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Health and economic benefits of scaling up a home-based neonatal care package in rural India: a modelling analysis

Health and economic benefits of scaling up a home-based neonatal care package in rural India: a modelling analysis

The Question

Among rural Indian households who currently do not have access to (or those who do not access) neonatal care, what are the health and economic benefits of scaling up access to a package of home-based newborn care (HBNC) delivered by community health workers? What are the distributional consequences of the scale-up across income groups and states, and what are the associated government costs?

What we found

Using, IndiaSim, an agent-based microsimulation model, we evaluated two different interventions for scaling up the HBNC: in the first, the existing network of community health workers in rural areas (with 60.1% coverage) would provide HBNC to households without current access to home- or facility-based newborn care. In the second, we examine increased coverage to the point where each state reached 90% coverage of neonatal care, by HNBC or other care.
 
We estimated that the first intervention would be effective in preventing 48 incident cases of severe neonatal ailments and 5 related deaths per 1000 live births in rural areas. The second intervention was even more effective, with estimates of 57 incident cases and 6 related deaths averted.  We also found that the interventions would save $4411 and $5024 respectively in out-of-pocket treatment costs, and provide $285 and $340 in incremental value of insurance per 1000 live births. The outcomes are highly progressive, with greater benefits for lower income groups and poorer states. 

Why it matters

Approximately 900 000 newborn children die every year in India, accounting for 28% of neonatal deaths globally. Preterm births, low birth weight and infections are responsible for two-thirds of the neonatal deaths in India. These conditions can often be prevented or treated with proper postnatal care, but only 44.5% of Indian newborns receive a health examination within their first day. Therefore, HBNC can potentially bring tremendous health and economic benefits.