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 f...
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| Format: | Article |
| Language: | English |
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BMC
2019-08-01
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| Series: | Human Resources for Health |
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| Online Access: | http://link.springer.com/article/10.1186/s12960-019-0402-4 |
| _version_ | 1818476720269819904 |
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| author | Smisha Agarwal Sian L. Curtis Gustavo Angeles Ilene S. Speizer Kavita Singh James C. Thomas |
| author_facet | Smisha Agarwal Sian L. Curtis Gustavo Angeles Ilene S. Speizer Kavita Singh James C. Thomas |
| author_sort | Smisha Agarwal |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-10T09:28:55Z |
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| institution | Directory Open Access Journal |
| issn | 1478-4491 |
| language | English |
| last_indexed | 2024-12-10T09:28:55Z |
| publishDate | 2019-08-01 |
| publisher | BMC |
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| series | Human Resources for Health |
| spelling | doaj.art-a83593d7eb594770ba946b9d581da6ee2022-12-22T01:54:25ZengBMCHuman Resources for Health1478-44912019-08-0117111310.1186/s12960-019-0402-4The impact of India’s accredited social health activist (ASHA) program on the utilization of maternity services: a nationally representative longitudinal modelling studySmisha Agarwal0Sian L. Curtis1Gustavo Angeles2Ilene S. Speizer3Kavita Singh4James C. Thomas5Department of International Health, Johns Hopkins Bloomberg School of Public HealthMaternal and Child Health, Gillings School of Global Public Health, University of North CarolinaMaternal and Child Health, Gillings School of Global Public Health, University of North CarolinaMaternal and Child Health, Gillings School of Global Public Health, University of North CarolinaMaternal and Child Health, Gillings School of Global Public Health, University of North CarolinaCarolina Population Center, University of North CarolinaAbstract 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.http://link.springer.com/article/10.1186/s12960-019-0402-4Primary health careCommunity health workersIndiaAntenatal careMaternity careImpact evaluation |
| spellingShingle | Smisha Agarwal Sian L. Curtis Gustavo Angeles Ilene S. Speizer Kavita Singh James C. Thomas The impact of India’s accredited social health activist (ASHA) program on the utilization of maternity services: a nationally representative longitudinal modelling study Human Resources for Health Primary health care Community health workers India Antenatal care Maternity care Impact evaluation |
| title | The impact of India’s accredited social health activist (ASHA) program on the utilization of maternity services: a nationally representative longitudinal modelling study |
| title_full | The impact of India’s accredited social health activist (ASHA) program on the utilization of maternity services: a nationally representative longitudinal modelling study |
| title_fullStr | The impact of India’s accredited social health activist (ASHA) program on the utilization of maternity services: a nationally representative longitudinal modelling study |
| title_full_unstemmed | The impact of India’s accredited social health activist (ASHA) program on the utilization of maternity services: a nationally representative longitudinal modelling study |
| title_short | The impact of India’s accredited social health activist (ASHA) program on the utilization of maternity services: a nationally representative longitudinal modelling study |
| title_sort | impact of india s accredited social health activist asha program on the utilization of maternity services a nationally representative longitudinal modelling study |
| topic | Primary health care Community health workers India Antenatal care Maternity care Impact evaluation |
| url | http://link.springer.com/article/10.1186/s12960-019-0402-4 |
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