Knowledge and practice of Accredited Social Health Activists for maternal healthcare delivery in Delhi

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Abstract

Introduction:

The role of community health workers in healthcare delivery system is considered inevitable to meet the goal of universal healthcare provision. The study was planned to assess the knowledge and practices for maternal health care delivery among Accredited Social Health Activist (ASHA) workers in North-East district of Delhi, India.

Materials and Methods:

A descriptive cross-sectional study was conducted in North-East district of Delhi among 55 ASHA workers after taking written informed consent. Data were collected using a pretested semi-structured questionnaire consisted of items on sociodemographic profile of ASHA workers, knowledge, and practices about maternal health. The data was analyzed by using SPSS software version 17. Qualitative data were expressed in percentages and quantitative data were expressed in mean ± standard deviation (SD).

Results:

Mean age (±SD) of ASHAs was 31.84 ± 7.2 years. Most of the ASHAs workers were aware of their role in provision of maternal health services. Most of the ASHAs workers were aware of their work of bringing mothers for antenatal check-up (94.5%), counseling for family planning (96.4%), and accompanying them for hospital for delivery (89.1%). 87% of ASHAs knew that iron tablets have to be taken for minimum 100 days during pregnancy. 51 (92.7%) ASHAs reported that they used to maintain antenatal register. Some problems reported by ASHAs while working in community were shortage of staff at health center (16.4%), no transportation facility available (14.5%), no money for emergency, and opposition from local dais (12.7% each).

Conclusion:

Present study showed that ASHAs knowledge is good but their practices are poor due to number of problems faced by them which need to be addressed through skill based training in terms of good communication and problem solving. Monitoring should be made an integral part of ASHA working in the field to ensure that knowledge is converted into practices as well.

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Most cited references 16

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Community health workers: integral members of the health care work force.

A Witmer, S Seifer, L Finocchio … (1995)

As the US health care system strives to function efficiently, encourage preventive and primary care, improve quality, and overcome nonfinancial barriers to care, the potential exists for community health workers to further these goals. Community health workers can increase access to care and facilitate appropriate use of health resources by providing outreach and cultural linkages between communities and delivery systems; reduce costs by providing health education, screening, detection, and basic emergency care; and improve quality by contributing to patient-provider communication, continuity of care, and consumer protection. Information sharing, program support, program evaluation, and continuing education are needed to expand the use of community health workers and better integrate them into the health care delivery system.

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Assessing community health workers’ performance motivation: a mixed-methods approach on India's Accredited Social Health Activists (ASHA) programme

Saji Gopalan, Satyanarayan Mohanty, Ashis Das (2012)

Objective This study examined the performance motivation of community health workers (CHWs) and its determinants on India's Accredited Social Health Activist (ASHA) programme. Design Cross-sectional study employing mixed-methods approach involved survey and focus group discussions. Setting The state of Orissa. Participants 386 CHWs representing 10% of the total CHWs in the chosen districts and from settings selected through a multi-stage stratified sampling. Primary and secondary outcome measures The level of performance motivation among the CHWs, its determinants and their current status as per the perceptions of the CHWs. Results The level of performance motivation was the highest for the individual and the community level factors (mean score 5.94–4.06), while the health system factors scored the least (2.70–3.279). Those ASHAs who felt having more community and system-level recognition also had higher levels of earning as CHWs (p=0.040, 95% CI 0.06 to 0.12), a sense of social responsibility (p=0.0005, 95% CI 0.12 to 0.25) and a feeling of self-efficacy (p=0.000, 95% CI 0.38 to 0.54) on their responsibilities. There was no association established between their level of dissatisfaction on the incentives (p=0.385) and the extent of motivation. The inadequate healthcare delivery status and certain working modalities reduced their motivation. Gender mainstreaming in the community health approach, especially on the demand-side and community participation were the positive externalities of the CHW programme. Conclusions The CHW programme could motivate and empower local lay women on community health largely. The desire to gain social recognition, a sense of social responsibility and self-efficacy motivated them to perform. The healthcare delivery system improvements might further motivate and enable them to gain the community trust. The CHW management needs amendments to ensure adequate supportive supervision, skill and knowledge enhancement and enabling working modalities.

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Factors affecting the performance of community health workers in India: a multi-stakeholder perspective

Reetu Sharma, Premila Webster, Sanghita Bhattacharyya (2014)

Background Community health workers (CHWs) form a vital link between the community and the health department in several countries. In India, since 2005 this role is largely being played by Accredited Social Health Activists (ASHAs), who are village-level female workers. Though ASHAs primarily work for the health department, in a model being tested in Rajasthan they support two government departments. Focusing on the ASHA in this new role as a link worker between two departments, this paper examines factors associated with her work performance from a multi-stakeholder perspective. Design The study was done in 16 villages from two administrative blocks of Udaipur district in Rajasthan. The findings are based on 63 in-depth interviews with ASHAs, their co-workers and representatives from the two departments. The interviews were conducted using interview guides. An inductive approach with open coding was used for manual data analysis. Results This study shows that an ASHA's motivation and performance are affected by a variety of factors that emerge from the complex context in which she works. These include various personal (e.g. education), professional (e.g. training, job security), and organisational (e.g. infrastructure) factors along with others that emerge from external work environment. The participants suggested various ways to address these challenges. Conclusion In order to improve the performance of ASHAs, apart from taking corrective actions at the professional and organisational front on a priority basis, it is equally essential to promote cordial work relationships amongst ASHAs and other community-level workers from the two departments. This will also have a positive impact on community health.

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Author and article information

Journal

Journal ID (nlm-ta): J Family Med Prim Care

Journal ID (iso-abbrev): J Family Med Prim Care

Journal ID (publisher-id): JFMPC

Title: Journal of Family Medicine and Primary Care

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 2249-4863

ISSN (Electronic): 2278-7135

Publication date (Print): Jul-Sep 2015

Volume: 4

Issue: 3

Pages: 359-363

Affiliations

[1 ] Department of Community Medicine, Maulana Azad Medical College, New Delhi, India

Author notes

Address for correspondence: Dr. Charu Kohli, Department of Community Medicine, Maulana Azad Medical College, New Delhi - 110 002, India. E-mail: kohlicdoc17s@ 123456gmail.com

Article

Publisher ID: JFMPC-4-359

DOI: 10.4103/2249-4863.161317

PMC ID: 4535095

PubMed ID: 26288774

SO-VID: 7cb2a2ab-c363-4bde-acb1-0bacb382449b

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Knowledge and practice of Accredited Social Health Activists for maternal healthcare delivery in Delhi

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Most cited references 16

Community health workers: integral members of the health care work force.

Assessing community health workers’ performance motivation: a mixed-methods approach on India's Accredited Social Health Activists (ASHA) programme

Factors affecting the performance of community health workers in India: a multi-stakeholder perspective

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