The Impact of Financial Incentives on ASHA’s Performances and Health Outcomes

Gujarat has in recent years experienced significant improvements across a number of key health indicators from NFHS-3 to 4. However, large gaps remain especially in the take-up of maternal and child health services. As an example, in Gujarat only 24% of mothers had full ANC care (as per data from NFHS-4). In order to address the health needs of the most vulnerable parts of society, in 2005 the Government of India created a new figure of community based functionaries, called Accredited Social Health Activist (ASHA). ASHAs are meant to be the first port of call for any health-related demands of deprived sections of the population, especially women and children, who have difficulties in accessing health services. However, the ASHAs are honorary volunteers and do not receive any salary or honorarium, although they are supposed to receive compensation for completion of some specific activities. Hence, they currently face very limited financial incentives to perform their task. Dissatisfaction with incentives can lead to lower health worker motivation, and negatively affect performances.

This project aimed at achieving the desired improvements in health outcomes by strengthening the existing ASHA cadre of frontline workers. Specifically, the pilot and scoping study was designed to lead into a full evaluation, which aimed at studying whether pay-for-performance, fixed pay, or an entrepreneurial approach to health delivery have different impact on community health worker performance and, in that case, how and why.

This project is now closed, and did not proceed into full evaluation stage. Final results were shared in June 2020.