strengthening support mechanisms for performance improvement of ashas-d.s.panwar
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Strengthening Support Mechanisms for Performance Improvement of
ASHAs
EPHP Conference
Dr DS Panwar, Vistaar ProjectIntraHealth 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:
i. Gaps between the desired and actual performance of ASHAs
ii. Key factors affecting ASHA performanceiii. 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
PI Framework
CONSIDERINSTITUTIONAL
CONTEXT
MISSION
GOALS
STRATEGIES
CULTURE
CLIENT ANDCOMMUNITY
PERSPECTIVES
OBTAIN AND MAINTAIN STAKEHOLDER AGREEMENT
MONITOR AND EVALUATE PERFORMANCE
DEFINE DESIREDPERFORMANCE
FIND ROOTCAUSES
WHY DOES THEPERFORMANCE
GAP EXIST?
SELECTINTERVENTIONS
WHAT CAN BE DONETO CLOSE THE
PERFORMANCE GAP?
DESCRIBE ACTUALPERFORMANCE
PERFORMANCEGAP
IMPLEMENTINTERVENTION
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
RecommendationsStrengthen 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