Differential effects of community health worker visits across social and economic groups in Uttar Pradesh, India: a link between social inequities and health disparities

Seth, Aparna; Tomar, Shweta; Singh, Kultar; Chandurkar, Dharmendra; Chakraverty, Amit; Dey, Arnab; Das, Arup; Hay, Katherine; Saggurti, Niranjan; Boyce, Sabrina C.; Raj, Anita; Silverman, Jay G.

doi:10.1186/s12939-017-0538-6

Cited by 43 publications

(56 citation statements)

References 17 publications

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“…In India, although the role of FHWs is not empirically analysed at the national level, small sample case studies have shown that greater access to FHWs can greatly improve MCH care utilisation and outcomes [13,14,18,[30][31][32]. In India's health care delivery system, FHWs have an integral role to play in the supply of MCH services, particularly disseminating information about the government's flagship health care programmes among eligible beneficiaries such as pregnant women, mothers and their children [33].…”

Section: Resultsmentioning

confidence: 99%

Does engagement with frontline health workers improve maternal and child healthcare utilisation and outcomes in India?

Rammohan¹,

Goli²,

Saroj³

et al. 2020

Preprint

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Background Poor Maternal and Child Health (MCH) outcomes pose challenges to India’s ability to attain Goal-3 of the Sustainable Development Goals (SDGs). The government of India strengthened the existing network of Frontline Health Workers (FHWs), under its National Rural Health Mission in 2005 and subsequent National Urban Health Mission in 2013 as a strategy to mitigate the shortage of skilled health workers and to provide affordable healthcare services. However, there is a lack of robust national-level empirical analysis on the role of maternal engagement with FHWs in influencing the level of maternal and child health care utilisation and child health outcomes in India. Methods Using data from the nationally representative Indian National Family Health Survey (NFHS) 2015-16, this paper aims to investigate the intensity of engagement of FHWs with married women of child-bearing age (15-49 years), its influence on utilisation of maternal and child healthcare services, and child health outcomes. Our empirical analyses use multivariate regression analyses, focusing on five maternal and child health indicators: antenatal care visits (ANC) (4 or >4 times), institutional delivery, full-immunisation of children, postnatal care (PNC) (within 2 days of delivery), and child survival. Results Our analysis finds that maternal engagement with FHWs is statistically significant and a positive predictor of maternal and child health care utilisation, and child survival. Further, the level of engagement with FHWs is particularly important for women from economically poor households. Our robustness checks across sub-samples of women who delivered only in public health institutions and those from rural areas provides an additional confidence in our main results. Conclusions From a policy perspective, our findings highlight that strengthening the network of FHWs in the areas where they are in shortage which can help in further improving the utilisation of maternal and child healthcare services, and health outcomes.

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Section: Resultsmentioning

confidence: 99%

Does engagement with frontline health workers improve maternal and child healthcare utilisation and outcomes in India?

Rammohan¹,

Goli²,

Saroj³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Inadequate housing and living conditions are a matter of concern to poor migrants, and these conditions lead to the scarce quality of health services . Although health workers are supposed to carry out several preventive and curative services, this focus is offered only for antenatal care and childhood immunizations.…”

Section: Discussionmentioning

confidence: 99%

“…However, this seldom occurs. It is known that the manner in which information is delivered by health workers may influence the health care‐seeking behavior of households . Many of the migrants, particularly those who have recently migrated, do not know the location of government health facilities and, hence, often depend on unqualified practitioners nearer to their habitations .…”

Section: Discussionmentioning

confidence: 99%

“…The differential behavior of frontline health workers toward the poor and vulnerable was reported earlier as 1 of the deterring factors for seeking health care . A similar situation is found in other cities of India and affirms the utility of health‐care workers . The causes need further exploration, although low uptake of health‐care services specifically can be attributed to migrants' vulnerability, marginalization, and alienation in their new environment .…”

Section: Discussionmentioning

confidence: 99%

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Internal migrants' experiences with and perceptions of frontline health workers: A nationwide study in 13 Indian cities

Babu

Sharma

Kusuma

et al. 2018

Health Planning & Management

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The role of frontline health workers is crucial in strengthening primary health care in India. This paper reports on the extent of services provided by frontline health workers in migrants' experiences and perceptions of these services in 13 Indian cities. Cluster random sampling was used to sample 51 055 households for a quantitative survey through interviewer-administered questionnaires. Information was sought on the receipt of health workers' services for general health care overall (from the head/other adult member of the household) and maternal and immunization services in particular (from mothers of children <2 years old). Purposively, 240 key informants and 290 recently delivered mothers were selected for qualitative interviews. Only 31% of the total respondents were aware of the visits of frontline health workers, and 20% of households reported visits to their locality during past month. In 4 cities, approximately 90% of households never saw health workers in their locality. Only 20% of women and 22% of children received antenatal care and vaccination cards from frontline health workers. Qualitative data confirm that the frontline health workers' visits were not regular and that health workers limited their services to antenatal care and childhood immunization. It was further noted that health workers saw the migrants as"outsiders." These findings warrant developing migrant-specific health-care services that consider their vulnerability and living conditions. The present study has implications for India's National Urban Health Mission, which envisions addressing the health care needs of the urban population with a focus on the urban poor.

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“…Mothers who used ANC services ≥ 4 times during pregnancy are more aware of the health benefits that they receive from routine pregnancy tests and have better knowledge of pregnancy health than mothers who rarely check their pregnancies. The more often the mothers are associated with health personnel and learn about health information, the greater their interest in giving birth in health facilities to avoid the risk of birth delivery at home (Seth et al, 2017). 7.…”

Section: The Effect Of Maternal Educationmentioning

confidence: 99%

Socioeconomics Factors Associated with the Utilization of Primary Health Services of Mothers and Children at Nunukan District, North Kalimantan

Kristiani

Tamtomo

Wijaya

2017

J MATERN CHILD HEALTH

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Background: One of the main health development agenda in Indonesia 2015 to 2019 is reduction in maternal mortality ratio and infant mortality rate, and improve access and quality of maternal and child health services. However, variance in socioeconomics status between individual and between rural-urban have caused to difference in utilization of health service. This study aimed to analyze socioeconomics factors associated with the utilization of primary health services of mothers and childrenat Nunukan District, North Kalimantan. Subjects and Method: This was an analytic observational study with cross-sectional design. The study was conducted at six community health centers in Nunukan, North Kalimantan, from October to November, 2017. A total sample of 208 mothers was collected using stratified multistage random sampling. The dependent variables were antenatal care (ANC) service, place of birth delivery, and basic immunization. The independent variables were maternal education, maternal employment status, family income, family welfare, and residence. The data were collected by questionnaire and analyzed by path analysis. Results: Utilization of ANC increased with better family welfare (b=1.42; 95% CI= 0.34 to 2.49; p=0.010). Use of basic immunization increased with higher maternal education (b=0.71; 95% CI= 0.06 to 1.35; p=0.032). Place of birth delivery at formal health facility increased with living in urban area (b= 3.2; 95% CI= 1.97 to 4.44; p <0.001), maternal employment (b=2.34; 95% CI= 0.77 to 3.91; p=0.003), and regular ANC (b=1.04; 95% CI= -0.10 to 2.18; p=0.074). Family income increased with higher maternal education level (b=1.21; 95% CI= 0.50 to1.92; p=0.001) and maternal employment (b=2.54; 95% CI= 1.67 to 3.41; p <0.001). Family welfare increased with living in urban area (b=1.4; 95% CI= 0.09 to 2.68; p=0.035) and higher family income (b=2.5; 95% CI= 0.44to 4.54; p=0.017). Maternal employment status increased with higher maternal education level (b=2.45; 95% CI= 1.63 to 3.26; p <0.001). Conclusion: Utilization of ANC directly increases with better family welfare.Utilization of basic immunization increases with highermaternaleducation. Place of birth delivery at formal health facility increases with living in urban area, maternal employment, and regular ANC.

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Differential effects of community health worker visits across social and economic groups in Uttar Pradesh, India: a link between social inequities and health disparities

Cited by 43 publications

References 17 publications

Does engagement with frontline health workers improve maternal and child healthcare utilisation and outcomes in India?

Does engagement with frontline health workers improve maternal and child healthcare utilisation and outcomes in India?

Internal migrants' experiences with and perceptions of frontline health workers: A nationwide study in 13 Indian cities

Socioeconomics Factors Associated with the Utilization of Primary Health Services of Mothers and Children at Nunukan District, North Kalimantan

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