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Abstract
BackgroundCommunity Health Workers (CHWs) are critical to providing healthcare services in countries such as India which face a severe shortage of skilled healthcare personnel especially in rural areas. The aim of this study is to understand the work flow of CHWs in a rural Community Mental Health Project (CMHP) in India and identify inefficiencies which impede their service delivery. This will aid in formulating a targeted policy approach, improving efficiency and supporting appropriate work allocation as the roles and responsibilities of the CHWs evolve.MethodsA continuous observation Time Motion study was conducted on Community Health Workers selected through purposive sampling. The CHWs were observed for the duration of an entire working day (9 am- 3 pm) for 5 days each, staggered during a period of 1 month. The 14 different activities performed by the CHWs were identified and the time duration was recorded. Activities were then classified as value added, non-value added but necessary and non-value-added to determine their time allocation.ResultsHome visits occupied the CHWs for the maximum number of hours followed by Documentation, and Traveling. Documentation, Administrative work and Review of work process are the non-value-added but necessary activities which consumed a significant proportion of their time. The CHWs spent approximately 40% of their time on value added, 58.5% of their time on non-value added but necessary and 1.5% of their time on non-value added activities. The CHWs worked for 0.7 h beyond the stipulated time daily.ConclusionThe CHW’s are “dedicated” mental health workers as opposed to being “generalists” and their activities involve a significant investment of their time due to the specialized nature of the services offered such as counselling, screening and home visits. The CHWs are stretched beyond their standard work hours. Non-value added but necessary activities consumed a significant proportion of their time at the expense of value-added activities. Work flow redesign and implementation of Health Management Information Systems (HMIS) can mitigate inefficiencies.
Highlights
Community Health Workers (CHWs) are critical to providing healthcare services in countries such as India which face a severe shortage of skilled healthcare personnel especially in rural areas
* Correspondence: vijaya.s@ifmr.ac.in 1IFMR Graduate School of Business, KREA University, 5655, Central Expressway, Sri City, Andhra Pradesh 517646, India Full list of author information is available at the end of the article. Countries such as India, Brazil, Nepal and Bangladesh are attempting to bridge this gap and facilitate health care delivery with cadres of workers known as Community Health Workers (CHWs) [4, 5]
Program activities The workload analysis is for the current population size being served by the CHWs
Summary
Community Health Workers (CHWs) are critical to providing healthcare services in countries such as India which face a severe shortage of skilled healthcare personnel especially in rural areas. Imbalances in the availability of skilled personnel and inequalities within the distribution of a country’s health work force contribute to the deficit, with fewer health care providers attending to rural areas as compared to urban areas [1,2,3]. Countries such as India, Brazil, Nepal and Bangladesh are attempting to bridge this gap and facilitate health care delivery with cadres of workers known as Community Health Workers (CHWs) [4, 5]. The CHWs are generally incentivized volunteers who are imparted limited formal training and work in communities to enable the extension of health systems and services to resource constrained and low access areas [6, 7].
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