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Abstract <p>Community healthcare workers (CHWs) play a critical role in providing vital healthcare services, particularly in the field of reproductive and sexual health, as well as maternal, neonatal, child health and nutrition (RMNCHN) in India. Functioning at the intersection of healthcare system and local communities, CHWs not only facilitate access to care but also foster trust, acceptance and sustained engagement among beneficiaries. In this context, it becomes imperative to critically assess the motivational factors and the systemic conditions that shape the performance and aspirations of -Accredited Social Health Activists (ASHA), Anganwadi Workers (AWW), and Auxiliary Nurse Midwives (ANM)-as these factors directly impact the efficacy and sustainability of health interventions.</p> Objective <p>The study aims to investigate the intricacy of motivations, barriers and systemic challenges that may shape the performance of community health workers, specifically ASHAs, ANMs, and AWWs-working on the frontlines of healthcare services in the urban slums of Noida-Greater Noida, Uttar Pradesh, India.</p> Methodology <p>This study employs a cross-sectional design with a qualitative methodology, drawing on in-depth personal interviews and focus group discussions to capture the complex, lived experiences of community health workers. The array of qualitative data was systematically coded and analysed using NVIVO software, yielding deep insights into the motivational landscapes and contextual determinants that impact performance dynamics on the ground.</p> Conclusions <p>Lack of organisational support emerges as a critical constraint in the operational landscape of community health workers (CHWs) in India. This study underscores the dichotomy at the centre of grassroot healthcare delivery: CHWs remain indispensable to public health interventions among India’s marginalised and underserved communities, yet they continue to be overburdened, underpaid and structurally undervalued. Despite the scarcity of resources and institutional neglect, these frontline workers demonstrate a strikingly high degree of performance motivation. Intriguingly, their motivation is not primarily driven by material incentives but is deeply embedded in affective and symbolic realms—morality, religious and spiritual conviction, personal identity, and a sense of autonomy. Nonetheless, the absence of institutional recognition, limited financial compensation, insufficient infrastructural support, and inadequate appreciation from supervisory bodies significantly undermine their morale and long-term sustainability. The findings call for a reimagining of organisational frameworks that move beyond tokenism to genuinely support, recognise, and empower these vital agents of change.</p>

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Exploring the motivations and barriers affecting community health workers’ performance in the Noida-Greater Noida Region

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年9月13日

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  • Pratyush Bibhakar,
  • Manasi Sinha

摘要

Abstract

Community healthcare workers (CHWs) play a critical role in providing vital healthcare services, particularly in the field of reproductive and sexual health, as well as maternal, neonatal, child health and nutrition (RMNCHN) in India. Functioning at the intersection of healthcare system and local communities, CHWs not only facilitate access to care but also foster trust, acceptance and sustained engagement among beneficiaries. In this context, it becomes imperative to critically assess the motivational factors and the systemic conditions that shape the performance and aspirations of -Accredited Social Health Activists (ASHA), Anganwadi Workers (AWW), and Auxiliary Nurse Midwives (ANM)-as these factors directly impact the efficacy and sustainability of health interventions.

Objective

The study aims to investigate the intricacy of motivations, barriers and systemic challenges that may shape the performance of community health workers, specifically ASHAs, ANMs, and AWWs-working on the frontlines of healthcare services in the urban slums of Noida-Greater Noida, Uttar Pradesh, India.

Methodology

This study employs a cross-sectional design with a qualitative methodology, drawing on in-depth personal interviews and focus group discussions to capture the complex, lived experiences of community health workers. The array of qualitative data was systematically coded and analysed using NVIVO software, yielding deep insights into the motivational landscapes and contextual determinants that impact performance dynamics on the ground.

Conclusions

Lack of organisational support emerges as a critical constraint in the operational landscape of community health workers (CHWs) in India. This study underscores the dichotomy at the centre of grassroot healthcare delivery: CHWs remain indispensable to public health interventions among India’s marginalised and underserved communities, yet they continue to be overburdened, underpaid and structurally undervalued. Despite the scarcity of resources and institutional neglect, these frontline workers demonstrate a strikingly high degree of performance motivation. Intriguingly, their motivation is not primarily driven by material incentives but is deeply embedded in affective and symbolic realms—morality, religious and spiritual conviction, personal identity, and a sense of autonomy. Nonetheless, the absence of institutional recognition, limited financial compensation, insufficient infrastructural support, and inadequate appreciation from supervisory bodies significantly undermine their morale and long-term sustainability. The findings call for a reimagining of organisational frameworks that move beyond tokenism to genuinely support, recognise, and empower these vital agents of change.