RETURN ON INVESTMENT OF ASHA WORKERS FOR MATERNAL AND NEONATAL SERVICES IN INDIA...
Author(s)
Haripriya R. Mohan, Masters1, Muhammed Rashid, PhD2, Christy Thomas, Phd3, Krishna Undela, PhD4.
1Student, NIPER Guwahati Assam, Guwahati, India, 2University of Utah, Salt Lake City, UT, USA, 3NIPER Guwahati Assam, Changsari, India, 4NIPER Guwahati Assam, Guwahati, India.
1Student, NIPER Guwahati Assam, Guwahati, India, 2University of Utah, Salt Lake City, UT, USA, 3NIPER Guwahati Assam, Changsari, India, 4NIPER Guwahati Assam, Guwahati, India.
OBJECTIVES: Accredited Social Health Activists (ASHAs) are the key foundation of India’s public health system, delivering frontline maternal health services in rural and underserved communities. While the effectiveness of maternal health interventions are evident, the return on investment (ROI) assessment remains limited. This study aimed to evaluate the ROI of ASHA-led maternal health interventions in India.
METHODS: A cost-savings-based ROI analysis was conducted using a structured framework. The analysis focused exclusively on maternal health services delivered by ASHA, including antenatal care support, promotion of institutional delivery, birth preparedness, referral coordination, and postnatal follow-up. Program costs included training, incentives, honoraria, supervision, travel, communication expenses and administrative overheads. Benefits were estimated as direct medical cost savings attributable to reductions in emergency visits, and hospitalisations from the preventable maternal complications. Maternal health service coverage, cost inputs and the effectiveness of intervention were sourced from national datasets and literature sources, which were further validated through consultations with public health staff. ROI was then calculated through ratio of estimated cost savings to total program expenditures.
RESULTS: The ASHA program covered approximately 3,680 maternal beneficiaries across 100 villages during the evaluation period. Total program implementation costs was estimated to be INR 880,852, with no cost-saving (INR -740095.85) after the intervention compared to no intervention. The analysis demonstrated a negative financial ROI (-0.84), with a net loss of INR 140756.15 (1407 per ASHA worker). Although ASHA-led interventions contributed to improved service utilisation and potential downstream health benefits, the direct cost savings were insufficient to fully offset program expenditures within the evaluated time horizon
CONCLUSIONS: The ASHA program improved service utilisation among maternal beneficiaries; however, direct cost savings were insufficient to offset implementation costs within the evaluated period. These findings should be interpreted with caution due to limited evidence, highlighting the need for further research with extended follow-up and stronger outcome data.
METHODS: A cost-savings-based ROI analysis was conducted using a structured framework. The analysis focused exclusively on maternal health services delivered by ASHA, including antenatal care support, promotion of institutional delivery, birth preparedness, referral coordination, and postnatal follow-up. Program costs included training, incentives, honoraria, supervision, travel, communication expenses and administrative overheads. Benefits were estimated as direct medical cost savings attributable to reductions in emergency visits, and hospitalisations from the preventable maternal complications. Maternal health service coverage, cost inputs and the effectiveness of intervention were sourced from national datasets and literature sources, which were further validated through consultations with public health staff. ROI was then calculated through ratio of estimated cost savings to total program expenditures.
RESULTS: The ASHA program covered approximately 3,680 maternal beneficiaries across 100 villages during the evaluation period. Total program implementation costs was estimated to be INR 880,852, with no cost-saving (INR -740095.85) after the intervention compared to no intervention. The analysis demonstrated a negative financial ROI (-0.84), with a net loss of INR 140756.15 (1407 per ASHA worker). Although ASHA-led interventions contributed to improved service utilisation and potential downstream health benefits, the direct cost savings were insufficient to fully offset program expenditures within the evaluated time horizon
CONCLUSIONS: The ASHA program improved service utilisation among maternal beneficiaries; however, direct cost savings were insufficient to offset implementation costs within the evaluated period. These findings should be interpreted with caution due to limited evidence, highlighting the need for further research with extended follow-up and stronger outcome data.
Conference/Value in Health Info
2026-09, ISPOR Asia Pacific 2026, Bangkok, Thailand
Value in Health, Volume 55, Issue S1
Code
EE77
Topic
Economic Evaluation
Disease
No Additional Disease & Conditions/Specialized Treatment Areas