Remuneration systems of community health workers in India and promoted maternal health outcomes: a cross-sectional study

Koehn, Hannah; Zheng, Shenglin; Houser, Robert F.; O’Hara, Corey; Rogers, Beatrice Lorge

doi:10.1186/s12913-019-4883-6

Cited by 13 publications

(22 citation statements)

References 11 publications

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“…Studies from a wide range of settings have shown that greater access to Frontline Health Workers (FHWs) or Community Health Workers (CHW) can greatly improve maternal and child health care utilisation and outcomes. FHWs play an important role in disseminating community-based health information and encouraging the utilisation of MCH and family planning services [13,[17][18][19][20][21][22][23]. FHWs directly interact with women and their family members, particularly in poor and remote disadvantaged communities [21,[23][24][25].…”

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confidence: 99%

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

et al. 2021

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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) 2015–2016, 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. Also, the role of FHWs in the government health system needs to be enhanced by improving skills, working environment, and greater financial incentives.

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confidence: 99%

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

et al. 2021

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“…33 However, a recent study conducted in four Indian states showed that ASHAs’ visits to beneficiaries were not more strongly associated with outcomes for which they were paid than outcomes for which they were unpaid. 34 The Home Based Newborn Care initiative, rolled out in Bihar after 2014, provided incentives to ASHAs for postnatal follow-up visits and tracking of low birthweight newborns. 35 The increased emphasis on postnatal care, while important, might have also affected the time ASHAs had for household visits to pregnant women.…”

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confidence: 99%

From direct engagement to technical support: a programmatic evolution to improve large community health worker programs in Bihar, India

et al. 2021

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IntroductionIn 2011, through a multipartner Integrated Family Health Initiative (IFHI), CARE started supporting maternal and neonatal health (MNH) improvement goals in 8 of 38 districts in Bihar, India. The programme included a frontline health worker (FHW) component offering health advice through household visits and benefited from CARE’s direct engagement during IFHI, which then evolved into statewide Technical Support Unit (TSU) to the Government of Bihar in 2014.MethodsUsing eight rounds of state-representative household surveys with mothers of infants aged 0–2 months (N=73 093) linked with two facility assessments conducted during 2012–2017, we assessed changes in FHW visit coverage, intensity and quality between IFHI and TSU phases. Using logistic regression models, we ascertained associations between FHW outputs and three MNH core practices: ≥3 antenatal care check-ups (ANC3+), institutional delivery and early breastfeeding initiation.ResultsWomen’s receipt of 1+ FHW visits declined from 60.2% (IFHI phase) to 46.3% (TSU phase) in the eight IFHI districts, being below 40% statewide during the TSU phase. Despite a parallel decline in FHW visit quality measured as the number of health advice received, all three outcomes improved during the TSU versus IFHI phase in IFHI districts. We found significant positive associations between all three outcomes and receipt of 1+ FHW visits and programme phase (TSU vs IFHI) in the eight IFHI districts. During the TSU phase, receipt of 2+ FHW visits in the third trimester increased the odds of women receiving ANC3+ (adjusted OR (aOR)=1.21; 95% CI: 1.13 to 1.31), delivering in a facility (aOR=1.64; 95% CI: 1.51 to 1.77) and initiating breast feeding early (aOR=1.18; 95% CI: 1.05 to 1.18). Independent of the number and timing of FHW visits, we also found positive associations between women reporting higher than lower quality of FHW interactions and receiving outcome-specific advice and all three MNH outcomes.ConclusionImplementation of large community-based interventions under the technical support model should be continuously and strategically evaluated and adapted.

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“…Since 1975, Anganwadi workers (AWWs) and auxiliary nurse-midwives (ANMs) have been the major CHWs in India; they focus on women and child health (44). In addition, Accredited Social Health Activists (ASHAs) were introduced in 2005 by the National Rural Health Mission (NRHM) to improve the outreach and coverage of health services in rural areas.…”

Section: Introduction and Aim Of The Studymentioning

confidence: 99%

“…In addition, Accredited Social Health Activists (ASHAs) were introduced in 2005 by the National Rural Health Mission (NRHM) to improve the outreach and coverage of health services in rural areas. Each village in India is supposed to have at least one ASHA and one AWW (44). ASHAs represent a new kind of CHW; they supplement the work of AWWs and ANMs by also addressing noncommunicable diseases (NCDs) (45).…”

Section: Introduction and Aim Of The Studymentioning

confidence: 99%

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The Architecture of the Primary Mental Healthcare System for Older People in India – What Public Policies Tell Us

Kafczyk

Haemel

2021

Preprint

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Background: Old age mental healthcare is an issue that cuts across old age, general health, and mental healthcare policies. While strengthening the primary mental healthcare system in India is a common strategy across policy fields to improve the mental health of older persons, very little is known about the system’s planned architecture. This study explores public policy strategies for and approaches to the mental health of older persons, focusing on the primary healthcare (PHC) level and the role of the family.Methods: A document analysis of 39 key public national policy documents (2007-2019) from three thematically grouped policy fields (mental health, old age, and general health) was conducted.Results: Comprehensive community-based primary mental healthcare – focusing on vulnerable population groups including older persons – has been strengthened significantly since 2007. The promulgated approaches and strategies build on traditional community-based approaches to mental healthcare in India. They focus on (a) integrating community health workers into primary mental healthcare, (b) empowering the community to participate in healthcare planning, implementation, and monitoring, (c) supporting the family through a family-led approach to mental healthcare, and (d) integrating traditional Ayurveda, Yoga and Naturopathy, Unani, Siddha, Sowa-Rigpa and Homeopathy (AYUSH) services into primary mental healthcare.Conclusions: While all policy fields address mental PHC, they do so in different ways, and approaches and strategies that promote an integrated perspective across policy fields are lacking. Further research should evaluate strategies and approaches in light of social developments such as eroding family norms and the poor state of the public health system in India in order to assess their opportunities, challenges, and overall feasibility, with the benefits older people would experience taking center stage in these inquiries.

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Remuneration systems of community health workers in India and promoted maternal health outcomes: a cross-sectional study

Cited by 13 publications

References 11 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?

From direct engagement to technical support: a programmatic evolution to improve large community health worker programs in Bihar, India

The Architecture of the Primary Mental Healthcare System for Older People in India – What Public Policies Tell Us

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