Last Modified

• March 19, 2019

Creator

• Kaysin, Smisha
  • Affiliation: Gillings School of Global Public Health, Department of Maternal and Child Health

Abstract

• India’s Community Health Worker program- called the Accredited Social Health Activist (ASHA) program- is the largest among all countries, with nearly one million ASHA trained nationally. In 2006, the Government of India launched the ASHA program with the goal to connect communities to the healthcare system and improve maternity health outcomes. The aim of this dissertation is to evaluate the effects of the ASHA program on the utilization of maternity services. In paper 1, we examine the association between exposure to ASHA and retention in the continuum of maternity care from the antepartum to the post-partum period, using the 2011-2012 Indian Human Development Survey (IHDS). We use a multinomial logistic regression model to show that exposure to ASHA accounts for a 12 percentage point increase in women receiving at least some of the services, and an nine percentage point decrease in women receiving no services. However, exposure to ASHA does not increase the likelihood of women utilizing all the services along the continuum. In paper 2, we assess the characteristics associated with the utilization of services by ASHA workers, and the effect of the ASHA program on individual maternity services- —namely, at least one antenatal care (ANC) visits, four or more ANC visits, presence of a skilled attendant at the time of birth (SBA), and delivery in a health facility. Our study finds that poor women and those belonging to marginalized castes were more likely to report ASHA services. Exposure to ASHA services was associated with a 19% (95% CI 11.5-26.4) increase in ANC-1, 7% increase in four or more ANC visits (95% CI -0.4 – 14.6), 28% increase in SBA (95% CI 20.8-35.4), and 26% increase (95% CI 19.5-33.1) in facility births. Sensitivity analysis suggests that conditional cash transfer schemes drive the increase in SBA and facility births. The ASHA program is successfully connecting marginalized communities to maternity health services. The study highlights the need to improve the coverage of four or more ANC visits. Given the potential of the ASHA in impacting service utilization, we emphasize the need to strengthen strategies to recruit, train, incentivize and retain ASHA workers.

Date of publication

• May 2017

Keyword

• India
• Developing countries
• Epidemiology
• Community health workers
• Public policy
• Impact evaluation
• Maternal Health
• Health services

DOI

• https://doi.org/10.17615/t6ej-j623

Resource type

• Dissertation

Rights statement

• In Copyright

Advisor

• Curtis, Sian
• Thomas, James C.
• Ongechi, Kavita
• Speizer, Ilene
• Angeles, Gustavo

Degree

• Doctor of Public Health

Degree granting institution

• University of North Carolina at Chapel Hill Graduate School

Graduation year

• 2017

Language

• English

Parents:

This work has no parents.

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