Supplementary information S2

This was a Quasi-experimental pre-post implementation study without a parallel control group conducted in 10 govt. medical college and hospital in Bihar state of India. A baseline assessment was conducted across 10 medical college and hospital between December 2022 and August 2023 using the WHO Health Facility Laboratory Assessment Tool, adapted for India by the Integrated Disease Surveillance Program (IDSP). The findings were used to prioritize framework of interventions combining technical assistance (routine on-site follow-up, interdepartmental coordination, and HICC activation), capacity building (QMS workshops, on-site mentoring, and hands-on wet-lab training), and quality improvement measures including enrolment in EQAS. Follow-up assessments were conducted in 2025 (Feb–May).