Abdel-All Marwa, Angell Blake, Jan Stephen, Howell Martin, Howard Kirsten, Abimbola Seye, Joshi Rohina
Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
The George Institute for Global Health, Newtown, New South Wales, Australia.
BMJ Glob Health. 2019 May 31;4(3):e001509. doi: 10.1136/bmjgh-2019-001509. eCollection 2019.
A number of factors contribute to the performance and motivation of India's Accredited Social Health Activists (ASHAs). This study aims to identify the key motivational factors (and their relative importance) that may help retain ASHAs in service.
A discrete choice experiment (DCE) survey presented ASHAs with eight unlabelled choice sets, each describing two hypothetical jobs that varied based on five attributes, specifically salary, workload, travel allowance, supervision and other job benefits. Multinomial logit and latent class (LC) models were used to estimate stated preferences for the attributes.
We invited 318 ASHAs from 53 primary health centres of Guntur, a district in south India. The DCE was completed by 299 ASHAs using Android tablets. ASHAs were found to exhibit a strong preference for jobs that incorporated training leading to promotion, a fixed salary and free family healthcare. ASHAs were willing to sacrifice 2530 Indian rupee (INR) from their monthly salary, for a job offering training leading to promotion opportunity and 879 INR for a free family health-check. However, there was significant heterogeneity in preferences across the respondents. The LC model identified three distinct groups (comprising 51%, 35% and 13% of our cohort, respectively). Group 1 and 2 preferences were dominated by the training and salary attributes with group 2 having higher preference for free family health-check while group 3 preferences were dominated by workload. Relative to group 3, ASHAs in groups 1 and 2 were more likely to have a higher level of education and less likely to be the main income earners for their families.
ASHAs are motivated by both non-financial and financial factors and there is significant heterogeneity between workers. Policy decisions aimed at overcoming workforce attrition should target those areas that are most valued by ASHAs to maximise the value of investments into these workers.
CTRI/2018/03/012425.
多种因素影响着印度认证社会健康活动家（ASHAs）的工作表现和积极性。本研究旨在确定有助于ASHAs继续从事该工作的关键激励因素（及其相对重要性）。
一项离散选择实验（DCE）调查向ASHAs展示了八个未标记的选择集，每个选择集描述了两个基于五个属性而有所不同的假设工作，这五个属性分别是工资、工作量、差旅津贴、监督和其他工作福利。使用多项logit模型和潜在类别（LC）模型来估计对这些属性的既定偏好。
我们邀请了来自印度南部贡图尔区53个初级卫生中心的318名ASHAs。299名ASHAs使用安卓平板电脑完成了DCE调查。结果发现，ASHAs对包含晋升培训、固定工资和免费家庭医疗保健的工作表现出强烈偏好。ASHAs愿意为提供晋升培训机会的工作每月牺牲2530印度卢比（INR）的工资，为免费家庭健康检查牺牲879印度卢比。然而，不同受访者的偏好存在显著差异。LC模型确定了三个不同的群体（分别占我们队列的51%、35%和13%）。第1组和第2组的偏好主要由培训和工资属性主导，第2组对免费家庭健康检查的偏好更高，而第3组的偏好主要由工作量主导。相对于第3组，第1组和第2组的ASHAs更有可能拥有较高的教育水平，且不太可能是家庭的主要收入者。
ASHAs受到非财务和财务因素的激励，且不同工作者之间存在显著差异。旨在克服劳动力流失的政策决策应针对ASHAs最看重的领域，以最大限度地提高对这些工作者的投资价值。
CTRI/2018/03/012425。
