ABSTRACT
Objective: We aimed to identify key barriers to Water Sanitation and Hygiene (WASH) promotion and infant diarrhea prevention services delivered by Accredited Social Health Activists (ASHAs) in rural India. Methods: A case-study was conducted across nine tribal villages in Banswara district (Rajasthan), where in-depth observational and qualitative data was collected from frontline health workers and infant caregivers. Results: ASHAs’ prioritization of their incentive-based link-worker tasks over their health activist roles, limited community mobilization, and lack of monitoring of such activities hindered the delivery of WASH promotion and infant diarrhea prevention services. Caregivers’ lack of trust in ASHA’s health knowledge and preference for private providers and traditional healers also hindered the uptake of ASHA’s health promotion services. Conclusions: Strengthening ASHAs’ health activism roles and building trust on frontline health workers’ knowledge among tribal communities will be the key to address the determinants of child malnutrition and stunting and accelerate progress towards the national development agenda.
ABSTRACT
The Participatory Approach for Nutrition in Children: Strengthening Health, Education, Engineering and Environment Linkages(PANChSHEEEL) project is a collaboration between University College London, Save the Children India, Jawaharlal Nehru Universityand Indian Institute of Technology Delhi to develop a socio-culturally appropriate, tailored, integrated and interdisciplinary intervention inrural India and test its acceptability for delivery through Anganwadi Centre (AWCs) and schools. Recognizing the socio-ecologicaldeterminants of under-nutrition, the POSHAN Abhiyan (POSHAN Mission) adopts a multi-sectoral approach to achieve five goals, ofwhich two are directly related to children. The POSHAN Abhiyan resonates with the conceptual framework of the PANChSHEEEL study inits interdisciplinary scope and focus on local linka ges. This paper draws upon empirical evidence from the PANChSHEEEL Project inBanswara (one of the POSHAN mission districts), Rajasthan to help understand linkages between policy and practice, specifically thechallenges of operationalizing ‘convergence’, the core strategy of the Abhiyan.