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

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cg.authorship.typesCGIAR single centreen
cg.contributor.affiliationInternational Food Policy Research Instituteen
cg.contributor.crpAgriculture for Nutrition and Health
cg.contributor.donorBill & Melinda Gates Foundationen
cg.coverage.countryIndia
cg.coverage.iso3166-alpha2IN
cg.coverage.regionSouthern Asia
cg.coverage.regionAsia
cg.creator.identifierRasmi Avula: 0000-0003-0066-6964
cg.creator.identifierPurnima Menon: 0000-0001-5988-2894
cg.creator.identifierSumati Bajaj: 0000-0002-8255-7181
cg.identifier.doihttps://doi.org/10.1136/bmjgh-2021-007298en
cg.identifier.projectIFPRI - Partnerships and Opportunities to Strengthen and Harmonize Actions for Nutrition in India (POSHAN)
cg.identifier.projectIFPRI - Poverty, Health, and Nutrition Division
cg.identifier.publicationRankA
cg.isijournalISI Journalen
cg.issn2059-7908en
cg.issue5 e007298en
cg.journalBMJ Global Healthen
cg.reviewStatusPeer Reviewen
cg.volume6en
dc.contributor.authorPatil, Sumeet R.en
dc.contributor.authorNimmagadda, Snehaen
dc.contributor.authorGopalakrishnan, Lakshmien
dc.contributor.authorAvula, Rasmien
dc.contributor.authorBajaj, Sumatien
dc.contributor.authorDiamond-Smith, Nadiaen
dc.contributor.authorPaul, Anushmanen
dc.contributor.authorMenon, Purnimaen
dc.contributor.authorWalker, Dilysen
dc.date.accessioned2024-04-12T13:37:40Zen
dc.date.available2024-04-12T13:37:40Zen
dc.identifier.urihttps://hdl.handle.net/10568/141312
dc.titleCan 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 Indiaen
dcterms.abstractBackground: 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.en
dcterms.accessRightsOpen Access
dcterms.bibliographicCitationPatil, 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-2021-007298en
dcterms.issued2022-07-14
dcterms.languageen
dcterms.licenseCC-BY-4.0
dcterms.publisherBMJen
dcterms.replaceshttps://ebrary.ifpri.org/digital/collection/p15738coll5/id/8312en
dcterms.subjectpregnancyen
dcterms.subjectchild developmenten
dcterms.subjectsurveysen
dcterms.subjecthealthen
dcterms.subjectservicesen
dcterms.subjectdata collectionen
dcterms.subjectlabouren
dcterms.subjectcounsellingen
dcterms.subjectnutritionen
dcterms.subjectfeeding practicesen
dcterms.subjectdecision makingen
dcterms.subjectinformation and communication technologiesen
dcterms.subjecthealth careen
dcterms.subjectwomenen
dcterms.subjectdigital technologyen
dcterms.subjectcommunitiesen
dcterms.typeJournal Article

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