Keeping up the morale of the foot soldiers of Indian public health: an appraisal of the economic aspects of ASHAs in Uttarakhand, India.

ABSTRACT

Background: Accredited social health activist (ASHA) is a voluntary community health worker and an important human resource for public health system of India. Their motivation to become a community health worker and continued efforts is a mix of monetary and non-monetary factors. Their motivation to work comes partly from desire to work for the community and prestige, but is furthered by the monetary compensation. Objectives: To study the economic status of ASHAs in Uttarakhand, and their contribution to household income and the role the monetary incentives play in their work. Methods: This cross sectional study was conducted in Haridwar and Dehradun districts of Uttarakhand. Eighty one ASHAs were interviewed using pre-piloted semi-structured questionnaire. Their economic status was assessed using Modified BG Prasad Classification. Results: Majority of the ASHAs belonged to class 4 according to modified B G Prasad Classification. Mean monthly earning as ASHA was 1335 rupees (SD 748) and the mean contribution to the total household income was 28%. Financial incentive was an important motivating factor with associated concerns about delay in payments. About 75% felt that the amount was inadequate considering the time and effort involved. Conclusions: There is need to review the financial and non-financial incentives with due consideration to inflation and consumer price index.