Research suggests ways to motivate Accredited Social Health Activists (ASHAs) in India

Both financial and non-financial factors highlighted to improve policies aiming to retain ASHAs

One of the major challenges faced by the Indian health system is keeping Accredited Social Health Activists motivated, and retaining them in service. Several factors including individual, social, economic and work-related factors impact the motivation and retention of ASHAs. A new research study conducted by The George Institute of Global Health and published in BMJ Global Health this week highlights that ASHAs are motivated by both non-financial and financial factors. The study suggests that policy decisions aimed at overcoming workforce attrition should target factors that are most valued by ASHAs.

According to the study, career progression was found to be the main influencing factor for ASHAs choosing between job options in addition to the fixed salary and other non-financial factors such as priority free family health-check and reduced workload.

The researchers selected 318 ASHAs from 53 primary health centres of Guntur, a district in south India. A Discrete Choice Experiment (DCE) was completed by 299 ASHAs using Android tablets. A DCE is a survey which helps quantify choices from participants without asking them directly about their preferences. ASHAs were found to exhibit a strong preference for jobs that incorporated training leading to promotion, a fixed salary and free family healthcare. ASHAs were willing to sacrifice 2530 INR from their monthly salary, for a job offering training leading to promotion opportunity and 879 INR for a free family health-check.

Ms Marwa Abdel-All, lead Author of the study explains that:

“there was significant heterogeneity in preferences across the respondents. ASHAs could be grouped into 3 distinct groups based on their education level, having a second job and whether they were the main household earner. The preferences of Group 1 (51% of the cohort) and 2 (35%) were dominated by the training and salary attributes with Group 2 having higher preference for free family health-check while group 3 (13% of the cohort) preferences were dominated by workload. Relative to group 3, ASHAs in groups 1 and 2 were more likely to have a higher level of education and less likely to be the main income earners for their families”.   

Associate Prof Rohina Joshi, a Senior Author on the study, says:

“There is a need to understand the preferences of health workers and certain aspects of career development valued by ASHAs. Non-financial and financial incentives should be combined to improve health workers satisfaction and their performance, which ultimately leads to better health outcomes. Effective incentives aiming to improve their motivation should be part of policy designs to improve healthcare delivery in India,” 

Read the full research paper published in BMJ Global