Effects of Various Financial and Non-financial Incentives on the Performance of Accredited Social Health Activist: Evidence from Two Selected Districts of Odisha

Abstract

Introduction: The performance of Accredited Social Health Activists (ASHAs) is crucial for the achievement of the ‘health for all’ goal in India. The performance and motivation of workforce are dependent on various financial and non-financial incentives. This study analyses the linkage of current incentive practices and perceived rewards/sanctions, with the motivation and performance of ASHA. Methods: Cross-sectional qualitative approach and interpretive structural modelling (ISM). Results: The motivation and performance of ASHAs were driven by various inter-related factors. The predominant rewarding factors identified were: monetary incentives, awards, and support and respect of the community towards the ASHAs. Dissatisfaction was fuelled by factors, such as sense of underpayment, comparison with peers and the community cadres of other departments, erratic duty hours, scarce disbursement of resources, financial insecurity post-retirement, difficulty in reading or writing, unavailability of health services and medicines in the nearby healthcare facilities. Conclusions: For a sustained advance in motivation and performance of ASHAs, the public health systems’ focus needs to be oriented on: capacity building; optimal resource allocation, rationalised payoffs to the ASHAs working in difficult terrains and improving availability of healthcare services in primary healthcare facilities.

Analyzing the effect on performance and motivation of ASHA workers based on the incentive systems on the basis of geospatial context.

“…They are trained health activists and agents of community mobilisation, providing health related information and services to the community. The workload on ASHAs has substantially increased over the past decades as the programme was initiated with just a handful of activities, and now they are rendering 53 listed health-related activities against nancial incentives (4).…”