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

Abstract

Background: This study assessed the association of remuneration systems of paid-for-performance Accredited Social Health Activists (ASHAs) and salaried Anganwadi workers (AWWs) on seven maternal health outcomes in four states in India: Andhra Pradesh (AP), Chhattisgarh, Odisha (Orissa), and Uttar Pradesh (UP). Methods: The cross-sectional study surveyed mothers of children aged 6-23 months. A total of 3,455 mothers were selected via multistage cluster sampling. The seven health outcomes related to the community health worker (CHW) visits were: institutional delivery, complete immunization, exclusive breastfeeding for six months, timely introduction of complementary feeding, continued breastfeeding during child’s illness, handwashing, and awareness of Nutrition and Health Days (NHDs). Results: The results varied by state. Mothers who received ASHA visits were significantly less likely to have an institutional delivery, timely introduction of complementary feeding, awareness of Nutrition and Health Days (NHDs), proper handwashing, and exclusive breastfeeding for the first six months in at least one of the four states. Conversely, AWW’s home visits were positively predictive of the following health outcomes in certain states: complete immunization for index child, continued breastfeeding during the child’s illness, handwashing, and awareness of NHDs. Conclusions: ASHAs’ home visits were not more strongly associated with health outcomes for which they were paid than outcomes for which they were unpaid. AWWs’ home visits were positively associated with awareness of NHDs, and associations varied for other recommended health behaviors. Further research could elucidate the causes for successes and failures of CHW programs in different states of India.

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

“…Studies from a wide range of settings have shown that greater access to Frontline Health Workers (FHWs) and 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].…”

“Through their eyes, I can work” – rural physicians' perceptions about mobile phone use among community health workers – a qualitative analysis

“…ASHAs are voluntary women workers typically between the age group 25-45 years, with a minimum eight years of formal education. This cadre was launched under the National Rural Health Mission (NRHM) in the year 2005, to supplement the work of ANMs and AWWs (Koehn et al, 2020). Drawn from the community they live, the ASHAs help connect people from the community to the public health systems by improving health awareness and access to primary healthcare services (Abdel-All et al, 2018).…”