Barriers to the Delivery and Uptake of Water Sanitation and Hygiene (WASH) Promotion and Infant Diarrhea Prevention Services: A Case Study in Rural Tribal Banswara, Rajasthan

Abstract

Objective: We aimed to identify key barriers to Water, Sanitation and Hygiene (WASH) promotion and infant diarrhea prevention services delivered by Accredited Social Health Activists (ASHAs) in rural India. Methods: A case-study was conducted across nine tribal villages in Banswara district (Rajasthan), where in-depth observational and qualitative data was collected from frontline health workers and infant caregivers. Results: ASHAs' prioritization of their incentive-based link-worker tasks over their health activist roles, limited community mobilization, and lack of monitoring of such activities hindered the delivery of WASH promotion and infant diarrhea prevention services. Caregivers' lack of trust in ASHA's health knowledge and preference for private providers and traditional healers also hindered the uptake of ASHA's health promotion services. Conclusions:Strengthening ASHAs' health activism roles and building trust on frontline health workers' knowledge among tribal communities will be key to address the determinants of child malnutrition and stunting and accelerate progress towards the national development agenda.

A district-level geospatial analysis of the availability of improved water and sanitation among tribal households in India

“…Evidence on determinants and spatial clustering of WASH practices among the tribal households is limited, and the available literature is based either on a specific region or particular tribes or on a small sample size. Existing small-scale studies indicate higher levels of unimproved sanitation and drinking water among the tribal population due to remote locations, limited resources (Pradhan 2015;Saha et al 2020), and inadequate program outreach (Vila-Guilera et al 2022). Considering the large tribal population and their socio-cultural and geographical diversity, it is pertinent to assess their access to improved water and sanitation facilities from nationally representative data.…”