The Mixed Nature of Incentives for Community Health Workers: Lessons from a Qualitative Study in Two Districts in India

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:  Enisha Sarin,^1,* Sarah Smith Lunsford,² Ankur Sooden,¹ Sanjay Rai,¹ and Nigel Livesley¹

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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India's PornHub 2015 Use Review

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Treatment Seeking Behavior of Inhalant Using Street Children: Are We Prepared to Meet Their Treatment Needs

Context:

There is a lack of evidence for help and treatment seeking behavior of street children using inhalants.

Aims:

The present study was planned to provide a comprehensive understanding on the patterns, correlates of inhalant use and treatment seeking behavior of street children from Delhi, India.

Material and Methods:

Participants were a purposive sample of 100 inhalant using street children below 18 years identified with the assistance of five community service organizations/nongovernmental organization working with street children in the city of Delhi. Information on a semi-structured questionnaire with items pertaining to the demographic and drug use parameters was collected by trained research staff in a one-to-one in field setting.

Statistical Analysis:

All data were entered into SPSS 12.0, data quality checks performed and examined.

Results:

The sample had an average age of 12.8 ± 2.4 years (range 4-17 years), 96.5% reported regular past month and 87.0% past 24 h use of inhalants. The mean age of onset of inhalant use was 9.3 ± 2.8 years The substances most commonly reported were toluene from eraser fluid (by 83.0%), glues (34.0%) and petroleum products (3.0%); mean frequency of use was 9.8 times in a day. Of the sample, 18% used inhalants when they were alone, and the rest reported using with drug using network friends; 76% reported tolerance and mild withdrawal symptoms such as restlessness, anxiety, craving, irritability and lethargy. A variety of problems and perceived benefits due to inhalant use were reported; 46% inhalant users had never abstained from its use, and 77% reported never having sought any medical help.

Conclusions:

Study findings provide a better contemporary understanding of inhalant abuse among Delhi street children. This information can assist in the formulation of a needs-based intervention for the inhalant using street children.

Table 1

Drugs used by street children (n = 100)

Table 2

Pattern of inhalant use

  

Table 3

Perceived benefits and problems experienced due to inhalant use

Table 4

Treatment seeking behavior

Full article at:  http://goo.gl/yCkGRx

By:   Anju Dhawan, Anita Chopra,1 Atul Ambekar,1 and Rajat Ray1

Department of Psychiatry, AIIMS, New Delhi, India

¹National Drug Dependence Treatment Centre, AIIMS, New Delhi, India

Address for correspondence: Prof. Anju Dhawan Department of Psychiatry, National Drug Dependence Treatment Centre, AIIMS, Ansari Nagar, New Delhi, India. E-mail: moc.liamtoh@hdujna

 

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Factors Associated with the Likelihood of Further Movement among Mobile Female Sex Workers in India: A Multinomial Logit Approach

Female sex workers (FSWs) are vulnerable to HIV infection. Their socioeconomic and behavioural vulnerabilities are crucial push factors for movement for sex work. 

This paper assesses the factors associated with the likelihood of movement of sex workers from their current place of work. Data were derived from a cross-sectional survey conducted among 5498 mobile FSWs in 22 districts of high in-migration across four states in southern India. 

A multinomial logit model was constructed to predict the likelihood of FSWs moving from their current place of work. Ten per cent of the sampled mobile FSWs were planning to move from their current place of sex work. Educational attainment, marital status, income at current place of work, debt, sexual coercion, experience of violence and having tested for HIV and collected the results were found to be significant predictors of the likelihood of movement from the current place of work. 

Consistent condom use with different clients was significantly low among those planning to move. Likewise, the likelihood of movement was significantly higher among those who had any STI symptom in the last six months and those who had a high self-perceived risk of HIV. 

The findings highlight the need to address factors associated with movement among mobile FSWs as part of HIV prevention and access to care interventions.

Full article at: http://goo.gl/xndgpk

By: Suryawanshi D1, Sharma V1, Saggurti N2, Bharat S1.

• 1*School of Health Systems Studies,Tata Institute of Social Sciences,Mumbai,India.
• 2†HIV and AIDS Program,Population Council,New Delhi,India.

  

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Factors Affecting Drug Use During Incarceration: A Cross-Sectional Study of Opioid-Dependent Persons from India

Substance abuse and criminality share a complex relationship. The rates of substance use among the prisoners, and that of criminal acts among substance users in community setting are high. Data from South Asian countries, including from India are inadequate. This study aimed to assess the pattern of criminal acts among opioid-dependent subjects and their substance use pattern in the month before, during and after imprisonment.

Using a cross-sectional study design and purposive sampling, opioid-dependent subjects (n=101) attending two community drug treatment clinics who have had any contact with the law were assessed using a specifically-designed tool to record criminal acts and substance use before, during and after last imprisonment.

Most subjects (93%) had committed illegal acts in their lifetime. Physical assault was the most common illegal act, while 23% reported selling drugs and 9% reported committing serious crimes. About 95% were arrested and 92% had spent time in police lockups. About 29% were arrested for drugs possession or drug use, and 3% of injecting drug users arrested for carrying injection equipment. About 85% had been imprisoned at least once, of whom 88% used psychoactive substances in the 1-month period before their last imprisonment. Opioids were the most common substances used daily (68%), followed by cannabis (34%) and alcohol (22%). Ninety-seven percent reported the availability of substances in prisons, and 65% also used substances during their last imprisonment. Cannabis (35%) was the most common substances used in prison followed by opioids (19%). Seventy-six percent used substances soon after prison release, and 13% of opioid users experienced opioid overdose soon after prison release. Use of cannabis, injecting drugs, and opioid use before imprisonment were predictors of substance use in prison.

Opioid-dependent people have various contacts with the law, including imprisonment. Many users are dependent on substances during prison-entry, which is an important reason for their continued substance use in prisons. There is a need to provide substance abuse treatment across all stages of criminal justice system.

Purchase full article at: http://goo.gl/o98udX

By: Rao R1, Mandal P2, Gupta R2, Ramshankar P2, Mishra A3, Ambekar A3, Jhanjee S3, Dhawan A3

• 1National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India. Electronic address: drrvrao@gmail.com.
• 2Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
• 3National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India.  

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Three Sides of a Coin in the Life of People Living with HIV (PLWH)

Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) is a global epidemic, a major challenge as a health care problem of modern times. As the survival of life increases from the time of an HIV-positive diagnosis, growing concern for the quality of the life has been extended.

To assess and correlate the coping, social support and quality of life.

A descriptive cross-sectional study was conducted at antiretroviral therapy (ART) clinic of AIIMS, New Delhi. The sample comprised people living with HIV/AIDS (PLWHA) who were seropositive for last six months. The tools used to assess the coping, social support and quality of life were BREF COPE, MOS social support survey and WHO QOL-HIV BREF, respectively. Permission was taken from the authors of the tools. The ethical permission was taken from the center. The coping, social support and quality of life were assessed and their association was observed. Data were analyzed using SPSS 17.

The most commonly used coping styles were acceptance and religion. The social support used by most of PLWHA was tangible support and affectionate support, while the least used support was positive social interaction. The lowest quality of life is seen in social relations, followed by physical quality of life. There was positive association seen between coping and quality of life as well as social support and quality of life.

There was positive association between coping, social support and quality of life.

Below:  Showing baseline coping strategies adopted by PLWH

Below:  Bar graph showing domains of QOL of PLWH HIV/AIDS

Below: Association of baseline QOL with the Social Support of PLWH

Full article at: http://goo.gl/VxF2ge

By: Deepika Cecil Khakha,1 Bimla Kapoor,2 Manju,1 and Singh K Sharma3

²Former Director and Professor, Indira Gandhi Open University, New Delhi, India

³

1Lecturer, College of Nursing, All India Institute of Medicine Sciences (AIIMS), New Delhi, India

2Former Director and Professor, Indira Gandhi Open University, New Delhi, India

3Prof. and Head Department of Medicine, All India Institute of Medical Sciences, New Delhi, India

1Lecturer, College of Nursing, All India Institute of Medicine Sciences (AIIMS), New Delhi, India

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