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Strengthening support mechanisms for performance improvement of ASHAs-D.S.Panwar

Strengthening support mechanisms for performance improvement of ASHAs-D.S.Panwar






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    Strengthening support mechanisms for performance improvement of ASHAs-D.S.Panwar Strengthening support mechanisms for performance improvement of ASHAs-D.S.Panwar Presentation Transcript

    • Strengthening Support Mechanisms for Performance Improvement of ASHAs EPHP Conference Dr DS Panwar, Vistaar Project IntraHealth International
    • The problem
      • ASHAs undergoing rounds of induction training and receiving additional training like the Comprehensive Child Survival training . Yet, gaps in ASHA performance and their ability to take “ knowledge to practice” noticed
    • Objective
      • Vistaar Project planned assessments to identify:
        • Gaps between the desired and actual performance of ASHAs
        • Key factors affecting ASHA performance
        • On-the-job support and capacity building needs to strengthen ASHA mentoring
      • Rapid Needs Assessment (RNA)
      • Key areas of inquiry:
        • Application of knowledge and skills by ASHA (post-training)
        • Support provided to ASHAs in the post–training phase
      • Performance Needs Assessment (PNA) with Health system
        • Gap between actual and desired performance
      • Supervision Needs Assessment with Health system
      Needs Assessments to identify program gaps
      • Systematic random sampling applied to select ASHAs
      • ASHAs interviewed and observed to assess inter-personal communication skills during home-visits
      • IDIs conducted with ANMs (15), LHVs (15) and MOs (15) to assess the existing supportive supervision for ASHA
      • Field investigators trained and provided standardized tools
      • Content analysis of the qualitative data using N6 software package
      Rapid Needs Assessment
    • Performance Needs Assessment
      • Performance Improvement Approach - method for analyzing performance problems and setting-up systems to ensure good performance
      • A systematic methodology to find the root causes of a performance problem and then implement an intervention that applies to that specific performance deficit
    • Assessment findings :
      • ASHAs possessed basic theoretical knowledge, however, significant gaps remained in application of knowledge
      • ASHAs lacked inter-personal communication (IPC) skills to negotiate behavior change
      • Post-training mentoring support to periodically update knowledge and enhance skills of ASHAs lacking.
      • ASHAs lacked confidence to use newly acquired skills and equipment
      • Forums like the ASHA monthly meetings not adequately utilized (for on-the job capacity building, for example)
    • Assessment findings (Contd.):
        • Greater clarity required among LHVs and ANMs on their role in supporting ASHAs
        • ANMs needed job-aides and requisite skills for supporting, provide on-site mentoring and do problem solving for ASHAs.
        • Focus of MOs/LHVs limited to administrative supervision – actions on non-performing workers usually punitive
        • Village Health & Nutrition Days -missed opportunities to provide on-site /in-field support to ASHAs
    • Recommendations
      • Strengthen ASHA meeting forum for optimal use
      • Strengthen mechanisms for supportive supervision of ASHAs through the existing Government system, for example re-structuring ASHA meetings.
      • Create opportunities for ASHAs to meet in smaller groups to make meetings more interactive and effective
      • Structure ASHAs meeting to provide opportunity for joint problem-solving and on-the-job capacity building –use participatory approaches
      • Build in-house capacity (of Block Health Education Officers, for example ) to facilitate ASHA monthly meetings
    • Recommendations
      • Strengthen Support mechanisms for ASHAs
      • Build capacity of ANMs and LHVs to extend support to ASHAs for performance improvement
      • Enhance capacity in the Health System to look beyond training as solutions to performance problems and strengthen other factors affecting performance
      • Use monthly PHC meetings for continuous capacity-building and joint problem solving with Medical Officers/Other supervisory staff
      • Promote Village Health & Nutrition Day as a potential opportunity for ANMs to provide on-site support to ASHAs
    • Thank You