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Selection process of community health workers: A qualitative study from a multi-stakeholder perspective in Rajasthan, India

Author: 
Reetu Sharma, Premila Webster and Sanghita Bhattacharyya,
Subject Area: 
Health Sciences
Abstract: 

Background: Community Health Workers (CHWs) form a vital link between community and the health system. In India, this role is played by Accredited Social Health Activists (ASHAs)-village level female workers. Studies indicate that CHWs, if selected in consultation with community and in a transparent way, can lead to better acceptability of CHWs in community, better performance of CHWs and expected outcomes of the programme. Aim: This study looks at the selection process of the ASH As and its effects on the working relationship with her co- workers. Methods: The study was done in 16 villages from two administrative blocks of Udaipur district of Rajasthan. Study area was selected using multistage purposive sampling. It is based on 48 in-depth interviews with ASHA’s co-workers and the health system representatives. Data was collected using interview guides and manually analysed following an inductive approach. Results: The study showed non-consultative selection of ASHAs. It showed favoritism rather than competency based selection of ASHAs. Such selection not only affected ASHA’s attitude, behavior and work performance but also caused strained relationships and unhealthy work environment between ASHAs and her co-workers. Study participants suggested strict adherence to ASHA’s selection criteria by a joint village level committee that has representation of all stakeholders associated with ASHA's work. Conclusion: Unbiased, competency based, consultative selection of ASHA is essential to promote her good performance as well as create enabling work environment to jointly address community health issues.

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