IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0242460.html
   My bibliography  Save this article

Factors influencing the performance of community health workers: A qualitative study of Anganwadi Workers from Bihar, India

Author

Listed:
  • Aparna John
  • Nicholas Nisbett
  • Inka Barnett
  • Rasmi Avula
  • Purnima Menon

Abstract

Globally, there remain significant knowledge and evidence gaps around how to support Community Health Worker (CHW) programmes to achieve high coverage and quality of interventions. India’s Integrated Child Development Services scheme employs the largest CHW cadre in the world—Anganwadi Workers (AWWs). However, factors influencing the performance of these workers remain under researched. Lessons from it have potential to impact on other large scale global CHW programmes. A qualitative study of AWWs in the Indian state of Bihar was conducted to identify key drivers of performance in 2015. In-depth interviews were conducted with 30 AWWs; data was analysed using both inductive and deductive thematic analysis. The study adapted and contextualised existing frameworks on CHW performance, finding that factors affecting performance occur at the individual, community, programme and organisational levels, including factors not previously identified in the literature. Individual factors include initial financial motives and family support; programme factors include beneficiaries’ and AWWs’ service preferences and work environment; community factors include caste dynamics and community and seasonal migration; and organisational factors include corruption. The initial motives of the worker (the need to retain a job for family financial needs) and community expectations (for product-oriented services) ensure continued efforts even when her motivation is low. The main constraints to performance remain factors outside of her control, including limited availability of programme resources and challenging relationships shaped by caste dynamics, seasonal migration, and corruption. Programme efforts to improve performance (such as incentives, working conditions and supportive management) need to consider these complex, inter-related multiple determinants of performance. Our findings, including new factors, contribute to the global literature on factors affecting the performance of CHWs and have wide application.

Suggested Citation

  • Aparna John & Nicholas Nisbett & Inka Barnett & Rasmi Avula & Purnima Menon, 2020. "Factors influencing the performance of community health workers: A qualitative study of Anganwadi Workers from Bihar, India," PLOS ONE, Public Library of Science, vol. 15(11), pages 1-17, November.
    • Handle: RePEc:plo:pone00:0242460
    DOI: 10.1371/journal.pone.0242460
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0242460
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0242460&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0242460?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Olang'o, Charles Omondi & Nyamongo, Isaac K. & Aagaard-Hansen, Jens, 2010. "Staff attrition among community health workers in home-based care programmes for people living with HIV and AIDS in western Kenya," Health Policy, Elsevier, vol. 97(2-3), pages 232-237, October.
    2. Alam, Khurshid & Tasneem, Sakiba & Oliveras, Elizabeth, 2012. "Performance of female volunteer community health workers in Dhaka urban slums," Social Science & Medicine, Elsevier, vol. 75(3), pages 511-515.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Nandi, Arindam & Sahoo, Soham & Haberland, Nicole & Ngô, Thoại D., 2023. "A glass ceiling at the playhouse? Gender gaps in public and private preschool enrollment in India," International Journal of Educational Development, Elsevier, vol. 103(C).
    2. Skylab Sahu & Pradeep Kumar Mehta, 2023. "Committed for Social Change: Analysing the Role of Frontline Health Workers During Pandemic in Rural Odisha," Indian Journal of Human Development, , vol. 17(2), pages 359-369, August.
    3. Rebecca Mitchell & Jessica Gordon & Gopal Krushna Bhoi & Nicholas Nisbett, 2023. "Applying the ‘Candidacy’ Model to understand access to key nutrition, food & health services in LMIC contexts: a qualitative study in Odisha, India," Food Security: The Science, Sociology and Economics of Food Production and Access to Food, Springer;The International Society for Plant Pathology, vol. 15(3), pages 649-660, June.
    4. Drèze, Jean & Khera, Reetika & Somanchi, Anmol, 2021. "Maternity Entitlements in India: Women's Rights Derailed," SocArXiv v5mc6, Center for Open Science.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Martin, Stephanie L. & Muhomah, Teresia & Thuita, Faith & Bingham, Allison & Mukuria, Altrena G., 2015. "What motivates maternal and child nutrition peer educators? Experiences of fathers and grandmothers in western Kenya," Social Science & Medicine, Elsevier, vol. 143(C), pages 45-53.
    2. Haribondhu Sarma & Ishrat Jabeen & Sharmin Khan Luies & Md Fakhar Uddin & Tahmeed Ahmed & Thomas J Bossert & Cathy Banwell, 2020. "Performance of volunteer community health workers in implementing home-fortification interventions in Bangladesh: A qualitative investigation," PLOS ONE, Public Library of Science, vol. 15(4), pages 1-20, April.
    3. Khurshid Alam & Sakiba Tasneem & Molla Huq, 2014. "Reservation wage of female volunteer community health workers in Dhaka urban slums: a bidding game approach," Health Economics Review, Springer, vol. 4(1), pages 1-10, December.
    4. Abimbola Olaniran & Barbara Madaj & Sarah Bar‐Zeev & Aduragbemi Banke‐Thomas & Nynke van den Broek, 2022. "Factors influencing motivation and job satisfaction of community health workers in Africa and Asia—A multi‐country study," International Journal of Health Planning and Management, Wiley Blackwell, vol. 37(1), pages 112-132, January.
    5. Thidar Pyone & Shilpa Karvande & Somasundari Gopalakrishnan & Vidula Purohit & Sarah Nelson & Subha Sri Balakrishnan & Nerges Mistry & Matthews Mathai, 2019. "Factors governing the performance of Auxiliary Nurse Midwives in India: A study in Pune district," PLOS ONE, Public Library of Science, vol. 14(12), pages 1-17, December.
    6. Olaniran, Abimbola & Madaj, Barbara & Bar Zeev, Sarah & Banke-Thomas, Aduragbemi & van den Broek, Nynke, 2022. "Factors influencing motivation and job satisfaction of community health workers in Africa and Asia - a multi-country study," LSE Research Online Documents on Economics 111837, London School of Economics and Political Science, LSE Library.
    7. Edward, Anbrasi & Branchini, Casey & Aitken, Iain & Roach, Melissa & Osei-Bonsu, Kojo & Arwal, Said Habib, 2015. "Toward universal coverage in Afghanistan: A multi-stakeholder assessment of capacity investments in the community health worker system," Social Science & Medicine, Elsevier, vol. 145(C), pages 173-183.
    8. Kibur Engdawork & Colleen M McBride & Desta Ayode & Caitlin G Allen & Gail Davey & Getnet Tadele, 2018. "Rural youths' understanding of gene x environmental contributors to heritable health conditions: The case of podoconiosis in Ethiopia," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 12(9), pages 1-13, September.
    9. Mary B Adam & Maria Dillmann & Mei-kuang Chen & Simon Mbugua & Joram Ndung’u & Priscilla Mumbi & Eunice Waweru & Peter Meissner, 2014. "Improving Maternal and Newborn Health: Effectiveness of a Community Health Worker Program in Rural Kenya," PLOS ONE, Public Library of Science, vol. 9(8), pages 1-8, August.
    10. Druetz, Thomas & Kadio, Kadidiatou & Haddad, Slim & Kouanda, Seni & Ridde, Valéry, 2015. "Do community health workers perceive mechanisms associated with the success of community case management of malaria? A qualitative study from Burkina Faso," Social Science & Medicine, Elsevier, vol. 124(C), pages 232-240.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0242460. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.