title: 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
  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.
authors.affiliation: School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India; shankarprinja@gmail.com.
authors.forename: Shankar
authors.initials: S
authors.lastname: Prinja
authors.affiliation: School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Ruby
authors.initials: R
authors.lastname: Nimesh
authors.affiliation: School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Aditi
authors.initials: A
authors.lastname: Gupta
authors.affiliation: School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Bahuguna
authors.affiliation: School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Jarnail Singh
authors.initials: JS
authors.lastname: Thakur
authors.affiliation: School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Madhu
authors.initials: M
authors.lastname: Gupta
authors.affiliation: School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Tarundeep
authors.initials: T
authors.lastname: Singh
mesh_terms: D002662:Child Health Services / Q000191:economics / Q000706:statistics & numerical data*; D003150:Community Health Workers; D003362:Cost-Benefit Analysis; D003376:Counseling; D003906:Developing Countries; D005260:Female; D006801:Humans; D007194:India; D007223:Infant; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000191:economics / Q000706:statistics & numerical data*; D063731:Mobile Applications / Q000191:economics*; D015233:Models, Statistical; D011247:Pregnancy; D011295:Prenatal Care; D057216:Propensity Score; D019057:Quality-Adjusted Life Years; D019035:Rural Health Services / Q000191:economics* / Q000706:statistics & numerical data; D017216:Telemedicine / Q000191:economics*
keywords: community health worker; cost-effectiveness analysis; health services research; impact assessment; m-health; maternal and child health