What do community health workers want? Findings of a discrete choice experiment among Accredited Social Health Activists (ASHAs) in India
Introduction A number of factors contribute to the performance and motivation of India’s Accredited Social Health Activists (ASHAs). This study aims to identify the key motivational factors (and their relative importance) that may help retain ASHAs in service.Methods A discrete choice experiment (DC...
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BMJ Publishing Group
2019-06-01
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| Series: | BMJ Global Health |
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| author | Blake Angell Rohina Joshi Kirsten Howard Martin Howell Marwa Abdel-All |
| author_facet | Blake Angell Rohina Joshi Kirsten Howard Martin Howell Marwa Abdel-All |
| author_sort | Blake Angell |
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| description | Introduction A number of factors contribute to the performance and motivation of India’s Accredited Social Health Activists (ASHAs). This study aims to identify the key motivational factors (and their relative importance) that may help retain ASHAs in service.Methods A discrete choice experiment (DCE) survey presented ASHAs with eight unlabelled choice sets, each describing two hypothetical jobs that varied based on five attributes, specifically salary, workload, travel allowance, supervision and other job benefits. Multinomial logit and latent class (LC) models were used to estimate stated preferences for the attributes.Result We invited 318 ASHAs from 53 primary health centres of Guntur, a district in south India. The DCE was completed by 299 ASHAs using Android tablets. ASHAs were found to exhibit a strong preference for jobs that incorporated training leading to promotion, a fixed salary and free family healthcare. ASHAs were willing to sacrifice 2530 Indian rupee (INR) from their monthly salary, for a job offering training leading to promotion opportunity and 879 INR for a free family health-check. However, there was significant heterogeneity in preferences across the respondents. The LC model identified three distinct groups (comprising 51%, 35% and 13% of our cohort, respectively). Group 1 and 2 preferences were dominated by the training and salary attributes with group 2 having higher preference for free family health-check while group 3 preferences were dominated by workload. Relative to group 3, ASHAs in groups 1 and 2 were more likely to have a higher level of education and less likely to be the main income earners for their families.Conclusion ASHAs are motivated by both non-financial and financial factors and there is significant heterogeneity between workers. Policy decisions aimed at overcoming workforce attrition should target those areas that are most valued by ASHAs to maximise the value of investments into these workers.Trial registration number CTRI/2018/03/012425. |
| format | Article |
| id | doaj-art-0123f7163ecb4de4b41ecf75cee5ac78 |
| institution | Kabale University |
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| language | English |
| publishDate | 2019-06-01 |
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| spelling | doaj-art-0123f7163ecb4de4b41ecf75cee5ac782024-12-15T11:00:09ZengBMJ Publishing GroupBMJ Global Health2059-79082019-06-014310.1136/bmjgh-2019-001509What do community health workers want? Findings of a discrete choice experiment among Accredited Social Health Activists (ASHAs) in IndiaBlake Angell0Rohina Joshi1Kirsten Howard2Martin Howell3Marwa Abdel-All4The George Institute for Global Health, Sydney, New South Wales, AustraliaThe George Institute for Global Health India, New Delhi, IndiaSchool of Public Health, The University of Sydney, Sydney, New South Wales, AustraliaSydney School of Public Health, The University of Sydney, Sydney, New South Wales, AustraliaSydney Medical School, University of Sydney, Sydney, New South Wales, AustraliaIntroduction A number of factors contribute to the performance and motivation of India’s Accredited Social Health Activists (ASHAs). This study aims to identify the key motivational factors (and their relative importance) that may help retain ASHAs in service.Methods A discrete choice experiment (DCE) survey presented ASHAs with eight unlabelled choice sets, each describing two hypothetical jobs that varied based on five attributes, specifically salary, workload, travel allowance, supervision and other job benefits. Multinomial logit and latent class (LC) models were used to estimate stated preferences for the attributes.Result We invited 318 ASHAs from 53 primary health centres of Guntur, a district in south India. The DCE was completed by 299 ASHAs using Android tablets. ASHAs were found to exhibit a strong preference for jobs that incorporated training leading to promotion, a fixed salary and free family healthcare. ASHAs were willing to sacrifice 2530 Indian rupee (INR) from their monthly salary, for a job offering training leading to promotion opportunity and 879 INR for a free family health-check. However, there was significant heterogeneity in preferences across the respondents. The LC model identified three distinct groups (comprising 51%, 35% and 13% of our cohort, respectively). Group 1 and 2 preferences were dominated by the training and salary attributes with group 2 having higher preference for free family health-check while group 3 preferences were dominated by workload. Relative to group 3, ASHAs in groups 1 and 2 were more likely to have a higher level of education and less likely to be the main income earners for their families.Conclusion ASHAs are motivated by both non-financial and financial factors and there is significant heterogeneity between workers. Policy decisions aimed at overcoming workforce attrition should target those areas that are most valued by ASHAs to maximise the value of investments into these workers.Trial registration number CTRI/2018/03/012425.https://gh.bmj.com/content/4/3/e001509.full |
| spellingShingle | Blake Angell Rohina Joshi Kirsten Howard Martin Howell Marwa Abdel-All What do community health workers want? Findings of a discrete choice experiment among Accredited Social Health Activists (ASHAs) in India BMJ Global Health |
| title | What do community health workers want? Findings of a discrete choice experiment among Accredited Social Health Activists (ASHAs) in India |
| title_full | What do community health workers want? Findings of a discrete choice experiment among Accredited Social Health Activists (ASHAs) in India |
| title_fullStr | What do community health workers want? Findings of a discrete choice experiment among Accredited Social Health Activists (ASHAs) in India |
| title_full_unstemmed | What do community health workers want? Findings of a discrete choice experiment among Accredited Social Health Activists (ASHAs) in India |
| title_short | What do community health workers want? Findings of a discrete choice experiment among Accredited Social Health Activists (ASHAs) in India |
| title_sort | what do community health workers want findings of a discrete choice experiment among accredited social health activists ashas in india |
| url | https://gh.bmj.com/content/4/3/e001509.full |
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