Interplaying role of healthcare activist and homemaker: a mixed-methods exploration of the workload of community health workers (Accredited Social Health Activists) in India

Abstract

Background Globally, community health workers (CHWs) are integral contributors to many health systems. In India, Accredited Social Health Activists (ASHAs) have been deployed since 2005. Engaged in multiple health care activities, they are a key link between the health system and population. ASHAs are expected to participate in new health programmes prompting interest in their current workload from the perspective of the health system, community and their family. Methods This mixed-methods design study was conducted in rural and tribal Primary Health Centers (PHCs), in Pune district, Western Maharashtra, India. All ASHAs affiliated with these PHCs were invited to participate in the quantitative study, those agreeing to contribute in-depth interviews (IDI) were enrolled in an additional qualitative study. Key informants’ interviews were conducted with the Auxiliary Nurse Midwife (ANM), Block Facilitators (BFF) and Medical Officers (MO) of the same PHCs. Quantitative data were analysed using descriptive statistics. Qualitative data were analysed thematically. Results We recruited 67 ASHAs from the two PHCs. ASHAs worked up to 20 h/week in their village of residence, serving populations of approximately 800–1200, embracing an increasing range of activities, despite a workload that contributed to feelings of being rushed and tiredness. They juggled household work, other paid jobs and their ASHA activities. Practical problems with travel added to time involved, especially in tribal areas where transport is lacking. Their sense of benefiting the community coupled with respect and recognition gained in village brought happiness and job satisfaction. They were willing to take on new tasks. ASHAs perceived themselves as ‘voluntary community health workers’ rather than as ‘health activists”. Conclusions ASHAs were struggling to balance their significant ASHA work and domestic tasks. They were proud of their role as CHWs and willing to take on new activities. Strategies to recruit, train, skills enhancement, incentivise, and retain ASHAs, need to be prioritised. Evolving attitudes to the advantages/disadvantages of current voluntary status and role of ASHAs need to be understood and addressed if ASHAs are to be remain a key component in achieving universal health coverage in India.

Love, labor and loss on the frontlines: India’s community health workers straddle life and the COVID-19 pandemic

“…The second surge of COVID-19 brought catastrophic consequences in rural India, home to 800 million people, and exacted an immeasurable toll on over two million community health workers (CHWs) [ 1 - 3 ]. Misleadingly called ‘volunteers’, CHWs, who are usually women from communities they serve, support health promotion and prevention which form the backbone of rural primary health care [ 4 - 6 ]. Limited research has been conducted on understanding how the pandemic impacted the professional and personal experiences of CHWs in India during the pandemic.…”

Assessment of Workload of ASHAs: A Multi-stakeholder Perspective Study for Task-sharing and Task-shifting

“…Additionally, the study found that ASHAs’ time walking in the field has increased. Other studies have found similar outcomes, with ASHAs reporting that they walk for 8 hours to deliver MCH services (Kaur & Chand, 2020), and that travel takes up a lot of their personal time (Kawade et al, 2021). It was also found that the frequent and unexpected meetings took a lot of time and had an impact on their daily routine.…”

Knowledge Attitude and Practices of Mitanin's (Community Health Workers) in Chhattisgarh: Malaria Elimination Perspective

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