Developing a Field Intervention for Disbursement of Incentives to Accredited Social Health Activists (ASHAs) Targeted at Improving Motivation and Effort
Background
India’s National Health Mission (NHM) engages close to one million women Accredited Social Health Activists (ASHAs) as community health workers. ASHAs play an important role in creating health awareness, mobilizing local community participation in public health planning, and increasing the utilization of existing health services.
Although ASHAs are considered volunteers, they receive performance-based incentives for various health related activities and outcomes. Prior research in various contexts of health care delivery has provided mixed evidence on whether such incentives have a positive impact on healthcare utilization and outcomes. In addition, existing studies have largely assumed away the practical complexity of incentive structures and the procedural delays in their disbursements.
About the Study
In our study we focus on how, owing to the uncertainties surrounding performance-based incentives, ASHAs often find it difficult to fully comprehend the effort-reward link, thereby reducing their motivation and effort. Implementation of first-best solutions such as simplifying the incentive structure and reducing payment delays is challenging due to the scale of the program and complexity of the administrative decision-making processes. Hence, we propose to develop an intervention aimed at introducing transparency in the disbursement of ASHAs’ incentives (e.g., sharing an updated list of unpaid incentives along with the corresponding list of services rendered and an estimate of the time by when they will receive it), thereby enhancing their satisfaction, motivation and performance.
Thus, our research objectives are two-fold:
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Understanding the critical factors that might undermine the efficacy of performance-based incentives in the context of ASHAs’ complex work and pay environment,
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Developing a field intervention related to the incentive disbursement process- targeted at improving ASHAs’ work motivation and effort
Methodology
The study used:
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One-on-one semi-structured interviews with ASHAs and other staff employed in the public health delivery system
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4 Focus Group Discussions
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Field observations (such as shadowing ASHAs, visiting immunization sites etc. We aim to design this intervention by employing both qualitative and quantitative research methods.
Outcome
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The relationship between activist mindset and financial incentives remains unclear
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There is evidence of complexity in ASHAs’ work environment, primarily arising due to the mixed nature of financial incentives, their multiplex relationships with supervisors and their role within the community as a change agent
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Community and co-workers can play a pivotal role in ASHA motivation