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Cost Effectiveness and Resource Allocation
Published in: Cost Effectiveness and Resource Allocation 1/2017

Open Access 01-12-2017 | Research

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

Authors: Rajesh Kumar Sinha, Hassan Haghparast-Bidgoli, Prasanta Kishore Tripathy, Nirmala Nair, Rajkumar Gope, Shibanand Rath, Audrey Prost

Published in: Cost Effectiveness and Resource Allocation | Issue 1/2017

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Abstract

Background

Neonatal mortality remains unacceptably high in many low and middle-income countries, including India. A community mobilisation intervention using participatory learning and action with women’s groups facilitated by Accredited Social Health Activists (ASHAs) was conducted to improve maternal and newborn health. The intervention was evaluated through a cluster-randomised controlled trial conducted in Jharkhand and Odisha, eastern India. This aims to assess the cost-effectiveness this intervention.

Methods

Costs were estimated from the provider’s perspective and calculated separately for the women’s group intervention and for activities to strengthen Village Health Sanitation and Nutrition Committees (VHNSC) conducted in all trial areas. Costs were estimated at 2017 prices and converted to US dollar (USD). The incremental cost-effectiveness ratio (ICER) was calculated with respect to a do-nothing alternative and compared with the WHO thresholds for cost-effective interventions. ICERs were calculated for cases of neonatal mortality and disability-adjusted life years (DALYs) averted.

Results

The incremental cost of the intervention was USD 83 per averted DALY (USD 99 inclusive of VHSNC strengthening costs), and the incremental cost per newborn death averted was USD 2545 (USD 3046 inclusive of VHSNC strengthening costs). The intervention was highly cost-effective according to WHO threshold, as the cost per life year saved or DALY averted was less than India’s Gross Domestic Product (GDP) per capita. The robustness of the findings to assumptions was tested using a series of one-way sensitivity analyses. The sensitivity analysis does not change the conclusion that the intervention is highly cost-effective.

Conclusion

Participatory learning and action with women’s groups facilitated by ASHAs was highly cost-effective to reduce neonatal mortality in rural settings with low literacy levels and high neonatal mortality rates. This approach could effectively complement facility-based care in India and can be scaled up in comparable high mortality settings.
Footnotes
1
Scheduled Tribe (ST) is an officially designated group recognised in the Constitution of India. The tribes under this group are historically disadvantaged indigenous people in India.
 
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Metadata
Title
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
Authors
Rajesh Kumar Sinha
Hassan Haghparast-Bidgoli
Prasanta Kishore Tripathy
Nirmala Nair
Rajkumar Gope
Shibanand Rath
Audrey Prost
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Cost Effectiveness and Resource Allocation / Issue 1/2017
Electronic ISSN: 1478-7547
DOI
https://doi.org/10.1186/s12962-017-0064-9

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