Abstract
PurposeThis study aimed to analyze the role of community health workers (CHWs) called accredited social health activists (ASHAs) in improving maternal health outcomes in the rural community of Punjab, India. The study also examined the expectations of these workers from the community and identified the problems faced by them in carrying out their roles.Design/methodology/approachUsing multistage sampling, a total of 28 villages were selected from seven districts of Punjab, and from these selected villages, a total of 57 ASHAs working as the interface between the rural community and the public health system and 420 women who had delivered a baby were interviewed.FindingsDesire to earn money was the most prominent reason for joining the community work program, but ASHAs felt overburdened and underpaid compared to their work commitments. Not only was the incentive paid to these workers was insufficient and irregular but they also suffered at the hands of medical staff at public hospitals.Originality/valueWhile exploring the problems experienced by the CHWs, this study recommends opting for a mix of monetary and nonmonetary incentives for acknowledging the work of CHWs. The study is the first of its kind for the state of Punjab battling with a worsening maternal mortality rate (MMR).
Highlights
Using community health workers (CHWs) for rendering basic health services and filling in the gaps created by the shortage of human resources, in low-income settings, is not a novel phenomenon
Two blocks from each district and two villages from each block were randomly selected in the second and third stages. From these 28 villages, a total of 57 accredited social health activists (ASHAs) who were working as an interface Community between the health system and these communities were willing to participate in the study, health workers and 420 ever-married women (15 from each village) who had delivered in one year preceding the date of the survey were questioned
The minimum incentive reported by an ASHA worker in the study was US$ 16.05, and the maximum incentive reported was US$ 80.25
Summary
Using community health workers (CHWs) for rendering basic health services and filling in the gaps created by the shortage of human resources, in low-income settings, is not a novel phenomenon. As defined in the report of a World Health Organization (WHO) Study Group, CHWs “should be members of the community where they work, should be selected by the communities, should be answerable to the communities for their activities, should be supported by health system but not necessarily a part of its organization and have shorter training than professional workers” [1]. The full terms of this licence may be seen at http://creativecommons.org/licences/by/4.0/ legalcodea
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