Abstract
BackgroundThis 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).MethodsThe cross-sectional study surveyed mothers of children aged 6–23 months. A total of 3455 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).ResultsThe 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.ConclusionsASHAs’ 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.
Highlights
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)
The purpose of this study is to determine, using data from four Indian states, 1) whether ASHAs’ home visits are more predictive of institutional deliveries and children’s complete immunization, for which they are paid, than of five unpaid, but important health practices: exclusive breastfeeding for the first six months of the child’s life, timely introduction of complementary feeding, continued breastfeeding during the child’s illness, proper handwashing, and awareness of Nutrition and Health Days (NHDs); 2) whether visits from AWWs are more predictive of certain health outcomes than other health outcomes
AP had the highest rate of AWW and other community health worker (CHW) home visits (53.94 and 54.00%, respectively) compared to other states
Summary
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). An acute shortage of health and human resources, infrastructure, and services in rural India is believed to contribute to the country’s high infant and maternal mortality [1]. India’s population and its health care system, especially in terms of maternal and child health services. Anganwadi workers (AWWs) are local female health workers with at least a 10th grade education, employed under the Integrated Child Development Service (ICDS). AWWs and the other senior level workers, auxiliary nurse-midwives (ANMs), have been the major CHWs in the Indian health care delivery system to meet women and children’s health needs since 1975 [2].
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