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The Impact of India's Accredited Social Health Activist (ASHA) Programme on the Utilization of Maternity Services: A Modelling Study

27 Pages Posted: 14 Mar 2019

See all articles by Smisha Agarwal

Smisha Agarwal

Johns Hopkins University - Department of International Health; University of North Carolina (UNC) at Chapel Hill - Department of Maternal and Child Health; University of North Carolina (UNC) at Chapel Hill - Carolina Population Center

Sian L. Curtis

University of North Carolina (UNC) at Chapel Hill - Department of Maternal and Child Health

Gustavo Angeles

University of North Carolina (UNC) at Chapel Hill - Department of Maternal and Child Health

Ilene Speizer

University of North Carolina (UNC) at Chapel Hill - Department of Maternal and Child Health

Kavita Singh Ongechi

University of North Carolina (UNC) at Chapel Hill - Department of Maternal and Child Health

James C. Thomas

Gilllings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA

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Abstract

Background: In 2006, the Government of India launched a community health worker programme called the Accredited Social Health Activist (ASHA) programme, with the goal to connect marginalized communities to the healthcare system and improve maternity health outcomes. We assessed the effect of the ASHA programme on the utilization of maternity services.

Methods: We used data from Indian Human Development Surveys done in 2004-2005, and in 2011-2012 to assess demographic and socio-economic factors associated with the receipt of ASHA services; and used difference-in-difference analysis with cluster-level fixed effects to assess the effect of the ASHA programme on the utilization of at least one antenatal care (ANC) visit, four or more ANC visits, skilled attendance at birth (SBA) and delivery at a health facility.

Findings: Substantial variations in the receipt of ASHA services were reported with 66% of women in northeastern states, 30% in high-focus states, and 16% of women in other states. In areas where active ASHA activity was reported, the poorest women, and women belonging to scheduled castes and other backwards castes, had the highest odds of receiving ASHA services. Exposure to ASHA services was associated with a 17% (95% CI 11.8-22.1) increase in ANC-1, 5% increase in four or more ANC visits (95% CI -1.6 - 11.1), 26% increase in SBA (95% CI 20-31.1), and 28% increase (95% CI 22.4-32.8) in facility births.

Interpretation: Our results suggest that the ASHA programme is successfully connecting marginalized communities to maternity health services. The study highlights the need improve the coverage of four or more ANC visits, and target programmatic activities to women belonging to scheduled tribes. Given the potential of the ASHA in impacting service utilization, we emphasize the need to strengthen strategies to recruit, train, incentivize and retain ASHAs.

Funding: None

Declaration of Interest: The authors declare no conflicts of interest that would influence the results and recommendations of this work.

Ethical Approval: Ethical approval was received from the University of North Carolina, Chapel Hill Institutional Review Board.

Keywords: community health worker, community health system, maternal health, child health, India, Asia, ASHA, primary health, impact evaluation

Suggested Citation

Agarwal, Smisha and Curtis, Sian L. and Angeles, Gustavo and Speizer, Ilene and Ongechi, Kavita Singh and Thomas, James C., The Impact of India's Accredited Social Health Activist (ASHA) Programme on the Utilization of Maternity Services: A Modelling Study (March 13, 2019). Available at SSRN: https://ssrn.com/abstract=3352000 or http://dx.doi.org/10.2139/ssrn.3352000

Smisha Agarwal (Contact Author)

Johns Hopkins University - Department of International Health ( email )

Baltimore, MD 21205
United States

University of North Carolina (UNC) at Chapel Hill - Department of Maternal and Child Health ( email )

Chapel Hill, NC
United States

University of North Carolina (UNC) at Chapel Hill - Carolina Population Center ( email )

CB# 8120, University Square
123 West Franklin St.
Chapel Hill, 27599-2524
United States

Sian L. Curtis

University of North Carolina (UNC) at Chapel Hill - Department of Maternal and Child Health

Chapel Hill, NC
United States

Gustavo Angeles

University of North Carolina (UNC) at Chapel Hill - Department of Maternal and Child Health

Chapel Hill, NC
United States

Ilene Speizer

University of North Carolina (UNC) at Chapel Hill - Department of Maternal and Child Health

Chapel Hill, NC
United States

Kavita Singh Ongechi

University of North Carolina (UNC) at Chapel Hill - Department of Maternal and Child Health

Chapel Hill, NC
United States

James C. Thomas

Gilllings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA ( email )

102 Ridge Road
Chapel Hill, NC NC 27514
United States