Cost effectiveness of mHealth intervention by community health workers for reducing maternal and newborn mortality in rural Uttar Pradesh, India

Abstract Background Rural communities in Nigeria account for high maternal and newborn mortality rates in the country. Thus, there is a need for innovative models of service delivery, possibly with greater community engagement. Introducing and strengthening community midwifery practice within the Nigerian primary healthcare system is a clear policy option. The potential of community midwifery to increase the availability of skilled care during pregnancy, at birth and within postpartum periods in the health systems of developing countries has not been fully explored. This study was designed to assess stakeholders’ perceptions about the performance of community health workers and the feasibility of introducing and using community midwifery to address the high maternal and newborn mortality within the Nigerian healthcare system. Methods This study was undertaken in two human resources for health (HRH) project focal states (Bauchi and Cross River States) in Nigeria, utilizing a qualitative research design. Interviews were conducted with 44 purposively selected key informants. Key informants were selected based on their knowledge and experience working with different cadres of frontline health workers at primary healthcare level. The qualitative data were audio-recorded, transcribed and then thematically analysed. Results Some study participants felt that introducing community midwifery will increase access to maternal and newborn healthcare services, especially in rural communities. Others felt that applying community midwifery at the primary healthcare level may lead to duplication of duties among the health worker cadres, possibly creating disharmony. Some key informants suggested that there should be concerted efforts to train and retrain the existing cadres of community health workers via the effective implementation of the task shifting policy in Nigeria, in addition to possibly revising the existing training curricula, instead of introducing community midwifery. Conclusion Applying community midwifery within the Nigerian healthcare system has the potential to increase the availability of skilled care during pregnancy, at birth and within postpartum periods, especially in rural communities. However, there needs to be broader stakeholder engagement, more awareness creation and the careful consideration of modalities for introducing and strengthening community midwifery training and practice within the Nigerian health system as well as within the health systems of other developing countries.

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Enhancing early detection of neurological and developmental disorders and provision of intervention in low-resource settings in Uttar Pradesh, India: study protocol of the G.A.N.E.S.H. programme

BMJ Open ◽

10.1136/bmjopen-2020-037335 ◽

2020 ◽

Vol 10 (11) ◽

pp. e037335

Author(s):

Moreno Toldo ◽

Swami Varishthananda ◽

Christa Einspieler ◽

Neeraj Tripathi ◽

Anshu Singh ◽

...

Keyword(s):

Community Health ◽

Community Health Workers ◽

Early Identification ◽

Developmental Disorders ◽

Health Workers ◽

Uttar Pradesh ◽

Autism Spectrum ◽

Low Resource ◽

Movement Assessment ◽

General Movement

IntroductionAround 9% of India’s children under six are diagnosed with neurodevelopmental disorders. Low-resource, rural communities often lack programmes for early identification and intervention. The Prechtl General Movement Assessment (GMA) is regarded as the best clinical tool to predict cerebral palsy in infants <5 months. In addition, children with developmental delay, intellectual disabilities, late detected genetic disorders or autism spectrum disorder show abnormal general movements (GMs) during infancy. General Movement Assessment in Neonates for Early Identification and Intervention, Social Support and Health Awareness (G.A.N.E.S.H.) aims to (1) provide evidence as to whether community health workers can support the identification of infants at high-risk for neurological and developmental disorders and disabilities, (2) monitor further development in those infants and (3) initiate early and targeted intervention procedures.MethodsThis 3-year observational cohort study will comprise at least 2000 infants born across four districts of Uttar Pradesh, India. Community health workers, certified for GMA, video record and assess the infants’ GMs twice, that is, within 2 months after birth and at 3–5 months. In case of abnormal GMs and/or reduced MOSs, infants are further examined by a paediatrician and a neurologist. If necessary, early intervention strategies (treatment as usual) are introduced. After paediatric and neurodevelopmental assessments at 12–24 months, outcomes are categorised as normal or neurological/developmental disorders. Research objective (1): to relate the GMA to the outcome at 12–24 months. Research objective (2): to investigate the impact of predefined exposures. Research objective (3): to evaluate the interscorer agreement of GMA.Ethics and disseminationG.A.N.E.S.H. received ethics approval from the Indian Government Chief Medical Officers of Varanasi and Mirzapur and from the Ramakrishna Mission Home of Service in Varanasi. GMA is a worldwide used diagnostic tool, approved by the Ethics Committee of the Medical University of Graz, Austria (27-388 ex 14/15). Apart from peer-reviewed publications, we are planning to deploy G.A.N.E.S.H. in other vulnerable settings.

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Assessing inequities in community health worker’s interaction and its impact in Uttar Pradesh, India

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.091 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

S Gupta ◽

S Tomar ◽

A Dey ◽

D Chandurkar

Keyword(s):

Health Service ◽

Health Outcomes ◽

Community Health ◽

Community Health Workers ◽

Service Utilization ◽

Health Service Utilization ◽

Health Workers ◽

Uttar Pradesh ◽

Economic Determinants

Abstract Given the high Neo-natal mortality in the state of Uttar Pradesh, India, an emphasis has been given to community health workers (CHW). CHW provides behavior push to pregnant women for utilizing health services, through the strategies of household contact and messaging. However, the disparity in health outcomes and interaction of CHW is profoundly affected by socio-economic determinants; still, the evidence is limited. This study aims to explore socio-economic inequities in quantity and quality of contacts by the CHW and its differential effect on health service utilization. Multistage sampling design identified live births in the last 12 months across the 25 highest-risk districts of Uttar Pradesh(n = 3703). Regression models described the relation between household demographics and CHW contact & specific messaging and interactions of demographics and CHW contact & messaging in predicting health service utilization ( > = 4 antenatal care (ANC) visits, Institutional delivery and 100 iron folic acid (IFA) consumption). No differential likelihood in contact of CHW and specific messaging is found. Further, association of CHW contacts and specific messaging with health outcomes were significantly affected by socio-economic determinants.2 or more contacts along with specific messaging increased the odds of 4+ ANC to a higher degree among illiterate women compared to literate women(AOR:3.39, 95% CI:2.28-5.04 vs AOR:1.44, 95% CI:1.09-1.92). Similarly, the odds of facility delivery increased to a higher degree among lower wealth women compared to higher wealth women (AOR:3.41, 95% CI:2.47-4.71 vs. AOR:1.53, 95% CI: 1.09-2.15). Specific messaging, along with CHW contacts, have a higher magnitude of effects on the marginalized population. This study provides evidence for adjusting implementation strategies based on socio-economic determinants to achieve equitable health service utilization. However, further research on training of CHW on heterogeneous interaction is recommended Key messages There exists differential effects of quantity and quality of contact by community health workers on health service utilization across the different socio-economic strata. Implementation agencies in the LMIC can reduce health inequity by shifting from coverage-oriented target approach towards more prioritized and focused interaction across socio-economic groups.

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Effectiveness of service models and organisational structures supporting tuberculosis identification and management in hard-to-reach populations in countries of low and medium tuberculosis incidence: a systematic review

BMJ Open ◽

10.1136/bmjopen-2017-019642 ◽

2018 ◽

Vol 8 (9) ◽

pp. e019642 ◽

Cited By ~ 1

Author(s):

Charlotte C Heuvelings ◽

Patrick F Greve ◽

Sophia G de Vries ◽

Benjamin Jelle Visser ◽

Sabine Bélard ◽

...

Keyword(s):

Systematic Review ◽

European Union ◽

Cost Effectiveness ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Cost Effective ◽

Service Models ◽

Hard To Reach Populations ◽

Organisational Structures

ObjectiveTo determine which service models and organisational structures are effective and cost-effective for delivering tuberculosis (TB) services to hard-to-reach populations.DesignEmbase and MEDLINE (1990–2017) were searched in order to update and extend the 2011 systematic review commissioned by National Institute for Health and Care Excellence (NICE), discussing interventions targeting service models and organisational structures for the identification and management of TB in hard-to-reach populations. The NICE and Cochrane Collaboration standards were followed.SettingEuropean Union, European Economic Area, European Union candidate countries and Organisation for Economic Co-operation and Development countries.ParticipantsHard-to-reach populations, including migrants, homeless people, drug users, prisoners, sex workers, people living with HIV and children within vulnerable and hard-to-reach populations.Primary and secondary outcome measuresEffectiveness and cost-effectiveness of the interventions.ResultsFrom the 19 720 citations found, five new studies were identified, in addition to the six discussed in the NICE review. Community health workers from the same migrant community, street teams and peers improved TB screening uptake by providing health education, promoting TB screening and organising contact tracing. Mobile TB clinics, specialised TB clinics and improved cooperation between healthcare services can be effective at identifying and treating active TB cases and are likely to be cost-effective. No difference in treatment outcome was detected when directly observed therapy was delivered at a health clinic or at a convenient location in the community.ConclusionsAlthough evidence is limited due to the lack of high-quality studies, interventions using peers and community health workers, mobile TB services, specialised TB clinics and improved cooperation between health services can be effective to control TB in hard-to-reach populations. Future studies should evaluate the (cost-)effectiveness of interventions on TB identification and management in hard-to-reach populations and countries should be urged to publish the outcomes of their TB control systems.PROSPERO registration numberCRD42015017865.

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Cost-effectiveness of the community-based management of severe acute malnutrition by community health workers in southern Bangladesh

Health Policy and Planning ◽

10.1093/heapol/czs070 ◽

2012 ◽

Vol 28 (4) ◽

pp. 386-399 ◽

Cited By ~ 54

Author(s):

Chloe Puett ◽

Kate Sadler ◽

Harold Alderman ◽

Jennifer Coates ◽

John L. Fiedler ◽

...

Keyword(s):

Cost Effectiveness ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Severe Acute Malnutrition ◽

Acute Malnutrition ◽

Community Based

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A Cost-Effectiveness Analysis of Community Health Workers in Mozambique

Journal of Primary Care & Community Health ◽

10.1177/2150131915579653 ◽

2015 ◽

Vol 6 (4) ◽

pp. 227-232 ◽

Cited By ~ 5

Author(s):

Diana Bowser ◽

Adeyemi Okunogbe ◽

Elizabeth Oliveras ◽

Laura Subramanian ◽

Tyler Morrill

Keyword(s):

Cost Effectiveness ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Cost Effectiveness Analysis ◽

Effectiveness Analysis

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Community Health Worker Evaluation of Implementing an mHealth Application to Support Maternal Health Care in Rural India

Frontiers in Global Women's Health ◽

10.3389/fgwh.2021.645690 ◽

2021 ◽

Vol 2 ◽

Author(s):

Umesh Charanthimath ◽

Geetanjali Katageri ◽

Mai-Lei Woo Kinshella ◽

Ashalata Mallapur ◽

Shivaprasad Goudar ◽

...

Keyword(s):

Qualitative Analysis ◽

Community Health ◽

Community Health Workers ◽

Self Efficacy ◽

Health Workers ◽

Adverse Outcomes ◽

Ease Of Use ◽

Rural India ◽

Mhealth Intervention ◽

Auxiliary Nurse

Introduction: PIERS on the Move (POM) is a mobile health (mHealth) application developed for a smartphone to support community health workers (CHWs) for identification and management of women at risk of adverse outcomes from pre-eclampsia. POM was implemented as an addition to routine antenatal care by accredited social health activists (ASHAs) and auxiliary nurse midwives (ANMs) during the community level intervention for pre-eclampsia (CLIP) Trial in Karnataka state, India (NCT01911494). The objective of this study was to evaluate the experiences of CHWs of using POM in rural India and their perceptions of acceptability and feasibility of this mHealth intervention.Methods: A posttrial mixed-methods evaluation was designed to measure CHW knowledge and self-efficacy regarding the care of women with pre-eclampsia and perceptions of CHWs on the ease of use and usefulness of POM. A structured survey with open-ended questions was conducted between October and November 2017. The median values on a 5-point Likert scale for knowledge and self-efficacy questions were compared between trial arms by Mann–Whitney U test (p < 0.05 significant). Qualitative analysis was undertaken on NVivo 12 (QSR International, Melbourne, Australia).Results: A total of 48 ASHAs and ANMs were interviewed, including 24 who used POM (intervention arm) and 24 who did not (control arm). Self-reported knowledge and self-efficacy for the care of women with pre-eclampsia did not differ between groups. The qualitative analysis highlighted that health workers who used POM reported improved interactions with women and families in their communities. POM strengthened the role of ASHA as a CHW beyond a “link-worker” accompanying women to health services. With training, the mHealth application was easy to use even for CHWs who did not have much experience with smartphones.Conclusions: Community health workers found the POM app easy to use, useful, and well-received by women and their families. POM did not improve care through increased knowledge but built capacity by increasing the recognition of the ASHA and ANM as critical members of the continuum of antenatal healthcare within their communities. These findings support the important role that mHealth technologies can play in strengthening health systems to reach rural, remote, and marginalized populations to reduce disparities in health.

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