Abstract for: Dynamics of the Work Performance of Accredited Social Health Activists (ASHA) in Bihar, India

In 2005, India introduced the accredited social health activist (ASHA) program as part of the National Rural Health Mission (NRHM) to strengthen rural public health service delivery, community engagement, and health program ownership. In 2010, the Bill & Melinda Gates Foundation (BMFG) formed a partnership with the Government of Bihar, one of the poorest states in India, to launch a series of interventions to improve the state-wide child and maternal health outcomes. The package of interventions includes programs to strengthen FLW service delivery by elevating their motivation and introducing tools to facilitate their job performance. The majority of ASHAs’ work performance indicators of showed increasing trends. However, some indicators show variations across districts. A district is a sub-geographical unit of the state. The indicator of the work performance of ASHAs we investigate in this project is the ASHA home visits for health in the third-trimester coverage (ASHAV3T). The districts that show the highest and lowest improvement after the introduction interventions are Buxar and Purnia. This paper seeks to conceptualize the dynamics between the monthly health sub-center meetings, the adoption of name-based tracking (NBT) system by ASHAs, level of ASHA supervision on ASHAV3T.