Identification of Challenges and Needs to Improve Community Health Workers Performance: Narratives of Accredited Social Health Activists (ASHA) from Two Indian Districts

Abstract

Background: Community health workers (CHW) are recognized for their value in providing reproductive, maternal, and child health services at the community level. Although available research points to challenges that they face, discussion on how they perceive these challenges or what they need to improve their work experience is not extensive. 

Methods: We conducted a qualitative study of Accredited Social Health Activists’ (ASHAs) professional experiences. We interviewed 49 randomly selected ASHAs and their family members from two districts in India over a period of one month from 10 June to 12 July 2014. Inductive and deductive codes were applied to identify key themes. 

Results: Within the health system, ASHAs were given insufficient equipment and supplies, delayed payment of incentives, and inadequate training for the tasks required. ASHAs also faced disrespect and abuse from facility-based health staff. Within the community, ASHAs struggled with marginalized segments of the population who resisted their advice and guidance due to socio-cultural norms. ASHAs expressed a need for timely incentives, sufficient materials and trainings to perform their tasks, and greater support in reaching out to hard to educate populations. 

Conclusions: ASHAs face challenges from the health system and community, and their needs emanate from these two main areas. Support should be offered in such a way as to enhance their legitimacy within the health system and the community leading to improved effectiveness and performance.