Interplaying role of healthcare activist and homemaker: a mixed-methods exploration of the workload of community health workers (Accredited Social Health Activists) in India

Abstract Background Globally, community health workers (CHWs) are integral contributors to many systems. In India, Accredited Social Health Activists (ASHAs) have been deployed since 2005. Engaged in multiple care activities, they a key link between the system and population. ASHAs expected participate new programmes prompting interest their current workload from perspective of system, family. Methods This mixed-methods design study was conducted rural tribal Primary Centers (PHCs), Pune district, Western Maharashtra, India. All affiliated with these PHCs were invited quantitative study, those agreeing contribute in-depth interviews (IDI) enrolled an additional qualitative study. Key informants’ Auxiliary Nurse Midwife (ANM), Block Facilitators (BFF) Medical Officers (MO) same PHCs. Quantitative data analysed using descriptive statistics. Qualitative thematically. Results We recruited 67 two worked up 20 h/week village residence, serving populations approximately 800–1200, embracing increasing range despite that contributed feelings being rushed tiredness. They juggled household work, other paid jobs ASHA activities. Practical problems travel added time involved, especially areas where transport is lacking. Their sense benefiting coupled respect recognition gained brought happiness job satisfaction. willing take on tasks. perceived themselves as ‘voluntary workers’ rather than ‘health activists”. Conclusions struggling balance significant work domestic proud role CHWs Strategies recruit, train, skills enhancement, incentivise, retain ASHAs, need be prioritised. Evolving attitudes advantages/disadvantages voluntary status understood addressed if remain component achieving universal coverage