Too much, too little – the art of balancing workload and personal life – community Health workers in Rural India An ethnographic study

The objective of this study was to understand trajectory of Accredited Social Health Activities (ASHAs). The study used ethnographic research methodology. A year and half long data collection had multiple approaches direct observation, in-depth interviews, informal discussions, time motion study (TMS), ranking and sorting of activities and group discussion on certain topic which emerged during field work. The study covered three blocks – in one of the districts of Rajasthan, India. The findings indicate that ASHAs look after two departments’ women and child development (WCD) and Health department in the State. They complain about their little payment and association with two departments. They are involved with multiples programmes, complain about unexpected and un-planned workload. They are taken as a volunteer but are expected to give certain amount of time to health department. Their work involves lot of running around between their homes, hospital, villages and Aganwadi. The TMS suggests that on an average per day a ASHAs walks 11.4 KM, which has negative impacts on their health. ASHAs are associated with private hospitals too, their interaction varied according to proximity to the private hospital, wealth of the community served, how “active” the ASHAs are, and the perspective of the ASHAs around her role. A number of ASHAs reported earning good incentives from the private sector. On personal front, ASHAs manage entire household work and help support family financially. When asked what motivates them in ASHA work, mostly they like ‘seva’ that they are able to give to community. The pride and respect which is associated with the work, their name in the village has increase. There is a need is to pay attention on equity and rights of ASHAs, they should not be burdened with new programmes. ASHAs should be consider for health and accidental insurance, one department association, fix working hours, better career pathways and job promotion. 

 

Moderator: Suriya Klangrit