Research Article: Cost and cost-effectiveness of health behavior change interventions implemented with self-help groups in Bihar, India

Date Published: March 28, 2019

Publisher: Public Library of Science

Author(s): S. Chandrashekar, S. Saha, B. Varghese, L. Mohan, G. Shetty, A. Porwal, A. Hazra, S. Mondal, R. Das, Eileen Stillwaggon.


Health interventions implemented with self-help groups (SHGs) enhance the relevance and acceptability of the health services. The Parivartan program was implemented in eight districts of Bihar with women’s self-help groups to increase adoption of maternal and newborn health behaviors through layering health behavior change communication. This study estimates the cost and cost-effectiveness of a health behavior change program with SHGs in Bihar.

Cost analysis was conducted from a provider’s perspective. All costs have been presented in US dollars for the purpose of international comparisons and converted to constant values. The effectiveness estimate was based on the reported changes in select newborn care practices. A decision model approach was used to estimate the potential number of neonatal deaths averted based on adoption of key newborn care practices. Using India’s life expectancy of 65 years, cost per life year saved was calculated. A one-way sensitivity analysis was conducted using the upper and lower estimates for various variables in the model, and functionality of SHGs.

The cost of forming an SHG group was US$254 and that of reaching a woman within the group was US$19. The unit cost for delivering health interventions through the Parivartan program was US$148 per group and US$11 per woman reached. During an 18 months period, Parivartan program reached around 17,120 SHGs and an estimated 20,544 pregnant women resulting in an estimated prevention of 23 neonatal deaths at a cost of US$3,825 per life year saved.

SHGs can be an effective platform to increase uptake of women’s health interventions and follow-up care, and also to broaden their utility beyond microfinance, particularly when they operate at a larger scale.

Partial Text

Self-help groups (SHGs) are informal groups of 10–20 individuals, mostly women and usually from the same village, formed with the objective of promoting collective savings. In recent years, there have been experiments and other efforts to engage SHGs to increase access to health services and to build bridges between the formal health systems and the communities to which they belong. It is argued that health interventions implemented through SHGs can enhance the uptake of health services.

Health interventions through Parivartan program at US$ 3,825 per life-year saved is within three times India’s per capita GDP of US$ 1,581. There are many social and health benefits of the intervention. A major limitation of this analysis and model is that it does not take into account all the health benefits of this intervention to both the mother and the newborn. We believe this intervention merits attention. The findings need to be contextualized keeping in view that this program was implemented as an innovation in the basket of high-intensity, high-input demonstration pilots, and was restricted to working with only about 224,287 women.




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