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 nearly one million ASHAs (Accredited Social Health Activists) as community health workers. They promote health awareness, mobilize community participation, and improve access to public health services. Though considered volunteers, ASHAs receive performance-based incentives. However, evidence on the effectiveness of such incentives is mixed, and studies often overlook the complexity and delays in disbursement.
About the Study
Our study explores how unclear and delayed incentives weaken ASHAs’ understanding of the effort-reward link, reducing motivation. Simplifying incentives and speeding up payments is difficult due to scale and administrative challenges. We propose an intervention to improve transparency by sharing details of unpaid incentives, services rendered and expected payment timelines to boost satisfaction and performance.
Thus, our research objectives are two-fold:
- Understanding the critical factors that might undermine the efficacy of performance-based incentives in the context of ASHAs’ complex work and pay environment.
- Developing a field intervention related to the incentive disbursement process- targeted at improving ASHAs’ work motivation and effort.
Methodology
The study used:
- One-on-one semi-structured interviews with ASHAs and other staff employed in the public health delivery system.
- 4 Focus Group Discussions.
- 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
- The relationship between activist mindset and financial incentives remains unclear.
- 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.
- Community and co-workers can play a pivotal role in ASHA motivation.