Effectiveness of a Quality Improvement Program Using Difference-in-Difference Analysis for Home Based Newborn Care – Results of a Community Intervention Trial
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To present evaluation of a quality improvement program for Accredited Social Health Activists (ASHAs).
This community intervention trial was conducted in Ballabgarh, India during 2012–2014 with two Primary Health Center (PHC) areas being the intervention areas and two PHC areas being non-intervention areas receiving standard care. Interventions included two-day training in technical and communication skills of ASHAs followed by supportive supervision in the field. Intervention was evaluated by comparing pre and post training scores, feedback from postnatal mothers and a difference-in-difference (DID) analysis on baseline and endline knowledge-practice survey of recently delivered mothers with 95% confidence intervals.
Only 11.1% ASHAs addressed specific barriers for adopting healthy behaviors. Sixty eight (91.8%) ASHAs attended the training after which knowledge improved by 33.3% (p < 0.001). ASHAs in intervention areas were rated by mothers (n = 69) to have better communication skills (81.2% vs. 59.7%, p = 0.005), make more postnatal visits (52.2% vs. 22.2%; p < 0.001), give advice on newborn care (64% vs. 50.5%; p < 0.001) as compared to standard care area ASHAs. Endline survey (n = 1360) showed a significant improvement in frequency of antenatal visits (0.26;0.19–0.33), knowledge about free transport (0.12;0.05–0.18), better cord-care practices (0.15;0.07–0.22), kangaroo mother care (0.19;0.13–0.25), delayed first bath (0.13;0.06–0.20), restrictive handling (0.11;0.06–0.15) and hand-washing (0.19;0.13–0.25).
Quality improvement program can help improve ASHA’s performance which in turn can address higher neonatal mortality in India.
KeywordsAccredited social health activists Home-based care Neonatal Communication skills Quality improvement program
UNICEF, District authorities, ENVISION.
AK, SKK, SR and RA: Conception and design and interpretation of data. ADG, MG and HS: Data acquisition, analysis and interpretation. All authors have contributed towards drafting the work, revising it critically for important intellectual content and have approved the final version to be published. AK is the guarantor for this paper.
Compliance with Ethical Standards
Conflict of Interest
Source of Funding
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