Motivating and demotivating factors for community health workers: A qualitative study in urban slums of Delhi, India

George, Mathew Sunil; Pant, Shradha; Devasenapathy, Niveditha; Ghosh-Jerath, Suparna; Zodpey, Sanjay

doi:10.4103/2224-3151.206170

Cited by 31 publications

(71 citation statements)

References 2 publications

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“…Measures like nancial incentives, structured reporting patterns, assignment of clear roles and responsibilities, have to be introduced before for CHWs to accept the role of OHAs. Evidence indicates the importance of social recognition [43,44] and fair monetary incentives [34,45] for FHWs, which was also re ected in both the quantitative and qualitative ndings of this study. A multi-stakeholder perspective study on the work performance of ASHAs by Sharma et al [46] documented professional factors such as training and job security strengthening that would improve their performance, which was also documented in the health system level qualitative ndings of this study.…”

Section: Discussionsupporting

confidence: 72%

Who could be One Health Activist at the community level?: A case for India

Yasobant

Bruchhausen

Saxena

et al. 2020

Preprint

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Background: Community Health Workers (CHWs) are the mainstay of the public health system, serving for decades in low resource countries. Their multi-dimensional work in diverse health care services, including the prevention of communicable diseases and health promotion for non-communicable diseases, are making 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 the western cities of India, Ahmedabad, targeted to identify OHA by exploring the motivation to become an OHA in a local setting.Methods: This case study explores two major CHWs i.e. female (Accredited Social Health Activists-ASHA) and male (multipurpose male health worker) on their motivation for becoming an OHA. The data was collected between September 2018 and August 2019 through a mixed design i.e. quantitative data (cross-sectional structured questionnaire) and qualitative data (focus group discussion with a semi-structured interview guide). Results: The motivation of the CHWs for OHA was found to be low. 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. ASHAs were found to be willing to accept the additional new liaison role of OHAs if measures like financial incentives and improved recognition are provided. Conclusion: The high demotivation of CHWs that has been documented on the individual, community, and health system level needs to be urgently addressed in future policies.

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Section: Discussionsupporting

confidence: 72%

Who could be One Health Activist at the community level?: A case for India

Yasobant

Bruchhausen

Saxena

et al. 2020

Preprint

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“…22,24 The many problems experienced by CHWs because of their position at the bottom of the health system hierarchy, and because of the unequal gender power relations between the generally female CHWs and other health cadres and society, have been well documented, 23 including in India. 19,20,28,29 These issues are important and are material to our study context too -they need to be systematically and thoroughly addressed at the policy-practice level. Our study however sheds light on a hitherto under-reported aspect of being a CHW.…”

Section: Discussionmentioning

confidence: 99%

Community Health Workers as Influential Health System Actors and not "Just Another Pair Of Hands"

Kane

Radkar

Gadgil

et al. 2020

Int J Health Policy Manag

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Background: Over the last 20 years, community health workers (CHWs) have become a mainstay of human resources for health in many low- and middle-income countries (LMICs). A large body of research chronicles CHWs’ experience of their work. In this study we focus on 2 narratives that stand out in the literature. The first is the idea that social, economic and health system contexts intersect to undermine CHWs’ experience of their work, and that a key factor underpinning this experience is that LMIC health systems tend to view CHWs as just an ‘extra pair of hands’ to be called upon to provide ‘technical fixes.’ In this study we show the dynamic and evolving nature of CHW programmes and CHW identities and the need, therefore, for new understandings. Methods: A qualitative case study was carried out of the Indian CHW program (CHWs are called accredited social health activists: ASHAs). It aimed to answer the research question: How do ASHAs experience being CHWs, and what shapes their experience and performance? In depth interviews were conducted with 32 purposively selected ASHAs and key informants. Analysis was focused on interpreting and on developing analytical accounts of ASHAs’ experiences of being CHWs; it was iterative and occurred throughout the research. Interviews were transcribed verbatim and transcripts were analysed using a framework approach (with Nvivo 11). Results: CHWs resent being treated as just another pair of hands at the beck and call of formal health workers. The experience of being a CHW is evolving, and many are accumulating substantial social capital over time – emerging as influential social actors in the communities they serve. CHWs are covertly and overtly acting to subvert the structural forces that undermine their performance and work experience. Conclusion: CHWs have the potential to be influential actors in the communities they serve and in frontline health services. Health systems and health researchers need to be cognizant of and consciously engage with this emerging global social dynamic around CHWs. Such an approach can help guide the development of optimal strategies to support CHWs to fulfil their role in achieving health and social development goals.

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“…Globally, the lack of recognition of CHWs in MoH programmes has been cited as a challenge (20,40,41,45,46). Increased recognition is seen as potentially improving lay health worker performance (43).…”

Section: Recommendationsmentioning

confidence: 99%

“They have been neglected for a long time”: a qualitative study on the role and recognition of Rural Health Motivators in the Shiselweni region, Eswatini

Walker

Burtscher

Myeni³

et al. 2020

Preprint

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Background: Community health workers (CHWs) are increasingly engaged to address human resource shortages and fill primary healthcare gaps. In Eswatini, a cadre of CHWs called Rural Health Motivators (RHM) was introduced in 1976 to respond to key public health challenges. However, the emergence of health needs, particularly HIV/TB, has been met with inadequate programme amendments; and the role of RHMs has become marginalised following the addition of other CHWs supported by non-governmental organisations. This study was implemented to understand the role of RHMs in decentralised HIV/TB activities. In this paper, we explore the findings in relation to the recognition of RHMs and the programme. Methods : This exploratory qualitative study utilised individual in-depth interviews, group and focus group discussions, participatory methods (utilising a game format) and observations. Participants were purposively selected and comprised RHM programme implementers, community stakeholders, and local and non-governmental personnel. Data collection took place between August and September 2019. Interviews were conducted in English or siSwati and transcribed. SiSwati interviews were translated directly into English. All interviews were audio recorded, manually coded and thematically analysed. Data was validated through methodical triangulation. Results: Suboptimal organisational structure and support, primarily insufficient training and supervision for activities were factors identified through interviews and observation activities. Significant confusion of the RHM role was observed, with community expectations beyond formally endorsed tasks. Community participants expressed dissatisfaction with receiving health information only, preferring physical assistance in the form of goods. Additionally, gender emerged as a significant influencing factor on the acceptability of health messages and the engagement of RHMs with community members. Expectations and structurally limiting factors shape the extent to which RHMs are recognised as integral to the health system, at all social and organisational levels. Conclusions: Findings highlight the lack of recognition of RHMs and the programme at both community and national level. This, along with historical neglect, has hindered the capacity of RHMs to successfully contribute to positive health outcomes for rural communities. Renewed attention and support mechanisms for this cadre are needed. Clarification of the RHM role in line with current health challenges and clearer role parameters is essential.

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Motivating and demotivating factors for community health workers: A qualitative study in urban slums of Delhi, India

Cited by 31 publications

References 2 publications

Who could be One Health Activist at the community level?: A case for India

Who could be One Health Activist at the community level?: A case for India

Community Health Workers as Influential Health System Actors and not "Just Another Pair Of Hands"

“They have been neglected for a long time”: a qualitative study on the role and recognition of Rural Health Motivators in the Shiselweni region, Eswatini

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