Incentives play an important
role in motivating community health workers (CHWs). In India, accredited social
health activists (ASHAs) are female CHWs who provide a range of services,
including those specific to reproductive, maternal, neonatal, child, and
adolescent health.
Qualitative interviews were conducted with 49 ASHAs and one
of their family members (husband, mother-in-law, sister-in-law, or son) from
Gurdaspur and Mewat districts to explore the role of family, community, and
health system in supporting ASHAs in their work. Thematic analysis revealed
that incentives were both empowering and a source of distress for ASHAs and
their families. Earning income and contributing to the household’s financial
wellbeing inspired a sense of financial independence and self-confidence for
ASHAs, especially with respect to relations with their husbands and
parents-in-law.
In spite of the empowering effects of the incentives, they were
a cause of distress. Low incentive rates relative to the level of effort
required to complete ASHA responsibilities, compounded by irregular and
incomplete payment, put pressure on families. ASHAs dedicated much of their
time and own resources to perform their duties, drawing them away from their
household responsibilities. Communication around incentives from supervisors
may have led ASHAs to prioritize and promote those services that yielded higher
incentives, as opposed to focusing on the most appropriate services for the
client. ASHAs and their families maintained hope that their positions would
eventually bring in a regular salary, which contributed to retention of ASHAs.
Incentives, therefore, are both motivating and inspiring as well as a cause
dissatisfaction among ASHAs and their families. Recommendations include
revising the incentive scheme to be responsive to the time and effort required
to complete tasks and the out-of-pocket costs incurred while working as an
ASHA; improve communication to ASHAs on incentives and responsibilities; and
ensure timely and complete payment of incentives to ASHAs.
The findings from
this study contribute to the existing literature on incentivized CHW programs
and help throw added light on the role incentives play in family dynamics which
affects performance of CHW.
Full article at: http://goo.gl/wyuobV
By:
1University Research Co., LLC, New Delhi,
India
2EnCompass LLC, Bethesda, MD, USA
Edited by: Chikaikeo Ogbonna, University of Jos, Nigeria
Reviewed by: Luret Albert Lar, University of Jos, Nigeria;
Emmanuel Nwabueze Aguwa, University of Nigeria Nsukka, Nigeria; Afolaranmi
Olumide Tolulope, University of Jos, Nigeria
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