TY - JOUR T1 - Can digitally enabling community health and nutrition workers improve services delivery to pregnant women and mothers of infants? Quasi-experimental evidence from a national-scale nutrition programme in India JF - BMJ Global Health JO - BMJ Global Health DO - 10.1136/bmjgh-2021-007298 VL - 6 IS - Suppl 5 SP - e007298 AU - Sumeet R Patil AU - Sneha Nimmagadda AU - Lakshmi Gopalakrishnan AU - Rasmi Avula AU - Sumati Bajaj AU - Nadia Diamond-Smith AU - Anshuman Paul AU - Lia Fernald AU - Purnima Menon AU - Dilys Walker Y1 - 2022/07/01 UR - http://gh.bmj.com/content/6/Suppl_5/e007298.abstract N2 - Background India’s 1.4 million community health and nutrition workers (CHNWs) serve 158 million beneficiaries under the Integrated Child Development Services (ICDS) programme. We assessed the impact of a data capture, decision support, and job-aid mobile app for the CHNWs on two primary outcomes—(1) timeliness of home visits and (2) appropriate counselling specific to the needs of pregnant women and mothers of children <12 months.Methods We used a quasi-experimental pair-matched controlled trial using repeated cross-sectional surveys to evaluate the intervention in Bihar and Madhya Pradesh (MP) separately using an intention-to-treat analysis. The study was powered to detect difference of 5–9 percentage points (pp) with type I error of 0.05 and type II error of 0.20 with endline sample of 6635 mothers of children <12 months and 2398 pregnant women from a panel of 841 villages.Results Among pregnant women and mothers of children <12 months, recall of counselling specific to the trimester of pregnancy or age of the child as per ICDS guidelines was higher in both MP (11.5pp (95% CI 7.0pp to 16.0pp)) and Bihar (8.0pp (95% CI 5.3pp to 10.7pp)). Significant differences were observed in the proportion of mothers of children <12 months receiving adequate number of home visits as per ICDS guidelines (MP 8.3pp (95% CI 4.1pp to 12.5pp), Bihar: 7.9pp (95% CI 4.1pp to 11.6pp)). Coverage of children receiving growth monitoring increased in Bihar (22pp (95% CI 0.18 to 0.25)), but not in MP. No effects were observed on infant and young child feeding practices.Conclusion The at-scale app integrated with ICDS improved provision of services under the purview of CHNWs but not those that depended on systemic factors, and was relatively more effective when baseline levels of services were low. Overall, digitally enabling CHNWs can complement but not substitute efforts for strengthening health systems and addressing structural barriers.Trial registration number ISRCTN83902145.Data are available on reasonable request. Anonymised data used in this study can be requested from the corresponding author. The authors also intend to make the data publicly available as per the funding agency’s policies and procedures at a later date. ER -