The Benefits of a Universal Home-Based Neonatal Care Package in Rural India: An Extended Cost-Effectiveness Analysis

Authors: Ashvin Ashok, Arindam Nandi, Ramanan Laxminarayan


Each year, 27 percent of the world’s neonatal deaths―748,000—occur in India. This chapter examines the health and economic benefits and government cost associated with scaling up a publicly financed home-based neonatal care (HBNC) package in rural India, by considering two intervention scenarios against a baseline of no HBNC: (1) the scaling up of access to HBNC through the current network of accredited social health activists (ASHA)—a group of community health workers (CHWs) that covers 60.1 percent of India’s villages (or roughly 54 percent of the rural population)—to those not presently receiving care, which would increase coverage from 39.8 percent of rural newborns to 72 percent who would have access to care either through the HBNC package or their existing home- or facility-based care; and (2) the provision of a near-universal setting in which access to HBNC—through expansion of the network of CHWs—is extended to 83.4 percent of those not presently receiving care, which would give 90 percent of rural newborns access.


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