Deepti Bettampadi1, Matthew L Boulton2, Laura E Power2, David W Hutton3. 1. Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA. Electronic address: bdeepti@umich.edu. 2. Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA; Department of Internal Medicine, Division of Infectious Diseases, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA. 3. Department of Health Management and Policy, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
Abstract
INTRODUCTION: Accredited Social Health Activists (ASHAs) are female community health workers whose primary role is to promote utilization of primary healthcare services and improve sanitation in rural areas and are financially incentivized for services provided. Prior studies evaluating ASHAs have been largely qualitative, and assess their knowledge, skills, and practice. Globally, there have been very few studies that have quantitatively assessed community health workers. We analyzed the cost effectiveness of ASHAs in facilitating measles vaccination among children under 5 years during 2012-2013. METHODS: We utilized Markov modeling simulating a cohort of children in villages with and without ASHAs. We extrapolated the health states to a lifetime of 68 years to estimate the effects of ASHA intervention. Measles vaccination rates were obtained from 2013 District Level Household and Facilities Survey 4. Other parameter estimates were obtained from a review of relevant literature. RESULTS: ASHA intervention was highly cost effective at $162 per DALY averted compared to no ASHA and remained cost effective with the ASHA incentive increased from $2 to $15, across the range of probabilities and cost parameters. Analyses were sensitive to probability of death due to childhood pneumonia, susceptibility to measles after one dose measles vaccine, and probability of pneumonia after measles infection. CONCLUSION: ASHAs were cost-effective under a wide range of scenarios even when a single health outcome such as measles vaccination was considered. The Government of India and individual state governments of India should consider increasing the incentives provided to ASHAs.
INTRODUCTION: Accredited Social Health Activists (ASHAs) are female community health workers whose primary role is to promote utilization of primary healthcare services and improve sanitation in rural areas and are financially incentivized for services provided. Prior studies evaluating ASHAs have been largely qualitative, and assess their knowledge, skills, and practice. Globally, there have been very few studies that have quantitatively assessed community health workers. We analyzed the cost effectiveness of ASHAs in facilitating measles vaccination among children under 5 years during 2012-2013. METHODS: We utilized Markov modeling simulating a cohort of children in villages with and without ASHAs. We extrapolated the health states to a lifetime of 68 years to estimate the effects of ASHA intervention. Measles vaccination rates were obtained from 2013 District Level Household and Facilities Survey 4. Other parameter estimates were obtained from a review of relevant literature. RESULTS: ASHA intervention was highly cost effective at $162 per DALY averted compared to no ASHA and remained cost effective with the ASHA incentive increased from $2 to $15, across the range of probabilities and cost parameters. Analyses were sensitive to probability of death due to childhood pneumonia, susceptibility to measles after one dose measles vaccine, and probability of pneumonia after measles infection. CONCLUSION: ASHAs were cost-effective under a wide range of scenarios even when a single health outcome such as measles vaccination was considered. The Government of India and individual state governments of India should consider increasing the incentives provided to ASHAs.
Keywords:
ASHA; Accredited social health activists; Community health workers; Cost effectiveness; India; Measles; Sustainable development goals; Vaccine
Authors: Patrick Wightman; Kelly McCue; Samantha Sabo; Rebecca Annorbah; Dulce Jiménez; Vern Pilling; Matthew Butler; Martín F Celaya; Sara Rumann Journal: BMC Public Health Date: 2022-10-04 Impact factor: 4.135