The INCLEN Trust International, New Delhi, India.
School of Management and Business Studies, Jamia Hamdard, New Delhi, India.
Front Public Health. 2022 Sep 29;10:956422. doi: 10.3389/fpubh.2022.956422. eCollection 2022.
Home visitation has emerged as an effective model to provide high-quality care during pregnancy, childbirth, and post-natal period and improve the health outcomes of mother- new born dyad. This 360 assessment documented the constraints faced by the community health workers (known as the Accredited Social Health Activists, ASHAs) to accomplish home visitation and deliver quality services in a poor-performing district and co-created the strategies to overcome these using a nexus planning approach.
The study was conducted in the Raisen district of Madhya Pradesh, India. The grounded theory approach was applied for data collection and analysis using in-depth interviews, and focus group discussions with stakeholders representing from health system (including the ASHAs) and the community (rural population). A key group of diverse stakeholders were convened to utilize the nexus planning five domain framework (social-cultural, educational, organizational, economic, and physical) to prioritize the challenges and co-create solutions for improving the home visitation program performance and quality. The nexus framework provides a systemic lens for evaluating the success of the ASHAs home visitation program.
The societal (caste and economic discrimination), and personal (domestic responsibilities and cultural constraints of working in the village milieu) issues emerged as the key constraints for completing home visits. The programmatic gaps in imparting technical knowledge and skills, mentoring system, communication abilities, and unsatisfactory remuneration system were the other barriers to the credibility of the services. The nexus planning framework emphasized that each of the above factors/domains is intertwined and affects or depends on each other for home-based maternal and newborn care services delivered with quality through the ASHAs.
The home visitation program services, quality and impact can be enhanced by addressing the social-cultural, organizational, educational, economic, and physical nexus domains with concurrent efforts for skill and confidence enhancement of the ASHAs and their credibility.
家庭访视已成为提供妊娠、分娩和产后期间高质量护理并改善母婴健康结局的有效模式。本 360 评估记录了社区卫生工作者（称为认证社会卫生活动家，ASHAs）在绩效不佳的地区完成家庭访视和提供优质服务所面临的限制，并利用网络规划方法共同制定了克服这些限制的策略。
该研究在印度中央邦赖森区进行。采用扎根理论方法，通过对代表卫生系统（包括 ASHAs）和社区（农村人口）的利益相关者进行深入访谈和焦点小组讨论来收集和分析数据。召集了一组多元化的利益相关者，利用网络规划的五个领域框架（社会文化、教育、组织、经济和物质）来确定挑战的优先级，并共同制定改善家庭访视计划绩效和质量的解决方案。网络框架为评估 ASHAs 家庭访视计划的成功提供了系统的视角。
社会（种姓和经济歧视）和个人（家庭责任和在乡村环境中工作的文化限制）问题成为完成家庭访视的主要限制因素。传授技术知识和技能、指导系统、沟通能力和不尽如人意的薪酬制度方面的方案差距也是服务可信度的障碍。网络规划框架强调，上述因素/领域中的每一个都是相互交织的，并相互影响或依赖，以通过 ASHAs 提供高质量的基于家庭的母婴护理服务。
通过解决社会文化、组织、教育、经济和物质网络领域的问题，并同时努力增强 ASHAs 的技能和信心及其可信度，家庭访视计划服务、质量和影响可以得到提高。
