Compiled by Meghendra Banerjee, Resource Person and Deeksha Sharma, Research Associate :Recognizing the need for a resident village health facilitator, the National Rural Health Mission (NRHM) created the Accredited Social Health Activist (ASHA) position, one of the most visible interventions of the programme.
Members found the query looking at ways to motivate ASHAs under NRHM pertinent, noting that sustaining the motivational levels of ASHAs and resolving probable demotivating factors is important for the success of NRHM.
Respondents explained that the motivating factors for any worker include clarity of job expectations; alignment between individual and organizational goals; availability of the necessary things to perform the job; perception of ability to perform required work; opportunity to use talent; and recognition of good work. They also highlighted that work motivation differs for every individual.
Elaborating on the unique motivational factors for ASHAs, members stressed financial remuneration is one of the key motivating factors, since it is the source for her livelihood. Respondents felt that the concept of ASHAs, serving as a “link-worker” to motivate women to utilize healthcare facilities is good; however, they argued against incentive-based remuneration for ASHA’s effort in marketing health services.
To address this concern, some members suggested the government consider offering a small honorarium with incentives, to keep up motivation levels. At the same time, others noted the dismal experience in terms of accountability with salary based healthcare providers, and felt performance-based payment (not incentives) for ASHAs would ensure delivery of health services and would prove a good initiative. The mechanism and amount of payment to ASHA is still evolving and thus, respondents suggested several ways to make the incentives substantial enough to sustain the motivation, such as:
· Increase in the amount of assigned incentives
· Introduce a wider range of services, for which the ASHA is eligible to receive an “incentive”
· Ensure timely and transparent payment of incentives by routing the money through local NGOs and/or Village Health Committees
Along with discussing financial factor, members mentioned other motivating factors for ASHA, like community recognition and having a supportive system to back their efforts. To ensure an enabling environment to keep up motivation levels requires a number of things: 1) adherence to eligibility criteria for selection; 2) clear performance criteria; 3) quality training for enhancement of knowledge and skills; 4) feedback on performance; 5) supportive supervision and mentoring; 6) regular and adequate supply of medical and non-medical commodities; and 7) rewards for good performance.
Sharing their experience identifying motivating factors for ASHAs, discussants cited a study from Uttar Pradesh, which reported clear job expectations, availability of necessary resources, and the opportunity to use talents along with recognition of good work as key motivating factors for health workers. Another national level review of evidence suggested supportive supervision, improving the quality of training with adequate follow-up with field-level mentoring and support, developing gender-sensitive human resource policies, and capacity building to decentralize primary health services as priority areas to improve performance of frontline service providers. Members also cited an experience from Uttarakhand, where multiple strategies were used to motivate ASHAs, such as supporting their work and improving their incomes. Additionally, in a Delhi project, operational and institutional arrangements helped ensure the motivation of link volunteers.
Finally, discussants highlighted additional areas of actions to sustain motivation levels of ASHAs, including:
· Improving, substantially the health system, (i.e. PHC and CHC) and making staff more responsive to peoples’ needs
· Enabling ASHA to offer basic curative care to communities by providing them appropriate kits, adequate budgetary provisions and opportunities for repeated basic training
· Improving the attitude and interaction between ASHAs and existing field workers in the health system (e.g. ANM, AWW, etc.)
· Offering an award for the best performing ASHA at the district level
In conclusion, members agreed that ensuring other motivating factors i.e. community recognition and a supportive system to back their efforts is equally important to providing adequate financial incentives and suggested various ways to keep up the motivation level of ASHA under NRHM.
sir , i pursuing my MASTER OF PUBLIC HEALTH, i hv also done my BSc & MSc in microbiology… i want to work as programme coordinator so plz suggest thanku
sir i have done ma bed. i want job a sasha supervisor .plz tell me where i applied.
Sir/mam
i want to say that i am wanted to work in your asha supervisor .i have done B.A,B.Ed,M.A,MSW(PRE)COURSE IN HIV/AIDS,deploma in population &and development .i have 5 years of working in ngo sector .i wanted to work as a asha co-ordinator
thanking you
chanderveer singh
ph-9413959077