Impact assessment and cost-effectiveness of m-health application used by community health workers for maternal, newborn and child health care services in rural Uttar Pradesh, India: a study protocol

Abstract

Background: An m-health application has been developed and implemented with community health workers to improve their counseling in a rural area of India. The ultimate aim was to generate demand and improve utilization of key maternal, neonatal, and child health services. The present study aims to assess the impact and cost-effectiveness of this project.

Methods/design: A pre-post quasi-experimental design with a control group will be used to undertake difference in differences analysis for assessing the impact of intervention. The Annual Health Survey (2011) will provide pre-intervention data, and a household survey will be carried out to provide post-intervention data.Two community development blocks where the intervention was introduced will be treated as intervention blocks while two controls blocks are selected after matching with intervention blocks on three indicators: average number of antenatal care checkups, percentage of women receiving three or more antenatal checkups, and percentage of institutional deliveries. Two categories of beneficiaries will be interviewed in both areas: women with a child between 29 days and 6 months and women with a child between 12 and 23 months. Propensity score matched samples from intervention and control areas in pre-post periods will be analyzed using the difference in differences method to estimate the impact of intervention in utilization of key services.Bottom-up costing methods will be used to assess the cost of implementing intervention. A decision model will estimate long-term effects of improved health services utilization on mortality, morbidity, and disability. Cost-effectiveness will be assessed in terms of incremental cost per disability-adjusted life year averted and cost per unit increase in composite service coverage in intervention versus control groups.

Conclusions: The study will generate significant evidence on impact of the m-health intervention for maternal, neonatal, and child services and on the cost of scaling up m-health technology for accredited social health activists in India.

Keywords: community health worker; cost-effectiveness analysis; health services research; impact assessment; m-health; maternal and child health.

Fig. 1

Conceptual frame work for impact of ReMiND project.

Fig. 2

Decision model for cost-effectiveness study of m-health application for ASHA workers as part of ReMind project. Note: DH=district hospital, CHC=community health center, FRU=first referral unit, PHC=primary health center, SC=sub-center, ASHA=accredited social health activist, AWW=Anganwadi worker, MNCH=maternal neonatal and child health. Cycle repeated for 15 birth cohorts. Source: This model is adapted from a similar figure in Ref. (29).

Fig. 3

Outcome model for cost-effectiveness study of m-health application for ASHA workers as part of the ReMind project. Note: In continuation to the model 1, outcome model describes the probable scenarios after a neonatal or post-neonatal infant had been treated or not (irrespective of type of health facility). YLD=years of life lived with disability, YLL=years of life lost due to premature mortality, DALY=disability-adjusted life years. Source: This model is adapted from a similar figure in Ref. (29).

Fig. 4

Decision model for cost-effectiveness (maternal health) study of m-health application for ASHA workers as part of ReMind project.