The impact of India's accredited social health activist (ASHA) program on the utilization of maternity services: A nationally representative longitudinal modelling study

Smisha Agarwal, Sian L. Curtis, Gustavo Angeles, Ilene S. Speizer, Kavita Singh, James C. Thomas

Research output: Contribution to journalArticle

Abstract

Background: In 2006, the Government of India launched the accredited social health activist (ASHA) program, with the goal to connect marginalized communities to the health care system. We assessed the effect of the ASHA program 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 socioeconomic 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 program on the utilization of at least one antenatal care (ANC) visit, four or more ANC visits, skilled birth attendance (SBA), and giving birth at a health facility. Results: 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 backward 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. Conclusions: Our results suggest that the ASHA program is successfully connecting marginalized communities to maternity health services. Given the potential of the ASHA in impacting service utilization, we emphasize the need to strengthen strategies to recruit, train, incentivize, and retain ASHAs.

Original languageEnglish (US)
Article number68
JournalHuman resources for health
Volume17
Issue number1
DOIs
StatePublished - Aug 19 2019

Keywords

  • Accredited Social Health Activist
  • Antenatal care
  • Community health workers
  • Impact evaluation
  • India
  • Maternity care
  • Primary health care

ASJC Scopus subject areas

  • Public Administration
  • Public Health, Environmental and Occupational Health

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