Functioning and time utilisation by female multi-purpose health workers in South India: a time and motion study

Abstract

BackgroundAuxillary nurse midwives (ANMs) are the most important frontline multi-purpose workers in rural India. This study was conducted to assess the spectrum of service delivery, time utilisation, work planning, and factors affecting functioning of ANMs in South India.MethodsWe conducted a time and motion study in three districts across two states in South India. The districts selected in such a manner that they had a considerable tribal population. We conducted multi-stage sampling to select ANMs. We directly observed 43 ANMs consecutively for six working days and in-depth interviewed all selected ANMs, their supervisors, medical officers, and district health officials. We conducted an FGD to substantiate the findings from observations and interviews. Observation findings were analysed under three broad domains: (i) programme activities, (ii) programme support activities, and (iii) other work. Time spent was calculated in median (interquartile range, IQR) minutes/ANM per week or day. Qualitative data were coded and analysed using grounded theory, and appropriate themes and sub-themes were identified.ResultsANMs worked for median 7 h a day (7:10 h, non-tribal; 6:20 h, tribal). There is variation in the hours of work, the pattern of service provided and time utilisation across days of a week. ANMs spent 60% of their on-job time on programmatic activities (median 22:38 h; IQR, 20:48–27:01 h) in a week. Emphasis is more on home visits, universal immunisation, antenatal care, school health, and seasonal diseases. ANMs spent negligible time on non-communicable diseases, adolescent health, nutrition, etc. ANMs spent the remaining time in program support activities, such as meetings with seniors, community meetings, and other non-health related work. There are no renewed job description, work plans, and supervision guidelines, even with newly added programs and tasks. ANMs prioritised work as per the priorities set by the supervisors and leaders. Health administration often disrupts the regular functioning of ANMs for training, meetings and other ad hoc work.ConclusionANMs are overworked; they often multi-task and fail to deliver efficiently. The administration needs to re-assess the workload. The administration may reduce expected work, provide strong supervisory support, and make conscious efforts to pose fewer disruptions in regular working of ANMs.

Teachers' time utilisation and students' enrolment in school certificate examination: implication for school leadership

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“…The greater job demand than they can handle can lead to inefficiency. This is consistent with Singh et al, 2018), On the other hand, the inability of the public secondary school teachers to increase their engagement in teaching and thus their time utilisation is a reflection of the inability of policymakers and the public school administrators to effectively manage the job demands and resources in the public school system. This demands the need for policymakers in government and public school administrators to re-strategize on the management of job demands and matching of human resources (teachers) with the job demands (required teaching hours).…”

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An Analysis of the Services Provided by Municipal Ward Based Primary Health Care Outreach Teams in an Urban District in South Africa: A Key Contribution Towards Universal Access to Care.

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