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

Smisha Kaysin, 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

Fingerprint

Prenatal Care
Health Services
Longitudinal Studies
India
utilization
Parturition
Health
health
Social Class
Community Health Services
Health Facilities
Human Development
caste
Cluster Analysis
Demography
Delivery of Health Care
socioeconomic factors
demographic factors
community
health service

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

Cite this

The impact of India's accredited social health activist (ASHA) program on the utilization of maternity services : A nationally representative longitudinal modelling study. / Kaysin, Smisha; Curtis, Sian L.; Angeles, Gustavo; Speizer, Ilene S.; Singh, Kavita; Thomas, James C.

In: Human Resources for Health, Vol. 17, No. 1, 68, 19.08.2019.

Research output: Contribution to journalArticle

@article{50aceb2d88fa482d8175ccabc98d0645,
title = "The impact of India's accredited social health activist (ASHA) program on the utilization of maternity services: A nationally representative longitudinal modelling study",
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.",
keywords = "Accredited Social Health Activist, Antenatal care, Community health workers, Impact evaluation, India, Maternity care, Primary health care",
author = "Smisha Kaysin and Curtis, {Sian L.} and Gustavo Angeles and Speizer, {Ilene S.} and Kavita Singh and Thomas, {James C.}",
year = "2019",
month = "8",
day = "19",
doi = "10.1186/s12960-019-0402-4",
language = "English (US)",
volume = "17",
journal = "Human Resources for Health",
issn = "1478-4491",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - The impact of India's accredited social health activist (ASHA) program on the utilization of maternity services

T2 - A nationally representative longitudinal modelling study

AU - Kaysin, Smisha

AU - Curtis, Sian L.

AU - Angeles, Gustavo

AU - Speizer, Ilene S.

AU - Singh, Kavita

AU - Thomas, James C.

PY - 2019/8/19

Y1 - 2019/8/19

N2 - 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.

AB - 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.

KW - Accredited Social Health Activist

KW - Antenatal care

KW - Community health workers

KW - Impact evaluation

KW - India

KW - Maternity care

KW - Primary health care

UR - http://www.scopus.com/inward/record.url?scp=85071272125&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85071272125&partnerID=8YFLogxK

U2 - 10.1186/s12960-019-0402-4

DO - 10.1186/s12960-019-0402-4

M3 - Article

C2 - 31426801

AN - SCOPUS:85071272125

VL - 17

JO - Human Resources for Health

JF - Human Resources for Health

SN - 1478-4491

IS - 1

M1 - 68

ER -