Abstract
BackgroundCommunity health workers (CHWs) are the mainstay of the public health system, serving for decades in low-resource countries. Their multi-dimensional work in various health care services, including the prevention of communicable diseases and health promotion of non-communicable diseases, makes CHWs, the frontline workers in their respective communities in India. As India is heading towards the development of One Health (OH), this study attempted to provide an insight into potential OH activists (OHA) at the community level. Thus, this case study in one of India’s western cities, Ahmedabad, targeted identifying OHA by exploring the feasibility and the motivation of CHWs in a local setting.MethodsThis case study explores two major CHWs, i.e., female (Accredited Social Health Activists/ASHA) health workers (FHWs) and male (multipurpose) health workers (MHWs), on their experience and motivation for becoming an OHA. The data were collected between September 2018 and August 2019 through a mixed design, i.e., quantitative data (cross-sectional structured questionnaire) followed by qualitative data (focus group discussion with a semi-structured interview guide).ResultsThe motivation of the CHWs for liaisoning as OHA was found to be low; however, the FHWs have a higher mean motivation score [40 (36–43)] as compared to MHWs [37 (35–40)] out of a maximum score of 92. Although most CHWs have received zoonoses training or contributed to zoonoses prevention campaigns, their awareness level was found to be different among male and female health workers. Comparing the female and male health workers to act as OHA, higher motivational score, multidisciplinary collaborative work experience, and way for incentive generation documented among the female health workers.ConclusionASHAs were willing to accept the additional new liaison role of OHAs if measures like financial incentives and improved recognition are provided. Although this study documented various systemic factors at the individual, community, and health system level, which might, directly and indirectly, impact the acceptance level to act as OHA, they need to be accounted for in the policy regime.
Highlights
Community health workers (CHWs) are the mainstay of the public health system, serving for decades in low-resource countries
Quantitative findings Out of the 349 CHWs sampled from two zones of the Ahmedabad city, 288 were FHWs, and 61 were male health workers (MHWs), with a mean age of 40.38 ± 7.65, 36.25 ± 6.48, respectively
As the FHWs are on incentivebased working models, their mean income in INR was 4098 ± 1190, whereas MHWs are on salary-based models with mean incomes of 28,662 ± 6914
Summary
Community health workers (CHWs) are the mainstay of the public health system, serving for decades in low-resource countries. Their multi-dimensional work in various health care services, including the prevention of communicable diseases and health promotion of non-communicable diseases, makes CHWs, the frontline workers in their respective communities in India. One among other strategies is to address this shortfall through “task-shifting”, i.e., allocation of tasks to actors at Yasobant et al Hum Resour Health (2021) 19:13 the lowest level who can perform them successfully [5, 6] In this context, the concept of using community health workers (CHWs) has gained acceptance again [7]. CHWs have been considered a valuable asset during outbreaks for social mobilization and the distribution of health information, improving health security and community-level resilience[13]
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