An assessment of performance based incentive system for ASHA Sahyogini in Udaipur, Rajasthan

Area of Science:

• Public Health
• Health Systems Research
• Community Health

Background:

• The Accredited Social Health Activist (ASHA) program is a key component of India's national rural health mission, aimed at improving maternal and child health outcomes.
• ASHA Sahyoginis play a crucial role in bridging the gap between healthcare services and rural communities.
• Performance-based incentive systems are designed to motivate ASHAs, but their effectiveness and equity require careful evaluation.

Purpose of the Study:

• To evaluate the performance-based incentive system for ASHA Sahyoginis in the Udaipur district of Rajasthan.
• To identify challenges and facilitators related to the incentive system's implementation and impact on ASHA performance.

Main Methods:

• A cross-sectional study was conducted in rural, urban, and tribal blocks of Udaipur district.
• 180 ASHAs were randomly selected, with data collected through interviews and focus group discussions.
• The study focused on the incentive system received by ASHAs over the preceding six months.

Main Results:

• Nearly 50% of ASHAs served populations between 1000-1500. All ASHAs demonstrated good community coordination and regular participation in meetings.
• While all received sterilization-related incentives, payment timing varied (55.5% urban, 85.7% rural, 82.7% tribal received same-day payment).
• A significant proportion received low monthly incentives (less than Rs. 50), with dissatisfaction highest among tribal ASHAs due to inadequate compensation for their workload.

Conclusions:

• Timely disbursement of incentives is essential for ASHA motivation and performance.
• Enhanced cooperation from Auxiliary Nurse Midwives (ANMs), Anganwadi Workers (AWWs), and hospital staff is vital.
• Increased community awareness and support systems are necessary to optimize ASHA effectiveness.