Background
Objective(s)
Methods
Study type
Study setting
Study sample
Study data collection
Study data analysis
Results
Quantitative findings
Profile | FHWs n = 288(%) | MHWs n = 61(%) |
---|---|---|
Age (in years) | 40.38 ± 7.65 | 36.25 ± 6.48 |
Education | ||
Up to secondary | 88 (30.6) | 0 |
Secondary/higher | 132 (45.8) | 13 (21.3) |
Graduate/above | 68 (23.6) | 48 (78.7) |
Professional experience (in years) | 8.29 ± 4.56 | 8.40 ± 3.78 |
Catering population | 3183 ± 2108 | 47,718 ± 66,966 |
Monthly income (INR) | 4098 ± 1190 | 28,662 ± 6914 |
Working hours per day | 4.49 ± 0.73 | 8.13 ± 0 .81 |
Training and knowledge on zoonoses
Factors | FHWs n = 288 (%) | MHWs n = 61 (%) | p-value |
---|---|---|---|
Awareness | |||
Awareness about National Rabies control Programme | 99 (34.4) | 45 (73.8) | 0.000* |
Awareness about the influenza vaccine? | 246 (85.4) | 54 (88.5) | 0.526 |
Awareness about anti-rabies vaccines | 287 (99.7) | 59 (96.7) | 0.024* |
Aware about at least one symptom of rabies | 226 (86.6) | 41 (67.2) | 0.060 |
Aware about at least one symptom of brucellosis | 3 (1.1) | 3 (4.9) | 0.034* |
Aware about at least one symptom of flu | 285 (98.9) | 60 (98.3) | 0.690 |
Practices | |||
Ever received zoonosis training | 229 (79.5) | 16 (26.2) | 0.000* |
Ever participated zoonosis campaigning | 194 (67.6) | 49 (80.3) | 0.049* |
What you do when you come across a case of a dog bite? | |||
Counsel for ARV | 43 (14.9) | 6 (9.8) | 0.298 |
Refer to UHC/ARC | 203 (70.5) | 29 (47.5) | 0.001* |
Inform to FHS/MO | 15 (5.2) | 0 | 0.068 |
What you do when you come across a case of flu-like symptoms? | |||
Give basic medicines | 117 (40.6) | 1 (1.6) | 0.000* |
Refer to UHC | 256 (88.9) | 47 (77) | 0.013* |
Inform to FHS/MO | 9 (3.1) | 3 (4.9) | 0.485 |
Multi-dimensional work of CHWs and prerequisites for OHAs
Factors | FHWs n = 288 (%) | MHWs n = 61 (%) | p-value |
---|---|---|---|
Training on coordinating roles | 208 (72.5) | 39 (63.9) | 0.182 |
Relation between staff members | 87 (30.4) | 22 (36.1) | 0.388 |
Knowledge and skills training | 235 (81.9) | 56 (91.8) | 0.057 |
Individuals’ social skills | 239 (83.6) | 53 (86.9) | 0.519 |
Trust with other actors/departments | 216 (75.3) | 54 (88.5) | 0.024* |
Specific objective | 234 (81.5) | 52 (85.2) | 0.491 |
Conflict resolution authority | 141 (49.3) | 20 (32.8) | 0.019* |
Institutional support | 279 (97.2) | 59 (96.7) | 0.835 |
Leadership skills | 252 (87.8) | 58 (95.1) | 0.098 |
Structured guidelines | 268 (93.4) | 60 (98.4) | 0.129 |
Level of the motivation of the CHWs
Constructs of motivation | FHWs (mean ± SD) | MHWs (mean ± SD) | p-value |
---|---|---|---|
General motivation | 2.1 ± 0.6 | 1.9 ± 0.5 | 0.099 |
Burnout | 2.5 ± 0.9 | 2.3 ± 1.2 | 0.045* |
Job satisfaction | 1.2 ± 0.3 | 1.1 ± 0.2 | 0.001* |
Intrinsic job satisfaction | 1.5 ± 0.5 | 1.5 ± 0.5 | 0.824 |
Organization commitment | 1.5 ± 0.5 | 1.4 ± 0.5 | 0.133 |
Conscientiousness and self-efficacy | 1.7 ± 0.6 | 1.5 ± 0.6 | 0.007* |
Timeliness | 1.8 ± 0.4 | 1.8 ± 0.4 | 0.954 |
Personal issues | 1.7 ± 0.6 | 1.8 ± 0.7 | 0.463 |
Overall motivation | 1.8 ± 0.2 | 1.6 ± 0.2 | 0.001* |
Qualitative findings
Individual level
“Our name is ‘ASHA’ (in the vernacular language it means Hope!), but we do not have any ‘ASHA’ (in the vernacular language it means also Expectations), they do not appreciate us, ASHA has no any appreciation” (FHWs-FGD-3)“The problem is we are not working for the malaria department only, right now I am working in the malaria department, but I may get transferred to some other department within a few months. Like I was working in the solid waste management department before current assignment” (MHWs-FGD-2)
Community level
“…..we feel proud that we are doing some good work, we feel good as they listen to us if we don’t go then they call us and tell that why we did not go there, even if we don’t go for a single day than also, they ask for us, they miss us!” (FHWs-FGD-1)“…..in field people still do not understand, they think we are a beggar and came for begging something, so they use to treat us like a beggar and say ‘aage jao’ means go to next door” (FHWs-FGD-2)“People do not cooperate with us! If we go for fogging in the morning, they ask to come in the afternoon, and when we go in their time, then the houses found to be locked and if we request to access to a rooftop or the water tank, they don’t allow us nor follow our any instructions” (MHWs-FGD-1)
Health system level
“We don’t have any fixed work schedule, they (superiors) give us diverse fieldwork if it is from the health department than ‘okay’, but it’s not like that. Today they tell to do this and next day anything else, everyday new work.” (FHWs-FGD-1)“Even though all ASHA workers are working more or less the same, but do not get equal incentives, someone has more population so earning more and someone has not that much population so not getting that much. Even if we work during an outbreak, it was free; we did not get any extra incentives for that.” (FHWs-FGD-3)“At present, we do not have fix pay, we people are doing work on incentive, we will get incentive according to completion of our task, the problem is if we have started any work and couldn’t complete it because of the patient side problem than we will not get the incentive for that. For an example of immunization, we have worked from the first dose of vaccination and in case if a patient would not ready to get measles dose or patient had migrated so, in that case, we would not get incentive even though we worked for rest all.” (FHWs-FGD-2)
Motivation for becoming OHAs
“We (ASHA) people were entered in reproductive child health care, that time we didn’t know anything, gradually family planning, vaccination, now non-communicable diseases, yoga many more we are expert, now you can send us anywhere, we can do everything” (FHWs-FGD-3)“Whether we get an incentive or not, but we always do all work for goodness of our area, all people do not think like that if incentive will be more than we will work more dedicatedly” (FHWs-FGD-2)“There should be a specific day for that, and it should be merged with your routine work so you can work in between and instead of two different reports it should go at one place so whoever wants to share about their field they can” (MHWs-FGD-1)“….first of all, we don’t have time. We already have our routine work which we have to finish as per the deadline” (MHWs-FGD-2)