Health layering of self-help groups: impacts on reproductive, maternal, newborn and child health and nutrition in Bihar, India

Abstract

Background: Self-help group (SHG) interventions have been widely studied in low and middle income countries. However, there is little data on specific impacts of health layering, or adding health education modules upon existing SHGs which were formed primarily for economic empowerment. We examined three SHG interventions from 2012-2017 in Bihar, India to test the hypothesis that health-layering of SHGs would lead to improved health-related behaviours of women in SHGs.

Methods: A model for health layering of SHGs - Parivartan - was developed by the non-governmental organisation (NGO), Project Concern International, in 64 blocks of eight districts. Layering included health modules, community events and review mechanisms. The health layering model was adapted for use with government-led SHGs, called JEEViKA+HL, in 37 other blocks of Bihar. Scale-up of government-led SHGs without health layering (JEEViKA) occurred contemporaneously in 433 other blocks, providing a natural comparison group. Using Community-based Household Surveys (CHS, rounds 6-9) by CARE India, 62 reproductive, maternal, newborn and child health and nutrition (RMNCHN) and sanitation indicators were examined for SHGs with health layering (Pavivartan SHGs and JEEViKA+HL SHGs) compared to those without. We calculated mean, standard deviation and odds ratios of indicators using surveymeans and survey logistic regression.

Results: In 2014, 64% of indicators were significantly higher in Parivartan members compared to non-members residing in the same blocks. During scale up, from 2015-17, half (50%) of indicators had significantly higher odds in health layered SHG members (Parivartan or JEEViKA+HL) in 101 blocks compared to SHG members without health layering (JEEViKA) in 433 blocks.

Conclusions: Health layering of SHGs was demonstrated by an NGO-led model (Parivartan), adapted and scaled up by a government model (JEEViKA+HL), and associated with significant improvements in health compared to non-health-layered SHGs (JEEViKA). These results strengthen the evidence base for further layering of health onto the SHG platform for scale-level health change.

Study registration: ClinicalTrials.gov number NCT02726230.

Figure 1

Map of Bihar showing self-help group types, 2014-2017.

Figure 2

Timeline of health layering of self-help groups (SHGs) in Bihar, 2012-2018.

Figure 3

Effect of Parivartan health layering on reproductive, maternal, newborn and child health and nutrition indicators by continuum of care, CHS round 6 (2014), compared to non-members, 64 blocks (odds ratio, OR ± 95% confidence interval, CI?. All models presented were adjusted for age of the mother and the sex of the focal child. These models also accounted for the study’s complex design by applying study weights. ANC – antenatal care, CHS – Community-based Household Survey, DPT – diphtheria-pertussis-tetanus, FLW – frontline worker, HL – health layering, IFA – iron-folic acid, IPV – inactivated polio vaccine, OPV – oral polio vaccine, PPIUD – postpartum intrauterine device, SHG – self-help group (sanitation indicators were not included herein as the models did not parameterise).

Figure 5

Effect of SHG interventions on reproductive, maternal, newborn and child health, nutrition and sanitation indicators by continuum of care, comparing members in health-layered SHGs (JEEViKA+HL and Parivartan) to members in non-health-layared JEEViKA SHGs, CHS rounds 8-9, 2016-2017. All models presented were adjusted for age of the mother and the sex of the focal child. These models also accounted for the study’s complex design by applying study weights. ANC - antenatal care, CHS – Community-based Household Survey, DPT - diphtheria-pertussis-tetanus, FLW – frontline worker, HL – health layering, IFA – iron-folic acid, IPV – inactivated polio vaccine, OPV – oral polio vaccine, PPIUD – postpartum intrauterine device, SHG – self-help group.

Figure 6

Summary of SHG interventions on reproductive, maternal, newborn and child health and nutrition domains, comparing members in health-layered SHGs (JEEViKA+HL and Parivartan) to members in non-health-layared JEEViKA SHGs, CHS rounds 8-9, 2016-2017. (% of indicators where HL outperformed SHG alone). Sanitation indicators are not included here as sanitation indicators had similar effects in JEEViKA+HL and JEEViKA groups.