No abstract

Background: The National Rural Health Mission (NRHM) was launched on April 12, 2005; it seeks to provide accessible, affordable, and quality health care at the grass-root level in India. ASHA (Accredited Social Health Activist) is one of the key components in the NRHM for the effective implementation of health-care services. ASHA is an honorary volunteer and receives monthly incentives. From April 1, 2013, a new scheme was introduced in "ASHA INCENTIVE SCHEME" for promoting family planning-permanent sterilization. It is an incentive of Rs. 1,000 given to an ASHA who motivates and promotes couples having two or less than two children to undergo permanent sterilization. This study was undertaken with a view to find out if there was any qualitative and/or quantitative improvement in the functioning of the ASHA after this scheme was introduced. Objective: To find out effects of the new ASHA incentive scheme on the performance of ASHA in motivating couples to undergo permanent sterilization method. Materials and Methods: Achievement data of permanent family planning methods were collected from the records of all primary health centers (PHCs) of Surendranagar district, with the assistance of medical officer. Ten PHCs were randomly selected from each Taluka, and all ASHAs of these PHCs were interviewed. A focus group discussion was also conducted on a group of 10 ASHAs from each PHC regarding problems faced during their motivation and their attitude toward incentive. Result: Study revealed that the knowledge of family planning methods such as oral contraceptive pills, condom, and intrauterine contraceptive device range from 92.86% to 95.71%, but for nonscalpel vasectomy (NSV) as a method was known to only 80.95%. Knowledge regarding incentive scheme was poor with only 17% who knew that incentive was given for both male (NSV) and female (laparoscopic tubal ligation/tubal ligation) sterilization methods. Contribution of ASHAs toward achievements in female sterilization shows that maximum work was done by ASHAs, and ASHAs performance was increased; 1.13 times for eligible couples and 1.14 times for couples having two or less children after introduction of an incentive, and incentive showed a significant impact on motivation of eligible couples (χ 2 = 121.744, df = 1, P < 0.0001) and motivation couple having two or less children (χ 2 = 74.893, df = 1, P < 0.0001) for female sterilization method by ASHAs. Focus group discussion and interview of ASHAs revealed many problems faced during their visits. Conclusion: Achievements in female sterilization before and after the incentive scheme introduced showed statistically significant improvements, and the contribution of ASHAs toward these achievements was significant when compared with other workers. Incentive scheme was beneficial in improving the acceptance of permanent sterilization method by the couples having two or less children.