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Factors influencing the performance of community health workers: A qualitative study of Anganwadi Workers from Bihar, India

Globally, there remain significant knowledge and evidence gaps around how to support Community Health Worker (CHW) programmes to achieve high coverage and quality of interventions. India’s Integrated Child Development Services scheme employs the largest CHW cadre in the world—Anganwadi Workers (AWWs...

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Autores principales: John, Aparna, Nisbett, Nicholas, Barnett, Inka, Avula, Rasmi, Menon, Purnima
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7688170/
https://www.ncbi.nlm.nih.gov/pubmed/33237939
http://dx.doi.org/10.1371/journal.pone.0242460
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author John, Aparna
Nisbett, Nicholas
Barnett, Inka
Avula, Rasmi
Menon, Purnima
author_facet John, Aparna
Nisbett, Nicholas
Barnett, Inka
Avula, Rasmi
Menon, Purnima
author_sort John, Aparna
collection PubMed
description Globally, there remain significant knowledge and evidence gaps around how to support Community Health Worker (CHW) programmes to achieve high coverage and quality of interventions. India’s Integrated Child Development Services scheme employs the largest CHW cadre in the world—Anganwadi Workers (AWWs). However, factors influencing the performance of these workers remain under researched. Lessons from it have potential to impact on other large scale global CHW programmes. A qualitative study of AWWs in the Indian state of Bihar was conducted to identify key drivers of performance in 2015. In-depth interviews were conducted with 30 AWWs; data was analysed using both inductive and deductive thematic analysis. The study adapted and contextualised existing frameworks on CHW performance, finding that factors affecting performance occur at the individual, community, programme and organisational levels, including factors not previously identified in the literature. Individual factors include initial financial motives and family support; programme factors include beneficiaries’ and AWWs’ service preferences and work environment; community factors include caste dynamics and community and seasonal migration; and organisational factors include corruption. The initial motives of the worker (the need to retain a job for family financial needs) and community expectations (for product-oriented services) ensure continued efforts even when her motivation is low. The main constraints to performance remain factors outside of her control, including limited availability of programme resources and challenging relationships shaped by caste dynamics, seasonal migration, and corruption. Programme efforts to improve performance (such as incentives, working conditions and supportive management) need to consider these complex, inter-related multiple determinants of performance. Our findings, including new factors, contribute to the global literature on factors affecting the performance of CHWs and have wide application.
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spelling pubmed-76881702020-12-05 Factors influencing the performance of community health workers: A qualitative study of Anganwadi Workers from Bihar, India John, Aparna Nisbett, Nicholas Barnett, Inka Avula, Rasmi Menon, Purnima PLoS One Research Article Globally, there remain significant knowledge and evidence gaps around how to support Community Health Worker (CHW) programmes to achieve high coverage and quality of interventions. India’s Integrated Child Development Services scheme employs the largest CHW cadre in the world—Anganwadi Workers (AWWs). However, factors influencing the performance of these workers remain under researched. Lessons from it have potential to impact on other large scale global CHW programmes. A qualitative study of AWWs in the Indian state of Bihar was conducted to identify key drivers of performance in 2015. In-depth interviews were conducted with 30 AWWs; data was analysed using both inductive and deductive thematic analysis. The study adapted and contextualised existing frameworks on CHW performance, finding that factors affecting performance occur at the individual, community, programme and organisational levels, including factors not previously identified in the literature. Individual factors include initial financial motives and family support; programme factors include beneficiaries’ and AWWs’ service preferences and work environment; community factors include caste dynamics and community and seasonal migration; and organisational factors include corruption. The initial motives of the worker (the need to retain a job for family financial needs) and community expectations (for product-oriented services) ensure continued efforts even when her motivation is low. The main constraints to performance remain factors outside of her control, including limited availability of programme resources and challenging relationships shaped by caste dynamics, seasonal migration, and corruption. Programme efforts to improve performance (such as incentives, working conditions and supportive management) need to consider these complex, inter-related multiple determinants of performance. Our findings, including new factors, contribute to the global literature on factors affecting the performance of CHWs and have wide application. Public Library of Science 2020-11-25 /pmc/articles/PMC7688170/ /pubmed/33237939 http://dx.doi.org/10.1371/journal.pone.0242460 Text en © 2020 John et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
John, Aparna
Nisbett, Nicholas
Barnett, Inka
Avula, Rasmi
Menon, Purnima
Factors influencing the performance of community health workers: A qualitative study of Anganwadi Workers from Bihar, India
title Factors influencing the performance of community health workers: A qualitative study of Anganwadi Workers from Bihar, India
title_full Factors influencing the performance of community health workers: A qualitative study of Anganwadi Workers from Bihar, India
title_fullStr Factors influencing the performance of community health workers: A qualitative study of Anganwadi Workers from Bihar, India
title_full_unstemmed Factors influencing the performance of community health workers: A qualitative study of Anganwadi Workers from Bihar, India
title_short Factors influencing the performance of community health workers: A qualitative study of Anganwadi Workers from Bihar, India
title_sort factors influencing the performance of community health workers: a qualitative study of anganwadi workers from bihar, india
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7688170/
https://www.ncbi.nlm.nih.gov/pubmed/33237939
http://dx.doi.org/10.1371/journal.pone.0242460
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