ABSTRACT
Background. Female health workers in India face an increasing workload that affects their performance. We did a study in 2 districts of West Bengal, India, to quantify their workload and identify determinants of good performance. Methods. We randomly sampled female health workers from the health department’s list. First, we quantified the time allocated to tasks through observations of work sessions. Second, we estimated the prevalence ratio (PR) of aboveaverage performance for three indicators (DPT-booster coverage, antenatal check-up coverage and family planning performance) according to selected potential determinants. Results. Female health workers spent 26% of their time in documentation. We recruited 42 female health workers (average population covered: 6495). Larger floor space (PR 2.5; 95% CI 1.2–5.3), use of simplified documentation procedures (PR 2.5; 95% CI 1.2–5.2) and monthly supervision (PR 3.0; 95% CI 1.1–8.5) were associated with above-average DPT-booster coverage. Availability of a private space was associated with above-average coverage in antenatal check-up (PR 1.9; 95% CI 1.0–3.5) and family planning (PR 2.5; 95% CI 1.2–5.2). Workers who used existing resources to cope with multi-tasking performed better. Conclusion. Female health workers spent excessive time in documentation which left less time for service delivery. Infrastructure, planning and supervision affected performance and these areas must be strengthened to improve primary healthcare services.