Healthy
Conditions
Keywords
health, nutrition, pregnancy, infant, child
Brief summary
This study is designed to evaluate the impact of team-based goals and performance-based incentives for community-based health workers on health-promoting behaviors among women related to reproductive, maternal, newborn and child health and nutrition in Bihar, India. The intervention was funded by the Bill and Melinda Gates Foundation (BMGF) and implemented from 2012 to 2014. Health sub-centers in the catchment areas of five blocks (sub-districts) of the district of Bengusarai were randomly assigned to treatment or control arms (38 sub-centers were assigned to each). Data were collected in the Intervention and Control areas from mothers of infants 0-12 months at baseline and at 2.5-year follow-up, to assess the intervention's effects on quality and quantity of FLW home visits, postnatal health behaviors, and among older infants/toddlers, complementary feeding and vaccination. Difference in difference analyses were used to assess outcome effects in this quasi experimental study. The TBGI intervention was implemented in areas where the BMGF-funded Ananya program (official title: Bihar Family Health Initiative) was also being implemented. Thus, the impact is of the \[TBGI intervention + Ananya\] versus \[Ananya alone\]. The Ananya program was developed and implemented via a partnership of BMGF and the Government of Bihar. The ultimate purpose of Ananya was to reduce maternal, newborn, and child mortality; fertility; and child undernutrition in Bihar, India. Ananya involved multi-level interventions designed to build front line health worker (FLW) capacities and reach to communities and households, as well as to strengthen public health facilities and quality of care to improve maternal and neonatal care and health behaviors, and thus survival. It was implemented from 2012 to 2014. Eight focal districts in western and central Bihar received Ananya, while 30 districts did not.
Interventions
BEHAVIORALTeam-Based Goals and Incentives
The intervention included 3 main components. 1) The intervention fostered a sense of team collective responsibility and solidarity (TEAM) by emphasizing the value of teamwork and front-line community health workers (FLWs) reciting a pledge at meetings to serve beneficiaries. 2) To establish goals and coverage targets related to maternal and child health outcomes (GOALs), 7 targets were identified related to delivery preparations, newborn care, exclusive breastfeeding, and family planning. 3) Small non-cash incentives were awarded to FLWs each quarter if their team met greater than 70% of the collective subcenter goals; incentives were most common cookware products (e.g., dish, cooking vessel, steamer). Non-cash incentives also included a certificate of recognition for teams that met their targets in all quarters (INCENTIVES). In the areas of the intervention and control arms, the Ananya program was also underway (see Brief Summary of the project).
OTHERControl Condition
Standard of care
Sponsors
Bill and Melinda Gates Foundation
Stanford University
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
15 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Mothers of infants 0-12 months residing in the catchment area of the subcenters (public health facilities)
Exclusion criteria
\-
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Child age 6-11 months old received DPT3 vaccination | 2.5 year follow-up | Assessed via self-report from representative sample of mothers of children aged 6-11 months. |
| At least 2 antenatal home visits in final trimester | Up to 2.5 years | Assessed via self-report from representative sample of mothers of children aged 0-11 months. |
| At least one home visit within 24 hours of delivery, among women who had a home delivery | 2.5 year follow-up | Assessed via self-report from representative sample of mothers of children aged 0-11 months. |
| At least one home visit within 1 week of delivery | 2.5 year follow-up | Assessed via self-report from representative sample of mothers of children aged 0-11 months. |
| Complementary feeding home visit for women with infant 6-11 months old | 2.5 year follow-up | Assessed via self-report from representative sample of mothers of children aged 0-11 months. |
| Postpartum family planning home visits | 2.5 year follow-up | Assessed via self-report from representative sample of mothers of children aged 0-11 months. |
| Obtained phone number for delivery (Frontline worker's (FLW) number, number for private vehicle, number for ambulance, any of the above) | 2.5 year follow-up | Assessed via self-report from representative sample of mothers of children aged 0-11 months. |
| Received 90 IFA tablets | 2.5 year follow-up | Assessed via self-report from representative sample of mothers of children aged 0-11 months. |
| Immediate breastfeeding (within 1 hour of delivery) | 2.5 year follow-up | Assessed via self-report from representative sample of mothers of children aged 0-11 months. |
| Nothing applied to the cord after cutting | 2.5 year follow-up | Assessed via self-report from representative sample of mothers of children aged 0-11 months. |
| Infant age 6-11 months old ate cereal-based meal in previous day | 2.5 year follow-up | Assessed via self-report from representative sample of mothers of children aged 6-11 months. |
| Current use of any modern method of contraception: | 2.5 year follow-up | Assessed via self-report from representative sample of mothers of children aged 0-11 months. |
Outcome results
None listed