Economic evaluation of participatory learning and action with women’s groups facilitated by Accredited Social Health Activists to improve birth outcomes in rural eastern India

Sinha, Rajesh Kumar; Haghparast‐Bidgoli, Hassan; Tripathy, Prasanta; Nair, Nirmala; Gope, Rajkumar; Rath, Suchitra; Prost, Audrey

doi:10.1186/s12962-017-0064-9

Cited by 16 publications

(28 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Without such information, the policy implications of studies examining the impact of women’s groups operating at scale will remain unclear. While various studies examine the costs and cost-effectiveness of women’s groups aiming to improve health outcomes ( Mangham-Jefferies et al, 2014 , Colbourn et al, 2015 , Sinha et al, 2017 , Pulkki- Brännström et al, 2020 ), somewhat paradoxically there is limited information on the costs of women’s groups with economic objectives.…”

Section: Introductionmentioning

confidence: 99%

Economies of scale of large-scale international development interventions: Evidence from self-help groups in India

2022

View full text Add to dashboard Cite

Section: Introductionmentioning

confidence: 99%

Economies of scale of large-scale international development interventions: Evidence from self-help groups in India

2022

View full text Add to dashboard Cite

“…The incremental cost-effectiveness ratio of $INT41 is substantially lower than India’s GDP per capita (ranging from 0.3% to 7% of GDP). FLAG’s ICER is 85% lower than that found in a smaller-scale efficacy trial of women’s groups facilitated by ASHAs conducted in Jharkhand and Odisha (ICER of 2017 INT$ 274 or US$83), and 70% lower than in another smaller trial of women’s groups supported by salaried facilitators in the same states (ICER of 2016 INT$ 135) [13] [12]. Similarly, FLAG’s ICER is also substantially lower than those reported for small scale efficacy trials of women’s groups in Nepal, Bangladesh, and Malawi[12] (Table S2).…”

Section: Discussionmentioning

confidence: 84%

Economic evaluation of participatory women’s groups scaled up by the public health system to improve birth outcomes in Jharkhand, eastern India

Haghparast‐Bidgoli

Ojha

Gope

et al. 2022

Preprint

Self Cite

View full text Add to dashboard Cite

An estimated 2.4 million newborn infants died in 2020, 80% of them in sub-Saharan Africa and South Asia. To achieve the Sustainable Development Target for neonatal mortality reduction, countries with high mortality need to implement evidence-based, cost-effective interventions at scale. Our study aimed to estimate the cost, cost-effectiveness, and benefit-cost ratio of a participatory women’s groups intervention scaled up by the public health system in Jharkhand, eastern India. The intervention was evaluated through a pragmatic cluster non-randomised controlled trial in six districts. We estimated the cost of the intervention from a provider perspective, with a 42-month time horizon for 20 districts. We estimated costs using a combination of top-down and bottom-up approaches. All costs were adjusted for inflation, discounted at 3% per year, and converted to 2020 International Dollars (INT$). Incremental cost-effectiveness ratios (ICERs) were estimated using extrapolated effect sizes for the impact of the intervention in 20 districts, in terms of cost per neonatal deaths averted and cost per life year saved. We assessed the impact of uncertainty on results through one-way and probabilistic sensitivity analyses. We also estimated benefit-cost ratio using a benefit transfer approach . Total intervention costs for 20 districts were INT$ 15,017,396. The intervention covered an estimated 1.6 million livebirths across 20 districts, translating to INT$ 9.4 per livebirth covered. ICERs were estimated at INT$ 1,272 per neonatal death averted or INT$ 41 per life year saved. Net benefit estimates ranged from INT$ 1,046 million to INT$ 3,254 million , and benefit-cost ratios from 71 to 218. Our study suggests that participatory women’s groups scaled up by the public health system are highly cost-effective in improving neonatal survival and have a very favourable return on investment. The intervention can be scaled up in similar settings within India and other countries.

show abstract

“… 43 44 The ICERs estimated in this study were substantially lower than those reported in earlier efficacy trials of participatory women’s groups in India. 45 Employing incentivised ASHAs and ASHA facilitators as well as building these frontline workers’ capacity through on-the-job-training reduced costs at scale. The intervention covered 1.6 million live births at a cost of INT$9.4 per live birth compared with average cost per live birth of INT$203 (range: 2016 INT$61–INT$537) in efficacy trials.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of participatory women’s groups scaled up by the public health system to improve birth outcomes in Jharkhand, eastern India: a pragmatic cluster non-randomised controlled trial

et al. 2021

Self Cite

View full text Add to dashboard Cite

IntroductionThe WHO recommends community mobilisation with women’s groups practising participatory learning and action (PLA) to improve neonatal survival in high-mortality settings. This intervention has not been evaluated at scale with government frontline workers.MethodsWe did a pragmatic cluster non-randomised controlled trial of women’s groups practising PLA scaled up by government front-line workers in Jharkhand, eastern India. Groups prioritised maternal and newborn health problems, identified strategies to address them, implemented the strategies and evaluated progress. Intervention coverage and quality were tracked state-wide. Births and deaths to women of reproductive age were monitored in six of Jharkhand’s 24 districts: three purposively allocated to an early intervention start (2017) and three to a delayed start (2019). We monitored vital events prospectively in 100 purposively selected units of 10 000 population each, during baseline (1 March 2017–31 August 2017) and evaluation periods (1 September 2017–31 August 2019). The primary outcome was neonatal mortality.ResultsWe identified 51 949 deliveries and conducted interviews for 48 589 (93.5%). At baseline, neonatal mortality rates (NMR) were 36.9 per 1000 livebirths in the early arm and 39.2 in the delayed arm. Over 24 months of intervention, the NMR was 29.1 in the early arm and 39.2 in the delayed arm, corresponding to a 24% reduction in neonatal mortality (adjusted OR (AOR) 0.76, 95% CI 0.59 to 0.98), including 26% among the most deprived (AOR 0.74, 95% CI 0.57 to 0.95). Twenty of Jharkhand’s 24 districts achieved adequate meeting coverage and quality. In these 20 districts, the intervention saved an estimated 11 803 newborn lives (min: 1026–max: 20 527) over 42 months, and cost 41 international dollars per life year saved.ConclusionParticipatory women’s groups scaled up by the Indian public health system reduced neonatal mortality equitably in a largely rural state and were highly cost-effective, warranting scale-up in other high-mortality rural settings.Trial registrationISRCTN99422435.

show abstract

Economic evaluation of participatory learning and action with women’s groups facilitated by Accredited Social Health Activists to improve birth outcomes in rural eastern India

Cited by 16 publications

References 20 publications

Economies of scale of large-scale international development interventions: Evidence from self-help groups in India

Economies of scale of large-scale international development interventions: Evidence from self-help groups in India

Economic evaluation of participatory women’s groups scaled up by the public health system to improve birth outcomes in Jharkhand, eastern India

Effectiveness of participatory women’s groups scaled up by the public health system to improve birth outcomes in Jharkhand, eastern India: a pragmatic cluster non-randomised controlled trial

Contact Info

Product

Resources

About