Cost and cost-effectiveness of health behavior change interventions implemented with self-help groups in Bihar, India

Abstract

Introduction Health interventions implemented with self-help groups (SHGs) enhance the relevance and acceptability of the health services. The Parivartan program was implemented in eight districts of Bihar with women’s self-help groups to increase adoption of maternal and newborn health behaviors through layering health behavior change communication. This study estimates the cost and cost-effectiveness of a health behavior change program with SHGs in Bihar. Methods Cost analysis was conducted from a provider’s perspective. All costs have been presented in US dollars for the purpose of international comparisons and converted to constant values. The effectiveness estimate was based on the reported changes in select newborn care practices. A decision model approach was used to estimate the potential number of neonatal deaths averted based on adoption of key newborn care practices. Using India’s life expectancy of 65 years, cost per life year saved was calculated. A one-way sensitivity analysis was conducted using the upper and lower estimates for various variables in the model, and functionality of SHGs. Results The cost of forming an SHG group was US$254 and that of reaching a woman within the group was US$19. The unit cost for delivering health interventions through the Parivartan program was US$148 per group and US$11 per woman reached. During an 18 months period, Parivartan program reached around 17,120 SHGs and an estimated 20,544 pregnant women resulting in an estimated prevention of 23 neonatal deaths at a cost of US$3,825 per life year saved. Conclusion SHGs can be an effective platform to increase uptake of women’s health interventions and follow-up care, and also to broaden their utility beyond microfinance, particularly when they operate at a larger scale.

Participation in microfinance based Self Help Groups in India: Who becomes a member and for how long?

“…Both components synergistically operating may also help to interrupt the mutually reinforcing cycle of poverty and poor maternal health. Evidence from a study in the state of Bihar, India also established the cost-effectiveness in promoting maternal and neonatal health when microfinance and health interventions are implemented at scale [53]. However, further research is required to capture costs effectiveness in promoting integrated microfinance and health interventions in Uttar Pradesh that is culturally distinct.…”

The Knowledge of Danger Signs of Obstetric Complications Among Women in Rural India: Evaluating an Integrated Microfinance and Health Literacy Program

“…The SHG model used in the IMFHL program additionally allows for rapidly scaling up, and the dissemination of developmental services to a largely marginalised and hard to reach population. Furthermore, micro nance and health interventions have also been found to be cost-effective in promoting maternal and neonatal health from another study conducted in the state of Bihar, India which has similar health and developmental indicators to Uttar Pradesh (72). Despite gains in knowledge of maternal danger signs, further research is required to establish the impact of membership in IMFHL programs on actual care-seeking practices among women who have experienced complications in the maternity period.…”

The knowledge of danger signs of obstetric complications among women in rural India: evaluating an integrated microfinance and health literacy program

“…The SHG model used in the IMFHL program additionally allows for rapidly scaling up, and the dissemination of developmental services to a largely marginalised and hard to reach population. Furthermore, an earlier study found microfinance and health interventions to be cost-effective in promoting maternal and neonatal health in Bihar, India which has similar health and developmental indicators to Uttar Pradesh [ 77 ]. Despite gains in knowledge of maternal danger signs, further research is required to establish the impact of membership in IMFHL programs on actual care-seeking practices among women who have experienced complications in the maternity period.…”