Authors: Peter Smittenaar, B.M. Ramesh, Mokshada Jain, James Blanchard, Hannah Kemp, Elisabeth Engl, Shajy Isac, John Anthony, Ravi Prakash, Vikas Gothalwal, Vasanthakumar Namasivayam, Pankaj Kumar, Sema K. Sgaier
Community health workers (CHWs) play a key role in the health of mothers and newborns in low- and middleincome countries. However, it remains unclear by what actions and messages CHWs enable good outcomes and respectful care.
We collected a uniquely linked set of questions on behaviors, beliefs, and care pathways from recently delivered women (n=5,469), their husbands (n=3,064), mothers-in-law (n=3,626), and CHWs (accredited social health activists; n=1,052) in Uttar Pradesh, India. We used logistic regression to study associations between CHW actions and household behaviors during antenatal, delivery, and postnatal periods.
Pregnant women who were visited earlier in pregnancy and who received multiple visits were more likely to perform recommended health behaviors including attending multiple checkups, consuming iron and folic acid tablets, and delivering in a health facility (ID), compared to women visited later or receiving fewer visits, respectively. Counseling the woman was associated with higher likelihood of attending 3þ checkups and consuming 100þ iron and folic acid tablets, whereas counseling the husband and mother-in-law was associated with higher rates of ID. Certain behavior change messages, such as the danger of complications, were associated with more checkups and ID, but were only used by 50%–80% of CHWs. During delivery, 57% of women had the CHW present, and their presence was associated with respectful care, early initiation of breastfeeding, and exclusive breastfeeding, but not with delayed bathing or clean cord care. The newborn was less likely to receive delayed bathing if the CHW incorrectly believed that newborns could be bathed soon after birth (which is believed by 30% of CHWs). CHW presence was associated with health behaviors more strongly for home than facility deliveries. Home visits after delivery were associated with higher rates of clean cord care and exclusive breastfeeding. Counseling the mother-in-law (but not the husband or woman) was associated with exclusive breastfeeding.
We identified potential ways in which CHW impact could be improved, specifically by emphasizing the importance of home visits, which household members are targeted during these visits, and what messages are shared. Achieving this change will require training CHWs in counseling and behavior change and providing supervision and modern tools such as apps that can help the CHW keep track of her beneficiaries, suggest behavior change strategies, and direct attention to households that stand to gain the most from support.
ASHAs act as an interface between the community and the public health system in creating awareness on health and its social determinants within the community, and mobilizing the community towards local health planning and increased utilization of health services. This brief highlights importance of building capacities of ASHAs through the cluster meeting platform.
This brief identifies the opportunity gaps in the effective coverage cascade for prevention of anaemia among pregnant women in India. The effective coverage cascade is used to identify coverage gaps, quantify coverage at each step, determine where the largest gaps exist within the cascade and prioritize where actions are most urgent. The findings are based on NFHS 5 data.
The fifteenth edition of PAHAL newsletter throws light on UP TSU’s support to GoUP in adopting a scientific approach for allocating Area of Responsibility (AoR) to ANMs working in sub-centres; also, geo-mapping of more than 1,80,000 Anganwadi Centres across the state by ICDS department with the support of UP TSU has been the highlight of the quarter.