An assessment of bicycle intervention to improve service delivery by accredited social health activists in selected blocks of West Champaran district of Bihar

Background: Several programmatic and logistic issues affect the overall performance of Accredited Social Health Activists (ASHAs). Bihar Government provided bicycles to ASHAs in West Champaran district for increasing coverage of services by improving their mobility. Objective: To assess the use of bicycles by ASHAs and it's effect on service delivery. It also captures the perspectives of ASHAs in terms of its utilization for performing tasks. Methods: A community-based quasi-experimental study was undertaken during March-May 2016. Proportion of newborn babies visited within 24 h of birth was the primary outcome. Data were collected from two intervention blocks (West Champaran district) and a control block from the neighboring East Champaran district. A total of 323 (177 from intervention blocks and 146 from control block) mothers having children <3 years of age and who had delivered at home were interviewed. Besides, 88 ASHAs working in intervention blocks were also interviewed. Results: Significantly higher proportion of mothers and newborn babies (44%) received postnatal care within 24 h of delivery in intervention blocks as compared to the control block (16%, P < 0.001). Nearly 73.1% of ASHAs were using the bicycle themselves. ASHAs were twice more likely to visit a newborn on the day of delivery if she was provided with mobility support. However, the likelihood of continuing visits after the 1st day was not statistically significant. Conclusion: The intervention demonstrated the potential of ASHAs to improve their functioning at the grass-root level. The scale-up of bicycle intervention should be supplemented with reforms in financial incentives disbursement and better system support