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_US
cg.contributor.affiliationInternational Food Policy Research Instituteen_US
cg.contributor.crpAgriculture for Nutrition and Healthen_US
cg.contributor.donorBill & Melinda Gates Foundationen_US
cg.coverage.countryIndiaen_US
cg.coverage.iso3166-alpha2INen_US
cg.coverage.regionSouthern Asiaen_US
cg.coverage.regionAsiaen_US
cg.creator.identifierRasmi Avula: 0000-0003-0066-6964en_US
cg.creator.identifierPurnima Menon: 0000-0001-5988-2894en_US
cg.creator.identifierSumati Bajaj: 0000-0002-8255-7181en_US
cg.identifier.doihttps://doi.org/10.1136/bmjgh-2021-007298en_US
cg.identifier.projectIFPRI - Partnerships and Opportunities to Strengthen and Harmonize Actions for Nutrition in India (POSHAN)en_US
cg.identifier.projectIFPRI - Poverty, Health, and Nutrition Divisionen_US
cg.identifier.publicationRankAen_US
cg.isijournalISI Journalen_US
cg.issn2059-7908en_US
cg.issue5 e007298en_US
cg.journalBMJ Global Healthen_US
cg.reviewStatusPeer Reviewen_US
cg.volume6en_US
dc.contributor.authorPatil, Sumeet R.en_US
dc.contributor.authorNimmagadda, Snehaen_US
dc.contributor.authorGopalakrishnan, Lakshmien_US
dc.contributor.authorAvula, Rasmien_US
dc.contributor.authorBajaj, Sumatien_US
dc.contributor.authorDiamond-Smith, Nadiaen_US
dc.contributor.authorPaul, Anushmanen_US
dc.contributor.authorMenon, Purnimaen_US
dc.contributor.authorWalker, Dilysen_US
dc.date.accessioned2024-04-12T13:37:40Zen_US
dc.date.available2024-04-12T13:37:40Zen_US
dc.identifier.urihttps://hdl.handle.net/10568/141312en_US
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_US
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_US
dcterms.accessRightsOpen Accessen_US
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_US
dcterms.issued2022-07-14en_US
dcterms.languageenen_US
dcterms.licenseCC-BY-4.0en_US
dcterms.publisherBMJen_US
dcterms.replaceshttps://ebrary.ifpri.org/digital/collection/p15738coll5/id/8312en_US
dcterms.subjectpregnancyen_US
dcterms.subjectchild developmenten_US
dcterms.subjectsurveysen_US
dcterms.subjecthealthen_US
dcterms.subjectservicesen_US
dcterms.subjectdata collectionen_US
dcterms.subjectlabouren_US
dcterms.subjectcounsellingen_US
dcterms.subjectnutritionen_US
dcterms.subjectfeeding practicesen_US
dcterms.subjectdecision makingen_US
dcterms.subjectinformation and communication technologiesen_US
dcterms.subjecthealth careen_US
dcterms.subjectwomenen_US
dcterms.subjectdigital technologyen_US
dcterms.subjectcommunitiesen_US
dcterms.typeJournal Articleen_US

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