Strengthening Support Mechanisms for Performance Improvement of

ASHAs

EPHP Conference

Dr DS Panwar, Vistaar ProjectIntraHealth International

The problem

ASHAs undergoing rounds of induction training and receiving additional training like the Comprehensive Child Survival training . Yet, gaps in ASHA performance and their ability to take “knowledge to practice” noticed

Objective

Vistaar Project planned assessments to identify:

i. Gaps between the desired and actual performance of ASHAs

ii. Key factors affecting ASHA performanceiii. On-the-job support and capacity building needs to

strengthen ASHA mentoring

• Rapid Needs Assessment (RNA) Key areas of inquiry:– Application of knowledge and skills by ASHA (post-training)– Support provided to ASHAs in the post–training phase

• Performance Needs Assessment (PNA) with Health system – Gap between actual and desired performance

• Supervision Needs Assessment with Health system

Needs Assessments to identify program gaps

• Systematic random sampling applied to select ASHAs

• ASHAs interviewed and observed to assess inter-personal communication skills during home-visits

• IDIs conducted with ANMs (15), LHVs (15) and MOs (15) to assess the existing supportive supervision for ASHA

• Field investigators trained and provided standardized tools

• Content analysis of the qualitative data using N6 software package

Rapid Needs Assessment

Performance Needs Assessment

• Performance Improvement Approach - method for analyzing performance problems and setting-up systems to ensure good performance

• A systematic methodology to find the root causes of a performance problem and then implement an intervention that applies to that specific performance deficit

PI Framework

CONSIDERINSTITUTIONAL

CONTEXT

MISSION

GOALS

STRATEGIES

CULTURE

CLIENT ANDCOMMUNITY

PERSPECTIVES

OBTAIN AND MAINTAIN STAKEHOLDER AGREEMENT

MONITOR AND EVALUATE PERFORMANCE

DEFINE DESIREDPERFORMANCE

FIND ROOTCAUSES

WHY DOES THEPERFORMANCE

GAP EXIST?

SELECTINTERVENTIONS

WHAT CAN BE DONETO CLOSE THE

PERFORMANCE GAP?

DESCRIBE ACTUALPERFORMANCE

PERFORMANCEGAP

IMPLEMENTINTERVENTION

Assessment findings:

• ASHAs possessed basic theoretical knowledge, however, significant gaps remained in application of knowledge

• ASHAs lacked inter-personal communication (IPC) skills to negotiate behavior change

• Post-training mentoring support to periodically update knowledge and enhance skills of ASHAs lacking.

• ASHAs lacked confidence to use newly acquired skills and equipment

• Forums like the ASHA monthly meetings not adequately utilized (for on-the job capacity building, for example)

Assessment findings (Contd.):

• Greater clarity required among LHVs and ANMs on their role in supporting ASHAs

• ANMs needed job-aides and requisite skills for supporting, provide on-site mentoring and do problem solving for ASHAs.

• Focus of MOs/LHVs limited to administrative supervision – actions on non-performing workers usually punitive

• Village Health & Nutrition Days -missed opportunities to provide on-site /in-field support to ASHAs

RecommendationsStrengthen ASHA meeting forum for optimal use

• Strengthen mechanisms for supportive supervision of ASHAs through the existing Government system, for example re-structuring ASHA meetings.

• Create opportunities for ASHAs to meet in smaller groups to make meetings more interactive and effective

• Structure ASHAs meeting to provide opportunity for joint problem-solving and on-the-job capacity building –use participatory approaches

• Build in-house capacity (of Block Health Education Officers, for example ) to facilitate ASHA monthly meetings

Recommendations

Strengthen Support mechanisms for ASHAs

• Build capacity of ANMs and LHVs to extend support to ASHAs for performance improvement

• Enhance capacity in the Health System to look beyond training as solutions to performance problems and strengthen other factors affecting performance

• Use monthly PHC meetings for continuous capacity-building and joint problem solving with Medical Officers/Other supervisory staff

• Promote Village Health & Nutrition Day as a potential opportunity for ANMs to provide on-site support to ASHAs

Thank You