Unpacking the Complex Determinants of the Performance of Accredited Social Health Activists in Bihar: A Qualitative Study.

The Accredited Social Health Activist (ASHA) programme has been associated with many improvements in health outcomes. However, the understanding of contextual performance constraints, particularly how these vary for different tasks, has been acknowledged as deficient. Relying on a means, motives and...

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Publicado en:Journal of Health Management Vol. 27; no. 4; pp. 512 - 523
Autores principales: Srinivasan, Shuchi, John, Aparna, Newton-Lewis, Thomas
Formato: research tables/charts Journal Article
Publicado: Sage Publications Inc. Aug2025
Acceso en línea:Ver este registro en EBSCOhost
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      dt: Aug2025
      vid: 27
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      pub: Sage Publications Inc.
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        atl: Unpacking the Complex Determinants of the Performance of Accredited Social Health Activists in Bihar: A Qualitative Study.
      aug:
        au:
          Srinivasan, Shuchi
          John, Aparna
          Newton-Lewis, Thomas
        affil: Oxford Policy Management, Oxford, United Kingdom
      sug:
        subj:
          Community Health Workers
          Accreditation
          Task Performance and Analysis
          Human
          Qualitative Studies
          India
          Thematic Analysis
          Semi-Structured Interview
          Home Health Agencies
          Grounded Theory
          Exploratory Research
          Funding Source
      ab: The Accredited Social Health Activist (ASHA) programme has been associated with many improvements in health outcomes. However, the understanding of contextual performance constraints, particularly how these vary for different tasks, has been acknowledged as deficient. Relying on a means, motives and opportunity (MMO) framework, this article qualitatively explores the context-specific constraints on the performance of four ASHA tasks. We undertake qualitative research to unpack ASHA's perspectives and conduct a thematic analysis of the interview data. We find that different combinations of MMO factors affect different services differently, although many affect all services. Immunisation day, survey and record-keeping duties and escorting for institutional deliveries were deemed 'core' deliverables due to the administrative focus, preference or the incentives tied to the task. Home visits for home-based newborn care (HBNC) were not preferred and were seen as effort-intensive. The rapidly evolving role of ASHAs in responding to evolving health system needs in Bihar demands special effort if the different factors are to be diagnosed. This article attempts to offer the various avenues to unlock ASHA performance and contributes to the current partial global evidence base on factors affecting the performance of community health workers (CHWs) in different contexts.
      pubtype: Academic Journal
      doctype:
        research
        tables/charts
        Journal Article
      ougenre: Article
    language: English
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