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Smisha
Kaysin
Author
Department of Maternal and Child Health
Gillings School of Global Public Health
THE IMPACT OF THE ACCREDITED SOCIAL HEALTH ACTIVISTS (ASHA) PROGRAM IN INDIA ON THE UTILIZATION OF MATERNITY SERVICES FROM THE ANTEPARTUM TO THE POSTPARTUM PERIOD
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.
Spring 2017
2017
Epidemiology
Public policy
Community health workers, Developing countries, Health services, Impact evaluation, India, Maternal Health
eng
Doctor of Public Health
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Maternal and Child Health
Sian
Curtis
Thesis advisor
Gustavo
Angeles
Thesis advisor
Ilene
Speizer
Thesis advisor
Kavita
Ongechi
Thesis advisor
James
Thomas
Thesis advisor
text
Smisha
Kaysin
Creator
Department of Maternal and Child Health
Gillings School of Global Public Health
THE IMPACT OF THE ACCREDITED SOCIAL HEALTH ACTIVISTS (ASHA) PROGRAM IN INDIA
ON THE UTILIZATION OF MATERNITY SERVICES FROM THE ANTEPARTUM TO THE POSTPARTUM
PERIOD
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.
Spring 2017
2017
Epidemiology
Public policy
Community health workers, Developing countries, Health
services, Impact evaluation, India, Maternal Health
eng
Doctor of Public Health
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting
institution
Maternal and Child Health
Sian
Curtis
Thesis advisor
Gustavo
Angeles
Thesis advisor
Ilene
Speizer
Thesis advisor
Kavita
Ongechi
Thesis advisor
James
Thomas
Thesis advisor
text
Smisha
Kaysin
Creator
Department of Maternal and Child Health
Gillings School of Global Public Health
THE IMPACT OF THE ACCREDITED SOCIAL HEALTH ACTIVISTS (ASHA) PROGRAM IN INDIA ON THE UTILIZATION OF MATERNITY SERVICES FROM THE ANTEPARTUM TO THE POSTPARTUM PERIOD
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.
Spring 2017
2017
Epidemiology
Public policy
Community health workers, Developing countries, Health services, Impact evaluation, India, Maternal Health
eng
Doctor of Public Health
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Maternal and Child Health
Sian
Curtis
Thesis advisor
Gustavo
Angeles
Thesis advisor
Ilene
Speizer
Thesis advisor
Kavita
Ongechi
Thesis advisor
James
Thomas
Thesis advisor
text
Smisha
Kaysin
Creator
Department of Maternal and Child Health
Gillings School of Global Public Health
THE IMPACT OF THE ACCREDITED SOCIAL HEALTH ACTIVISTS (ASHA) PROGRAM IN INDIA ON THE UTILIZATION OF MATERNITY SERVICES FROM THE ANTEPARTUM TO THE POSTPARTUM PERIOD
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.
2017-05
2017
Epidemiology
Public policy
Community health workers, Developing countries, Health services, Impact evaluation, India, Maternal Health
eng
Doctor of Public Health
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Maternal and Child Health
Sian
Curtis
Thesis advisor
Gustavo
Angeles
Thesis advisor
Ilene
Speizer
Thesis advisor
Kavita
Ongechi
Thesis advisor
James
Thomas
Thesis advisor
text
Smisha
Kaysin
Creator
Department of Maternal and Child Health
Gillings School of Global Public Health
THE IMPACT OF THE ACCREDITED SOCIAL HEALTH ACTIVISTS (ASHA) PROGRAM IN INDIA ON THE UTILIZATION OF MATERNITY SERVICES FROM THE ANTEPARTUM TO THE POSTPARTUM PERIOD
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.
2017
Epidemiology
Public policy
Community health workers, Developing countries, Health services, Impact evaluation, India, Maternal Health
eng
Doctor of Public Health
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Maternal and Child Health
Sian
Curtis
Thesis advisor
Gustavo
Angeles
Thesis advisor
Ilene
Speizer
Thesis advisor
Kavita
Ongechi
Thesis advisor
James
Thomas
Thesis advisor
text
2017-05
Smisha
Kaysin
Creator
Department of Maternal and Child Health
Gillings School of Global Public Health
THE IMPACT OF THE ACCREDITED SOCIAL HEALTH ACTIVISTS (ASHA) PROGRAM IN INDIA ON THE UTILIZATION OF MATERNITY SERVICES FROM THE ANTEPARTUM TO THE POSTPARTUM PERIOD
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.
2017
Epidemiology
Public policy
Community health workers, Developing countries, Health services, Impact evaluation, India, Maternal Health
eng
Doctor of Public Health
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Maternal and Child Health
Sian
Curtis
Thesis advisor
Gustavo
Angeles
Thesis advisor
Ilene
Speizer
Thesis advisor
Kavita
Ongechi
Thesis advisor
James
Thomas
Thesis advisor
text
2017-05
Smisha
Kaysin
Creator
Department of Maternal and Child Health
Gillings School of Global Public Health
THE IMPACT OF THE ACCREDITED SOCIAL HEALTH ACTIVISTS (ASHA) PROGRAM IN INDIA ON THE UTILIZATION OF MATERNITY SERVICES FROM THE ANTEPARTUM TO THE POSTPARTUM PERIOD
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.
2017
Epidemiology
Public policy
Community health workers, Developing countries, Health services, Impact evaluation, India, Maternal Health
eng
Doctor of Public Health
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Maternal and Child Health
Sian
Curtis
Thesis advisor
Gustavo
Angeles
Thesis advisor
Ilene
Speizer
Thesis advisor
Kavita
Ongechi
Thesis advisor
James
Thomas
Thesis advisor
text
2017-05
Smisha
Kaysin
Creator
Department of Maternal and Child Health
Gillings School of Global Public Health
THE IMPACT OF THE ACCREDITED SOCIAL HEALTH ACTIVISTS (ASHA) PROGRAM IN INDIA ON THE UTILIZATION OF MATERNITY SERVICES FROM THE ANTEPARTUM TO THE POSTPARTUM PERIOD
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.
2017
Epidemiology
Public policy
Community health workers, Developing countries, Health services, Impact evaluation, India, Maternal Health
eng
Doctor of Public Health
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Maternal and Child Health
Sian
Curtis
Thesis advisor
Gustavo
Angeles
Thesis advisor
Ilene
Speizer
Thesis advisor
Kavita
Ongechi
Thesis advisor
James C.
Thomas
Thesis advisor
text
2017-05
Smisha
Kaysin
Creator
Department of Maternal and Child Health
Gillings School of Global Public Health
THE IMPACT OF THE ACCREDITED SOCIAL HEALTH ACTIVISTS (ASHA) PROGRAM IN INDIA ON THE UTILIZATION OF MATERNITY SERVICES FROM THE ANTEPARTUM TO THE POSTPARTUM PERIOD
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.
2017
Epidemiology
Public policy
Community health workers, Developing countries, Health services, Impact evaluation, India, Maternal Health
eng
Doctor of Public Health
Dissertation
Maternal and Child Health
Sian
Curtis
Thesis advisor
Gustavo
Angeles
Thesis advisor
Ilene
Speizer
Thesis advisor
Kavita
Ongechi
Thesis advisor
James C.
Thomas
Thesis advisor
text
2017-05
University of North Carolina at Chapel Hill
Degree granting institution
Smisha
Kaysin
Creator
Department of Maternal and Child Health
Gillings School of Global Public Health
THE IMPACT OF THE ACCREDITED SOCIAL HEALTH ACTIVISTS (ASHA) PROGRAM IN INDIA ON THE UTILIZATION OF MATERNITY SERVICES FROM THE ANTEPARTUM TO THE POSTPARTUM PERIOD
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.
2017
Epidemiology
Public policy
Community health workers, Developing countries, Health services, Impact evaluation, India, Maternal Health
eng
Doctor of Public Health
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Maternal and Child Health
Sian
Curtis
Thesis advisor
Gustavo
Angeles
Thesis advisor
Ilene
Speizer
Thesis advisor
Kavita
Ongechi
Thesis advisor
James
Thomas
Thesis advisor
text
2017-05
Smisha
Kaysin
Creator
Department of Maternal and Child Health
Gillings School of Global Public Health
THE IMPACT OF THE ACCREDITED SOCIAL HEALTH ACTIVISTS (ASHA) PROGRAM IN INDIA ON THE UTILIZATION OF MATERNITY SERVICES FROM THE ANTEPARTUM TO THE POSTPARTUM PERIOD
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.
2017
Epidemiology
Public policy
Community health workers, Developing countries, Health services, Impact evaluation, India, Maternal Health
eng
Doctor of Public Health
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Maternal and Child Health
Sian
Curtis
Thesis advisor
Gustavo
Angeles
Thesis advisor
Ilene
Speizer
Thesis advisor
Kavita
Ongechi
Thesis advisor
James
Thomas
Thesis advisor
text
2017-05
Smisha
Kaysin
Creator
Department of Maternal and Child Health
Gillings School of Global Public Health
THE IMPACT OF THE ACCREDITED SOCIAL HEALTH ACTIVISTS (ASHA) PROGRAM IN INDIA ON THE UTILIZATION OF MATERNITY SERVICES FROM THE ANTEPARTUM TO THE POSTPARTUM PERIOD
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.
2017
Epidemiology
Public policy
Community health workers; Developing countries; Health services; Impact evaluation; India; Maternal Health
eng
Doctor of Public Health
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Maternal and Child Health
Sian
Curtis
Thesis advisor
Gustavo
Angeles
Thesis advisor
Ilene
Speizer
Thesis advisor
Kavita
Ongechi
Thesis advisor
James
Thomas
Thesis advisor
text
2017-05
Smisha
Kaysin
Creator
Department of Maternal and Child Health
Gillings School of Global Public Health
THE IMPACT OF THE ACCREDITED SOCIAL HEALTH ACTIVISTS (ASHA) PROGRAM IN INDIA ON THE UTILIZATION OF MATERNITY SERVICES FROM THE ANTEPARTUM TO THE POSTPARTUM PERIOD
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.
2017
Epidemiology
Public policy
Community health workers, Developing countries, Health services, Impact evaluation, India, Maternal Health
eng
Doctor of Public Health
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Maternal and Child Health
Sian
Curtis
Thesis advisor
Gustavo
Angeles
Thesis advisor
Ilene
Speizer
Thesis advisor
Kavita
Ongechi
Thesis advisor
James C.
Thomas
Thesis advisor
text
2017-05
Smisha
Kaysin
Creator
Department of Maternal and Child Health
Gillings School of Global Public Health
THE IMPACT OF THE ACCREDITED SOCIAL HEALTH ACTIVISTS (ASHA) PROGRAM IN INDIA ON THE UTILIZATION OF MATERNITY SERVICES FROM THE ANTEPARTUM TO THE POSTPARTUM PERIOD
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.
2017
Epidemiology
Public policy
Community health workers; Developing countries; Health services; Impact evaluation; India; Maternal Health
eng
Doctor of Public Health
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Maternal and Child Health
Sian
Curtis
Thesis advisor
Gustavo
Angeles
Thesis advisor
Ilene
Speizer
Thesis advisor
Kavita
Ongechi
Thesis advisor
James C.
Thomas
Thesis advisor
text
2017-05
Smisha
Kaysin
Creator
Department of Maternal and Child Health
Gillings School of Global Public Health
THE IMPACT OF THE ACCREDITED SOCIAL HEALTH ACTIVISTS (ASHA) PROGRAM IN INDIA ON THE UTILIZATION OF MATERNITY SERVICES FROM THE ANTEPARTUM TO THE POSTPARTUM PERIOD
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.
2017
Epidemiology
Public policy
Community health workers; Developing countries; Health services; Impact evaluation; India; Maternal Health
eng
Doctor of Public Health
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Sian
Curtis
Thesis advisor
Gustavo
Angeles
Thesis advisor
Ilene
Speizer
Thesis advisor
Kavita
Ongechi
Thesis advisor
James C.
Thomas
Thesis advisor
text
2017-05
Kaysin_unc_0153D_16988.pdf
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