Using mHealth to improve health care delivery in India: A qualitative examination of the perspectives of community health workers and beneficiaries

Gopalakrishnan, Lakshmi; Buback, Laura; Fernald, Lia C. H.; Walker, Dilys; Diamond‐Smith, Nadia

doi:10.1371/journal.pone.0227451

Cited by 42 publications

(56 citation statements)

References 34 publications

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“…In recent times, these centers are adopted and run by various governmental or non-governmental organizations providing nutritious meals, including fruits, nuts-embedded sweets, and energy-dense foods. The government of India has made strenuous efforts to upgrade these centers across states (39).…”

Section: Discussionmentioning

confidence: 99%

Dietary Patterns and Determinants of Pregnant and Lactating Women From Marginalized Communities in India: A Community-Based Cross-Sectional Study

et al. 2020

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Section: Discussionmentioning

confidence: 99%

Dietary Patterns and Determinants of Pregnant and Lactating Women From Marginalized Communities in India: A Community-Based Cross-Sectional Study

et al. 2020

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“…Similar issues have been pointed out in another recent study from rural Bihar and Madhya Pradesh. [ 19 ] The same study had also pointed out that adoption of the new software had helped AWWs feel better equipped to do community engagement, but in our setting, such perceptions were not apparent. At the time of this study, several technical training sessions had been initiated to prepare AWWs for this change from manual to digital data maintenance.…”

Section: Discussionmentioning

confidence: 88%

Implementing a “convergent” framework of action against childhood malnutrition in urban informal settlements of Mumbai

Jayaraman

Ramani

Sridhar

et al. 2021

Journal of Family Medicine and Primary Care

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Context: The National Nutrition Mission (POSHAN Abhiyaan) intends to “converge” nutrition-related program components across sectors (nutrition, health, water, and sanitation). In this study, we have examined the perspectives of Anganwadi workers (AWWs), the frontline workers of the Integrated Child Development Services, on working in convergence with the public health sector. Methods: This exploratory qualitative study was done between June 2018 and June 2019 in two urban informal settlements in Mumbai. We conducted in-depth interviews with 26 AWWs and their supervisors, purposively sampled and diversified in terms of age, education, and years of experience. We used the software NVivo version 12 to aid analysis. Results: Most AWWs acknowledged that a convergent framework of action between “nutrition” and “health” was likely to be beneficial to the community. However, they also shared that cross-sector convergence was currently limited due to technical unfamiliarity with “health-sector” issues in the frontline, discomfort with data sharing, and lack of meaningful incentives for joint work. Broader organizational challenges such as poor infrastructure and lack of supervision, as well as challenges in the urban context (migration and cultural barriers) further hindered joint activities. Conclusions: The findings indicate that critical structural gaps in the urban setup of ICDS need to be addressed and AWWs need to be better familiarized with the changing roles expected from them under POSHAN Abhiyaan . To work better with the health sector, the work timings of AWWs need to be aligned with those of the health sector and meaningful financial incentives need to be put in place for cross-sector activities.

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“…In other contexts, home visits by ASHAs have been shown to be efficacious at influencing behaviour and care-seeking, including in the neonatal period [ 12 , 24 ]. However, they have also been documented to be perfunctory and impersonalised due to low levels of trust between ASHAs and the community [ 25 , 26 ]. Evaluation of these CHW programmes would require perceptions of community members towards ASHAs providing these services to be established.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the effectiveness of Community Health Worker home visits on infant health: A quasi-experimental evaluation of Home Based Newborn Care Plus in India

Newton-Lewis¹,

Bahety

2021

J Glob Health

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Background Home visits by community health workers are promoted to improve the coverage and uptake of evidence-based newborn services and behaviours. However, evidence on the effectiveness of these home visits delivered through government systems at scale is limited, as is evidence from the post-neonatal period. From 2013 to 2017, the Government of India piloted an intervention called Home Based Newborn Care Plus with the goal of reducing pneumonia- and diarrhoea-related morbidity and malnutrition. Village-based Accredited Social Health Activists were incentivised to make quarterly home visits to infants between three and 12 months of age. After the pilot, the intervention was adapted and scaled up nationally (with an additional visit at 15 months of age) as a new programme called Home Based Care for Young Child. Methods The study used a quasi-experimental, difference-in-differences method to assess the quantitative impact on key outcome indicators by comparing changes over time in treatment districts with matched control districts. This was supplemented by a quantitative health worker survey and qualitative data collected at worker and community level. Results The intervention led to a significant increase in the number of home visits, and their content became more aligned with Home Based Newborn Care Plus protocols. However, absolute levels of coverage remained low. The intervention had no detectable effect on the key outcomes of feeding practices, handwashing, iron and folic acid and oral rehydration solution supplementation, growth monitoring, and immunisation. Conclusions Given the scale up of Home-Based Care for Young Child, there is a need to identify appropriate and comprehensive support for Accredited Social Health Activists to attain high coverage and quality and deliver impact. This will require reconsidering current design elements (such as incentives) and solving the underlying demand side and system level challenges (such as workload and supply chains) constraining Accredited Social Health Activists.

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Using mHealth to improve health care delivery in India: A qualitative examination of the perspectives of community health workers and beneficiaries

Cited by 42 publications

References 34 publications

Dietary Patterns and Determinants of Pregnant and Lactating Women From Marginalized Communities in India: A Community-Based Cross-Sectional Study

Dietary Patterns and Determinants of Pregnant and Lactating Women From Marginalized Communities in India: A Community-Based Cross-Sectional Study

Implementing a “convergent” framework of action against childhood malnutrition in urban informal settlements of Mumbai

Evaluating the effectiveness of Community Health Worker home visits on infant health: A quasi-experimental evaluation of Home Based Newborn Care Plus in India

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