Assessment of Workload of ASHAs: A Multi-stakeholder Perspective Study for Task-sharing and Task-shifting

The Accredited Social Health Activist (ASHA) programme has proven to be cost-effective and successful in addressing the growing shortage of health workers and reaching the vulnerable. ASHA's contribution towards the improvement in maternal and child health and other health programmes at the community level is reported and acknowledged widely in literature. However, nearly 16 years into the introduction of ASHA, challenges in terms of workload, fatigue, poor work-life balance and low levels of compensation have emerged. Aim: To assess the workload on ASHAs, impact of their responsibilities on their quality of life and the potential for structured task sharing/shifting among other healthcare workers. Methodology: The study used a mixed-method approach with data and source triangulation. A multi-stage random sampling method was used to collect the data. Qualitative research was carried out to explore ASHAs' and stakeholders' perspectives, and a thematic analysis was undertaken using NVivo-12. ASHAs' quality of life was also measured using the World Health Organization Quality of Life (WHO QOL)-BREF. The study was carried out in three districts of Karnataka: Mysuru, Raichur and Koppala. Results: The majority of ASHAs reported that they experience work burden in terms of population coverage, extended hours of work and additional tasks. Lack of access to transportation, inadequate support from other healthcare personnel and delayed payment of incentives add to them often feeling overworked and underpaid. The research also elicited perspectives on ASHAs' work from different stakeholders. Findings from the study emphasise the necessity for sharing/shifting of selected tasks among other frontline health workers based on complexity and capabilities.