when STEP 1 and STEP 2 have been finished, participants will be asked to fast overnight i.e. people will be asked not to consume any food or drinks after 10 p.m. at night, except water, until the morning of the following day. Those participants who comply with the fasting advice will be eligible for blood sample collection. Blood glucose, Lipid profile and Thyroid function test will be performed using locally available Semi/ full auto analyser. Venous Blood will be taken. Blood volume required for the test will be 5 cc. Respondent’s blood will be placed in specimen tube which will be labelled with respondent’s identification number. All the blood specimens will be analysed at the same day.

Timeline for data collection

Each enumerator team shall collect samples from a minimum of at least 10 households per day. The biochemical parameters will be collected in the working days of the consecutive week. At this rate, the data from the required sample size will be completed in a period of 8 weeks. (Samples covered by a field team per week will be minimum 18 accounting to 144 in a period of 8 weeks).

Training of data collectors

A 2-day ToT will be organized for the District Nodal and Team Supervisors by selected firm. The training workshop will include sessions on the overview of STEP wise approach to NCD risk factor surveillance, how to approach selected households and individuals including use of Kish method, orientation to m-STEPS app, interview skills, informed consent, detailed discussion on the survey instrument and how to use show cards, mock interviews, demonstration and practice on physical measurements. On the 2nd day of the training, workshop will be organised by the laboratory partner to orient the lab Supervisors on collecting blood samples for blood glucose, lipids and thyroid profile, emergency management and referral of critically high biochemical markers level for medical doctors in the data collection teams and quality control of all field processes.

One day training of the data collectors will be given at each district level by the above master trainers in cascade mode.

Ethical considerations

The survey proposal will be reviewed, and approval will be obtained by the departmental ethics committee of Health FW Dept, Govt. of West Bengal.

The survey team member will obtain the informed consent from each participant who agreed to participate in all steps of study after they were clearly and completely informed about the study nature. Interviews will be conducted in a manner that ensure confidentiality and privacy of the survey respondents.

Quality control

Data Quality Management

The Quality Control of the study will be decided later by the Department.

[1] WHO (World Health Organization). 2009. 2008–2013 Action Plan for the Global Strategy for the Prevention and Control of Non-Communicable Diseases

[2] Such as the WHO’s national quality policy and strategy (NQPS) and Lancet’s ‘High Quality Health Systems’ framework

[3] CEmONCs would offer quality obstetric care, including C-sections, newborn and emergency childcare, blood storage, and referral transport

[4] Key frameworks include the WHO’s Quality of Care Framework for Maternal and Newborn Health, Adolescent-Friendly Health Services Guidelines, and RESPECT Women for GBV response. The United Nations Population Fund’s GBV guidelines support multi-sectoral approaches. For SBCC, UNICEF’s C4D and Johns Hopkins Center for Communication Programs emphasize research, community engagement, and strategic messaging.

[5] https://www.****.int/teams/noncommunicable-diseases/surveillance/systems-tools/steps