Can digitally enabling community health and nutrition workers improve services delivery to pregnant women and mothers of infants? Quasi-experimental evidence from a national-scale nutrition programme in India
Background: India’s 1.4 million community health and nutrition workers (CHNWs) serve 158 million beneficiaries under the Integrated Child Development Services (ICDS) programme. We assessed the impact of a data capture, decision support, and job-aid mobile app for the CHNWs on two primary outcomes—(1...
| Autores principales: | , , , , , , , , |
|---|---|
| Formato: | Journal Article |
| Lenguaje: | Inglés |
| Publicado: |
BMJ
2022
|
| Materias: | |
| Acceso en línea: | https://hdl.handle.net/10568/141312 |
| _version_ | 1855525243602337792 |
|---|---|
| author | Patil, Sumeet R. Nimmagadda, Sneha Gopalakrishnan, Lakshmi Avula, Rasmi Bajaj, Sumati Diamond-Smith, Nadia Paul, Anushman Menon, Purnima Walker, Dilys |
| author_browse | Avula, Rasmi Bajaj, Sumati Diamond-Smith, Nadia Gopalakrishnan, Lakshmi Menon, Purnima Nimmagadda, Sneha Patil, Sumeet R. Paul, Anushman Walker, Dilys |
| author_facet | Patil, Sumeet R. Nimmagadda, Sneha Gopalakrishnan, Lakshmi Avula, Rasmi Bajaj, Sumati Diamond-Smith, Nadia Paul, Anushman Menon, Purnima Walker, Dilys |
| author_sort | Patil, Sumeet R. |
| collection | Repository of Agricultural Research Outputs (CGSpace) |
| description | Background: India’s 1.4 million community health and nutrition workers (CHNWs) serve 158 million beneficiaries under the Integrated Child Development Services (ICDS) programme. We assessed the impact of a data capture, decision support, and job-aid mobile app for the CHNWs on two primary outcomes—(1) timeliness of home visits and (2) appropriate counselling specific to the needs of pregnant women and mothers of children <12 months. Methods: We used a quasi-experimental pair-matched controlled trial using repeated cross-sectional surveys to evaluate the intervention in Bihar and Madhya Pradesh (MP) separately using an intention-to-treat analysis. The study was powered to detect difference of 5–9 percentage points (pp) with type I error of 0.05 and type II error of 0.20 with endline sample of 6635 mothers of children <12 months and 2398 pregnant women from a panel of 841 villages. Results: Among pregnant women and mothers of children <12 months, recall of counselling specific to the trimester of pregnancy or age of the child as per ICDS guidelines was higher in both MP (11.5pp (95% CI 7.0pp to 16.0pp)) and Bihar (8.0pp (95% CI 5.3pp to 10.7pp)). Significant differences were observed in the proportion of mothers of children <12 months receiving adequate number of home visits as per ICDS guidelines (MP 8.3pp (95% CI 4.1pp to 12.5pp), Bihar: 7.9pp (95% CI 4.1pp to 11.6pp)). Coverage of children receiving growth monitoring increased in Bihar (22pp (95% CI 0.18 to 0.25)), but not in MP. No effects were observed on infant and young child feeding practices. Conclusion: The at-scale app integrated with ICDS improved provision of services under the purview of CHNWs but not those that depended on systemic factors, and was relatively more effective when baseline levels of services were low. Overall, digitally enabling CHNWs can complement but not substitute efforts for strengthening health systems and addressing structural barriers. |
| format | Journal Article |
| id | CGSpace141312 |
| institution | CGIAR Consortium |
| language | Inglés |
| publishDate | 2022 |
| publishDateRange | 2022 |
| publishDateSort | 2022 |
| publisher | BMJ |
| publisherStr | BMJ |
| record_format | dspace |
| spelling | CGSpace1413122025-10-26T13:01:34Z Can digitally enabling community health and nutrition workers improve services delivery to pregnant women and mothers of infants? Quasi-experimental evidence from a national-scale nutrition programme in India Patil, Sumeet R. Nimmagadda, Sneha Gopalakrishnan, Lakshmi Avula, Rasmi Bajaj, Sumati Diamond-Smith, Nadia Paul, Anushman Menon, Purnima Walker, Dilys pregnancy child development surveys health services data collection labour counselling nutrition feeding practices decision making information and communication technologies health care women digital technology communities Background: India’s 1.4 million community health and nutrition workers (CHNWs) serve 158 million beneficiaries under the Integrated Child Development Services (ICDS) programme. We assessed the impact of a data capture, decision support, and job-aid mobile app for the CHNWs on two primary outcomes—(1) timeliness of home visits and (2) appropriate counselling specific to the needs of pregnant women and mothers of children <12 months. Methods: We used a quasi-experimental pair-matched controlled trial using repeated cross-sectional surveys to evaluate the intervention in Bihar and Madhya Pradesh (MP) separately using an intention-to-treat analysis. The study was powered to detect difference of 5–9 percentage points (pp) with type I error of 0.05 and type II error of 0.20 with endline sample of 6635 mothers of children <12 months and 2398 pregnant women from a panel of 841 villages. Results: Among pregnant women and mothers of children <12 months, recall of counselling specific to the trimester of pregnancy or age of the child as per ICDS guidelines was higher in both MP (11.5pp (95% CI 7.0pp to 16.0pp)) and Bihar (8.0pp (95% CI 5.3pp to 10.7pp)). Significant differences were observed in the proportion of mothers of children <12 months receiving adequate number of home visits as per ICDS guidelines (MP 8.3pp (95% CI 4.1pp to 12.5pp), Bihar: 7.9pp (95% CI 4.1pp to 11.6pp)). Coverage of children receiving growth monitoring increased in Bihar (22pp (95% CI 0.18 to 0.25)), but not in MP. No effects were observed on infant and young child feeding practices. Conclusion: The at-scale app integrated with ICDS improved provision of services under the purview of CHNWs but not those that depended on systemic factors, and was relatively more effective when baseline levels of services were low. Overall, digitally enabling CHNWs can complement but not substitute efforts for strengthening health systems and addressing structural barriers. 2022-07 2024-04-12T13:37:40Z 2024-04-12T13:37:40Z Journal Article https://hdl.handle.net/10568/141312 en Open Access BMJ Patil, Sumeet R.; Nimmagadda, Sneha; Gopalakrishnan, Lakshmi; Avula, Rasmi; Bajaj, Sumati; Diamond-Smith, Nadia; Paul, Anushman; Menon, Purnima; amd Walker, Dilys. 2022. Can digitally enabling community health and nutrition workers improve services delivery to pregnant women and mothers of infants? Quasi-experimental evidence from a national-scale nutrition programme in India. BMJ Global Health 6(5): e007298. https://doi.org/10.1136/bmjgh-2021-007298 |
| spellingShingle | pregnancy child development surveys health services data collection labour counselling nutrition feeding practices decision making information and communication technologies health care women digital technology communities Patil, Sumeet R. Nimmagadda, Sneha Gopalakrishnan, Lakshmi Avula, Rasmi Bajaj, Sumati Diamond-Smith, Nadia Paul, Anushman Menon, Purnima Walker, Dilys Can digitally enabling community health and nutrition workers improve services delivery to pregnant women and mothers of infants? Quasi-experimental evidence from a national-scale nutrition programme in India |
| title | Can digitally enabling community health and nutrition workers improve services delivery to pregnant women and mothers of infants? Quasi-experimental evidence from a national-scale nutrition programme in India |
| title_full | Can digitally enabling community health and nutrition workers improve services delivery to pregnant women and mothers of infants? Quasi-experimental evidence from a national-scale nutrition programme in India |
| title_fullStr | Can digitally enabling community health and nutrition workers improve services delivery to pregnant women and mothers of infants? Quasi-experimental evidence from a national-scale nutrition programme in India |
| title_full_unstemmed | Can digitally enabling community health and nutrition workers improve services delivery to pregnant women and mothers of infants? Quasi-experimental evidence from a national-scale nutrition programme in India |
| title_short | Can digitally enabling community health and nutrition workers improve services delivery to pregnant women and mothers of infants? Quasi-experimental evidence from a national-scale nutrition programme in India |
| title_sort | can digitally enabling community health and nutrition workers improve services delivery to pregnant women and mothers of infants quasi experimental evidence from a national scale nutrition programme in india |
| topic | pregnancy child development surveys health services data collection labour counselling nutrition feeding practices decision making information and communication technologies health care women digital technology communities |
| url | https://hdl.handle.net/10568/141312 |
| work_keys_str_mv | AT patilsumeetr candigitallyenablingcommunityhealthandnutritionworkersimproveservicesdeliverytopregnantwomenandmothersofinfantsquasiexperimentalevidencefromanationalscalenutritionprogrammeinindia AT nimmagaddasneha candigitallyenablingcommunityhealthandnutritionworkersimproveservicesdeliverytopregnantwomenandmothersofinfantsquasiexperimentalevidencefromanationalscalenutritionprogrammeinindia AT gopalakrishnanlakshmi candigitallyenablingcommunityhealthandnutritionworkersimproveservicesdeliverytopregnantwomenandmothersofinfantsquasiexperimentalevidencefromanationalscalenutritionprogrammeinindia AT avularasmi candigitallyenablingcommunityhealthandnutritionworkersimproveservicesdeliverytopregnantwomenandmothersofinfantsquasiexperimentalevidencefromanationalscalenutritionprogrammeinindia AT bajajsumati candigitallyenablingcommunityhealthandnutritionworkersimproveservicesdeliverytopregnantwomenandmothersofinfantsquasiexperimentalevidencefromanationalscalenutritionprogrammeinindia AT diamondsmithnadia candigitallyenablingcommunityhealthandnutritionworkersimproveservicesdeliverytopregnantwomenandmothersofinfantsquasiexperimentalevidencefromanationalscalenutritionprogrammeinindia AT paulanushman candigitallyenablingcommunityhealthandnutritionworkersimproveservicesdeliverytopregnantwomenandmothersofinfantsquasiexperimentalevidencefromanationalscalenutritionprogrammeinindia AT menonpurnima candigitallyenablingcommunityhealthandnutritionworkersimproveservicesdeliverytopregnantwomenandmothersofinfantsquasiexperimentalevidencefromanationalscalenutritionprogrammeinindia AT walkerdilys candigitallyenablingcommunityhealthandnutritionworkersimproveservicesdeliverytopregnantwomenandmothersofinfantsquasiexperimentalevidencefromanationalscalenutritionprogrammeinindia |