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

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