Analyzing the challenges and demotivating factors faced by accredited social health activist workers in tribal India in implementing their roles

Abstract

Background: The accredited social health activist (ASHA) is a link between community and health systems, so her services are very crucial for attainting universal health coverage. Comprehensive understanding of the demotivating factors, affecting the work efficacy of ASHA workers in the tribal areas, will not only help us in framing new ideas for providing them a positive work environment but also in retaining these health providers in their current job and increase their productivity and efficiency. Objectives: The study aims to find out the challenges and demotivating factors that ASHA workers face while implementing their responsibilities in tribal areas and frame recommendations based on study findings. Materials and Methods: An observational cross-sectional study conducted in a tribal area falling within the scope of a primary health care (PHC) center affiliated to a medical college. A semi-structured interview schedule was utilized to interview trained ASHA workers to understand the practical in-field challenges while implementing duties. Results: About 63% of ASHA workers were satisfied working in the tribal area. However, the major causes of de-motivation were community resistance (71.7%), less/irregular incentives (69.5%), transportation problems (52.2%), workload and stress (56.5%), and lack of training (23.9%). Family support and cooperation by auxiliary nurse midwife/multipurpose worker and other health-care staff in referral units were satisfactory for ASHAs in tribal areas. Conclusion: Most of the ASHA workers of the tribal area were satisfied with their job responsibilities, but timely activity-based incentives for the ASHA workers and regularity in their monthly salary and more community awareness about ASHA can motivate ASHA workers and increase their efficiency in providing PHC.