Abstract
BackgroundNeonatal mortality remains unacceptably high in many low and middle-income countries, including India. A community mobilisation intervention using participatory learning and action with women’s groups facilitated by Accredited Social Health Activists (ASHAs) was conducted to improve maternal and newborn health. The intervention was evaluated through a cluster-randomised controlled trial conducted in Jharkhand and Odisha, eastern India. This aims to assess the cost-effectiveness this intervention.MethodsCosts were estimated from the provider’s perspective and calculated separately for the women’s group intervention and for activities to strengthen Village Health Sanitation and Nutrition Committees (VHNSC) conducted in all trial areas. Costs were estimated at 2017 prices and converted to US dollar (USD). The incremental cost-effectiveness ratio (ICER) was calculated with respect to a do-nothing alternative and compared with the WHO thresholds for cost-effective interventions. ICERs were calculated for cases of neonatal mortality and disability-adjusted life years (DALYs) averted.ResultsThe incremental cost of the intervention was USD 83 per averted DALY (USD 99 inclusive of VHSNC strengthening costs), and the incremental cost per newborn death averted was USD 2545 (USD 3046 inclusive of VHSNC strengthening costs). The intervention was highly cost-effective according to WHO threshold, as the cost per life year saved or DALY averted was less than India’s Gross Domestic Product (GDP) per capita. The robustness of the findings to assumptions was tested using a series of one-way sensitivity analyses. The sensitivity analysis does not change the conclusion that the intervention is highly cost-effective.ConclusionParticipatory learning and action with women’s groups facilitated by ASHAs was highly cost-effective to reduce neonatal mortality in rural settings with low literacy levels and high neonatal mortality rates. This approach could effectively complement facility-based care in India and can be scaled up in comparable high mortality settings.
Highlights
Neonatal mortality remains unacceptably high in many low and middle-income countries, including India
The aim of this paper is to measure the cost-effectiveness of participatory learning and action (PLA) with women’s group facilitated by Accredited Social Health Activists (ASHAs) to improve birth outcome as compared to the control area
We observed a 31% reduction in neonatal mortality in the intervention arm compared to the control arm [14]
Summary
Neonatal mortality remains unacceptably high in many low and middle-income countries, including India. A community based intervention called Participatory Learning Approach (PLA) approach with women’s groups reduced neo-natal mortality in the underserved areas of two eastern states of India, Jharkhand and Odisha [5], and the benefits accrued most to the most marginalised [6]. Participatory Learning Approach (PLA) approach is a capacity building process in which women’s group members invite non group-members, adolescent girls, pregnant women, mothers, and men, frontline service providers for learning, planning, carrying out and evaluating activities in a participatory and sustained basis. This gives them idea of what worked well, what are their results, which are the areas where more effort is needed and how was the support from the other stakeholders
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