Publication:

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

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.