Motivation Behind Community Work Done by ASHAs : A qualitative study in rural Bihar

Abstract

The Accredited Social Health Activist (ASHA) forms a crucial link between the community and the health services. The ASHA program was launched alongside the National Health Mission in 2005, and realises the decentralization of health services mandate of the mission. The ASHAs, who are volunteers, perform an array of functions which include maternal and child care, family planning services, immunization campaigns, surveys on diseases, creating awareness about good health and hygienic practices, home visits and counselling, etc. They receive monetary incentives for most of the tasks assigned to them. The contribution of ASHAs towards in reducing maternal mortality rate and infant mortality rate has been widely accepted. The challenges ASHAs face have been researched extensively by many, yet new women continue to join the program while the currently involved one continue to work. The current study tries to gauge the factors and expectations which motivate ASHAs in Patna, Bihar. Twelve in-depth interviews were conducted with ASHAs in Patna. During these interviews, a lot of experience shared by ASHAs reflected the gender norms of the society, and even at times accommodated and reinforced these norms. Motivation for becoming an ASHA appeared to be derived from encouragement by others, financial reasons, to gain knowledge and experience, hope of career advancement, to gain a sense of freedom and pride and from concern of others. Six key factors played a role in motivation of ASHAs to continue work. These included job satisfaction, availability of better alternates of employment, support demonstrated by each, the community and the family, concern for the success of the program and realization of the pre-hire expectations. It is the trade-off between these factors, and the significance of one factor over another for each ASHA, that determine whether she will continue in the program or not. If measures are taken by the government parallel to these factors of motivation, the performance of ASHAs will be better. The gendered dimension of the experience of ASHA is presented to be working at three levels; individual, community and the institution. Measures to make the policy around the program gender transformative would help the ASHAs.