ABSTRACT
Child health in India is one of the most lagging indicators of the country's development. Despite impressive reductions in neonatal, infant and child mortality, current levels of these indicators in rural parts of the country are still staggeringly high, often cresting above 80 deaths per 1,000 births, resulting in approximately 2.5 million deaths per year. There is a large body of research on how to reach the inaccessible, highly underdeveloped areas where these problems are at their most stark, and a consensus has been built around the use of local women to serve as village health workers (VHWs), implementing basic curative and preventative care, information campaigns and participatory discussion groups to cost-effectively prevent many of these deaths. The National Rural Health Mission (NRHM) drew on this research in designing its own village health worker scheme. In this scheme, an accredited social health activist (ASHA), the equivalent of a VHW, is placed in each of India's villages in an attempt to scale-up these methods to address a set of highly prevalent and highly preventable diseases causing child mortality. This chapter synthesizes relevant theoretical and empirical literature and draws on the author's own research evaluating short-run and long-run VHW-based child health interventions which implement similar methods to illustrate the mechanisms behind the program, summarize what we know to date about the efficacy of such programs and, finally, to point out the possible pitfalls the Indian government must avoid if it hopes to achieve the child mortality-related goals of the NRHM.
