Measuring and understanding motivation among community health workers in rural health facilities in India-a mixed method study

Summary There have been limited attempts at measurement of health system performance at decentralized levels in low‐ and middle‐income countries. This study was undertaken to develop a composite indicator to measure health system performance at district level in India. Primary data were collected from 377 public health facilities in 21 districts of Haryana state in India using health facility surveys. In addition, 1700 health care providers and 800 clients visiting health facilities were interviewed. Routine health management information system data at district and state level were also analyzed. These data were used for computing 67 input and process indicators covering six health system building blocks. Indicators were normalized and aggregated to generate domain‐specific and overall composite health system performance index (HSPI) for each district. Several sensitivity analyses were performed to assess robustness of results. Overall, Panchkula and Ambala districts were found to be the best performing in the state (with HSPI scores of 0.64 and 0.62 out of 1), while Mewat, Faridabad, and Palwal districts had the poorest performance (with HSPI scores of 0.46, 0.49, and 0.48 out of 1). Significant variation in performance was observed for each health system building block. Sensitivity analyses results showed that study findings were robust to variations in methods of aggregation of indicators. Our study provides a framework and methods to measure health system performance at district level in a comprehensive manner. The composite indicator provides a summary snapshot to benchmark performance, while building block and domain scores provide critical information for programmatic action.

Section: Discussionmentioning

confidence: 99%

Comprehensive measurement of health system performance at district level in India: Generation of a composite index

Sharma

Prinja

Aggarwal

2019

“…1 There is a shortage of health workers especially in developing countries including Bhutan, and task shifting to village health workers (VHWs) is one way to address the human resource shortages. 2,3 However, VHWs leaving the health systems are increasing in Bhutan. 4 The problem is not limited to that but also to growing concern about the motivation and retention of the VHWs in the health system.…”

Section: Discussionmentioning

confidence: 99%

“…16 At the family level, the shortage of manpower to look after the family and household chores 15 and having to shoulder other family responsibilities hampered them from continuing to work as VHW. 17,18 In addition, the lack of support from the spouse and other family members, 15,19 conflict with family time, 17,18 and difficulties with work-related travel 16,20 were identified as problems.…”

Section: Discussionmentioning

confidence: 99%

“…23 The study identified that there was a lack of clear selection criteria. 20 Besides not involving VHWs during planning, 17 it was also found that poor support and supervision from the organization discouraged them. 3,25 Having to spend their own money on the official work such as transportation costs and the phone call without compensation 23 and irregular allowances and salary were stated discouraging.…”

Section: Discussionmentioning

confidence: 99%

“…20 Besides not involving VHWs during planning, 17 it was also found that poor support and supervision from the organization discouraged them. 3,25 Having to spend their own money on the official work such as transportation costs and the phone call without compensation 23 and irregular allowances and salary were stated discouraging. 18 It was also mentioned that VHWs were not acknowledged or recognized by the organization for the work they did and were not fully supported after the initial training was over.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Identifying and confirming demotivating factors for village health workers in rural communities of Bhutan

Tshering¹,

Tejativaddhana

Siripornpibul³

et al. 2018

Background: Bhutan achieved over 95% of health coverage through its primary health care network and geared towards achieving and ensuring Universal Health Coverage. About 62.2% of the Bhutanese people are rural dwellers, living in villages. Village health workers (VHWs) are essential for primary health care delivery at the community level in order to bridge the gap between the health care system and the communities. However, increasing numbers of VHWs leaving the health care system remain a challenge for Bhutan. This study intends to find existing problems of motivation and retention among VHWs in Bhutan and to devise appropriate strategies for making effective policy interventions.Methods: This quantitative study with a cross-sectional survey design aims to determine demotivating factors.One stage cluster sampling technique was applied for VHWs from 12 districts in three regions. Data were collected by the trained enumerators using a pre-tested semi-structured questionnaire.Results: The Confirmatory factor analysis identified and confirmed a four-factor model of demotivation among VHWs in Bhutan. Among the four factors, the social factor was the main factor for VHWs leaving the health care system. However, the holistic combination of both financial and non-financial motivator needs to be taken into consideration. The content analysis revealed six areas of

Internal migrants' experiences with and perceptions of frontline health workers: A nationwide study in 13 Indian cities

Babu

Sharma

Kusuma

et al. 2018

The role of frontline health workers is crucial in strengthening primary health care in India. This paper reports on the extent of services provided by frontline health workers in migrants' experiences and perceptions of these services in 13 Indian cities. Cluster random sampling was used to sample 51 055 households for a quantitative survey through interviewer-administered questionnaires. Information was sought on the receipt of health workers' services for general health care overall (from the head/other adult member of the household) and maternal and immunization services in particular (from mothers of children <2 years old). Purposively, 240 key informants and 290 recently delivered mothers were selected for qualitative interviews. Only 31% of the total respondents were aware of the visits of frontline health workers, and 20% of households reported visits to their locality during past month. In 4 cities, approximately 90% of households never saw health workers in their locality. Only 20% of women and 22% of children received antenatal care and vaccination cards from frontline health workers. Qualitative data confirm that the frontline health workers' visits were not regular and that health workers limited their services to antenatal care and childhood immunization. It was further noted that health workers saw the migrants as"outsiders." These findings warrant developing migrant-specific health-care services that consider their vulnerability and living conditions. The present study has implications for India's National Urban Health Mission, which envisions addressing the health care needs of the urban population with a focus on the urban poor.