Midline Findings from the Evaluation of the Ananya Program in Bihar

We evaluate the impact of the Ananya program, a large maternal and child health program funded by the Bill & Melinda Gates foundation that was implemented in the state of Bihar, India, starting in late 2011. The program consisted of a package of interventions aimed at improving the frequency and nature of interactions between FLWs and their targeted beneficiaries: pregnant women and mothers of infants. The program interventions included support for a full mapping and enumeration of beneficiary households by FLWs, training for FLWs in maternal and child health topics and in how to effectively communicate health messages to beneficiaries, and the provision of job aid tools to facilitate more effective communication with beneficiaries. The study uses a comparison group design to estimate impacts by comparing changes in outcomes between late 2011 and late 2013 in the eight districts that received the interventions to the changes in the other 30 districts, which did not receive the interventions (a difference-in-differences approach). The treatment and comparison districts were remarkably similar when program implementation started and also had similar pre-program trends in many outcomes, suggesting that  this design is valid. We found that the Ananya program had positive and statistically significant impacts on the receipt of home visits from FLWs during pregnancy, although impacts on the receipt of home visits after delivery were not significant. Beyond the frequency of interactions, there were indications of substantial improvements in the receipt of advice from FLWs on several maternal and child health topics. There were also significant impacts on beneficiary health behaviors in some, but not all, of the health domains that we examined. These included impacts on some newborn care practices, complementary feeding practices, and the use of modern methods of contraception. The large magnitude of these impacts—especially relative to low baseline means—suggests that the program had a substantive impact on beneficiary health behaviors, even though not all domains were affected in the same way.