Tying their hands? Institutional obstacles to the success of the ASHA community health worker programme in rural north India

被引:101
作者
Scott, Kerry [1 ,2 ]
Shanker, Shobhit [3 ]
机构
[1] London Sch Econ, Inst Social Psychol, London WC2A 2AE, England
[2] SATHI, Pune, Maharashtra, India
[3] Engineers Borders, Toronto Chapter, ON, Canada
来源
AIDS CARE-PSYCHOLOGICAL AND SOCIO-MEDICAL ASPECTS OF AIDS/HIV | 2010年 / 22卷
关键词
ASHA programme in India; community health workers; primary healthcare; reproductive health; thematic network analysis;
D O I
10.1080/09540121.2010.507751
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
This paper is a contribution to the growing literature on how best to design and support community health worker (CHW) programmes to maximise their positive impact. CHWs are laypeople trained to promote health among their peers. To do so they are commonly tasked with providing basic curative services, promoting the use of existing health services, facilitating cultural mediation between communities and healthcare providers and encouraging critical reflection and dialogue on social health issues. This paper presents a case study of a CHW project in rural Uttarakhand, north India, called the Accredited Social Health Activist (ASHA) programme. While the ASHA programme is not specifically targeting HIV/AIDS, CHW programmes have been flagged as a key means of addressing health resource shortages in poor countries, especially in relation to HIV/AIDS. This study of the ASHA programme provides insights into how best to support CHW programmes in general, including those focused on HIV/AIDS. The research involved 25 interviews and five focus groups with ASHAs, health professionals and community members as well as over 100 hours of non-participant observation at public health centres. The research investigated contextual features of the programme that are hindering the ASHAs' capacity to increase quantitative health outcomes and act as cultural mediators and agents of social change. Research found that ASHAs were institutionally limited by: (1) the outcome-based remuneration structure; (2) poor institutional support; (3) the rigid hierarchical structure of the health system; and (4) a dearth of participation at the community level. The conclusion suggests that progressive policy on CHW programmes must be backed up by concrete institutional support structures to enable CHWs to fulfil their role.
引用
收藏
页码:1606 / 1612
页数:7
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