Working at the Grassroots Level: A Qualitative Exploration of Frontline Health Workers' Experiences in Tribal...

Background Frontline health workers play a crucial role in bridging gaps between health systems and marginalized communities. However, there is limited evidence of their experiences within tribal maternal and reproductive health services. This study aimed to explore the nature of work, lived experiences, core competencies, challenges, and motivational factors of frontline health workers providing maternal and reproductive health services in a tribal setting in Kerala. Methods A qualitative exploratory study using a narrative inquiry approach was conducted in the Attapadi tribal settlement of Palakkad district, Kerala. Eighteen frontline health workers, including Accredited Social Health Activist (ASHA) workers, Anganwadi workers, and non-governmental organization (NGO) field staff with a minimum of five years of experience, were purposively selected. In-depth semi-structured interviews were conducted in Malayalam. Data were transcribed verbatim and analyzed manually using thematic analysis. Results Frontline health workers performed multifaceted roles extending beyond formal responsibilities, including home-based service delivery, health education, follow-up care, and facilitation of government welfare schemes. Cultural competence, trust-building, context-specific communication, and problem-solving in low-resource settings were identified as core competencies. Major challenges included difficult terrain, transportation barriers, cultural resistance, staff shortages, heavy workload, and emotional stress. Despite these constraints, strong commitment to community welfare, personal satisfaction from positive maternal outcomes, social recognition, and peer support sustained workers' motivation and resilience. Conclusion Strengthening policy support, enhancing culturally sensitive training, addressing workload and emotional well-being, and improving health infrastructure are essential to sustain their contributions and advance equitable maternal health outcomes among tribal populations.