A Study on the Factor Affecting Performance of FHW – A Study on FHW’s of Ahmedebad District

 

Mridula Pandey¹, Tarang Mishra²

¹Research Scholar, Department of Management, Kalinga University, New Raipur, Chhattisgarh,

²Senior Manager, Kalinga University, Naya Raipur, Chhattisgarh,

²Narottam Sekseria Foundation, Mumbai.

ABSTRACT:

Background: Indian health care delivery system is a three tire system, with FHW’s being the basic unit of service delivery. All the components of public health system are being implemented by them. The well functioning health care delivery system requires skilled and competent nursing workforce. The performance of female health workers does not depend solely on her knowledge level and competency, but to a large extent upon the facilities being provided by the organization, the demography of the region and upon other factors such as religion, occupation of her husband and other associated factors. The study explores the factors which contribute in performance of FHW’s. Methods: Stratified sampling technique was used to identify the target of the study, female health workers, district level officials and supervisory staff. Use of questionnaire and structured interviews were conducted to get responses of FHW’s and other officials. Octapace tool has been used to design the questionnaire. Results: The study shows that only 40% of FHW’s scored well in terms of performance, which depends upon many factors. Conclusion: The performance of FHW’s depends on many factors which are interrelated with each other. The motivation level of FHW’s plays big role in the achievement of organizational goals.

 

 

 

INTRODUCTION:

The role of FHW in India changed over the past four decades .Earlier they were seen as just assistants of the midwife in maternal and child health centers .But during 1960-1970 family planning was integrated with MCH activities and promoted as programme deserving highest priority.

 

The new Family welfare programme adopted a system of targets incentive and ANM’s along with other village level worker were identified as main stakeholders for the programme implementation, Later the executive committee of the center’s family planning council transformed FHW’s in to multipurpose worker (MPW).Since then they have become the key players at the grass-root level for health services provision. The performance of FSW’s depend to a large extent on the work environment she gets, her relationship with the peers, sub ordinates and supervisors and also upon the factors motivating her to perform her duties better. The FHW’s are the basic unit of the implementation and her performance directly affect the goal of any health programme. To enhance her performance, many efforts has been made like making provision for good infrastructure, provision of necessary equipment and capacity building through many training eg. IMNCI, TB, and Malaria  etc. The planning for ensuring provision of supplies and capacity building of FHW’s has been uniform with very slight variations, but still there has been huge variation in the performance of FHW’s. It has been noticed that the performance of FHW’s depends to a large extent on not only the competency but many other factors which needs to be considered to assess what are the factors which contribute in motivating the FHW’s to perform her duties well. The motivation level of FSW’s decides that whether she will perform her duties well and which will be translated into the achievement of organizations goals.

 

METHODS:

Study Approach:

Aim of the study is to assess factors which are affecting the performance of FHW’s.

·         A situational analysis of the district was done with keeping FHW in focus. Information associated with FHW had been collected

·         Series of interview conducted with the senior officials of district like CDHO, RCHO and other programme officer.

·         Interview of other employee like MO, PHN, LHV and FHS was also conducted.

·         The data collected by questionnaire of tool OCTAPACE.

 

Type of data:

·         Primary data – Data collected with help of Questionnaire checklist and interview.

·         Secondary data - Monthly records of the District Panchayat.

·         Annual action plan of the district   

 

Instruments or Tools:

·         Questionnaire:

OCTAPACE- The *OCTAPACE profile is a 40-item instrument that gives the profile of organization’s ethos in eight values. These values are openness, confrontation, trust, authenticity, pro-action, autonomy, collaboration and experimentation. The instrument contains two parts. In part I, values are stated in items 1 to 24 (three statements of each of the eight values), and the respondent is required to check (on a 4-point scale) how much each item is valued in his organization. Part 2 contains sixteen statements on beliefs, two each for eight values, and the respondent checks (on a 4-point scale) how widely each of them is shared in the organization.

 

CHEKLIST:

A checklist having close ended question which help to assess the performance of the FHW and to assess their work priorities.

·         Interview-Semi-Structured interview is been conducted to know the view of supervisors

 

Selection of Sample:

·         Stratified sampling - Using stratified sampling, the population is divided into homogeneous, mutually exclusive groups called strata, and then independent samples are selected from each stratum.

·         In 36 PHC of the district 9 PHC has been selected and 5 sub center from each PHC has been taken .The total sample size is of 45 FHW.

·         6 District officials were interviewed.

·         Block LHV, FHS and MO of all 9 PHC were also interviewed.

 

Study Process:

·         Preparation of checklist and questionnaire to gather the basic information about FHW and to assess her performance. The questionnaire of tool OCTAPACE was translated in Gujarati language

·         9 PHC were selected according to performance and distance from the district. The PHC near Ahmedabad is having rural as we as urban population also so distant PHC are also taken in to the consideration.

·         The data was compiled with help of Microsoft Excel.

 

RESULTS:

The responses of FHW’s were collected to understand the level of motivation and its impact on performance of FHW’s. The findings were collected on demographic and socio economic profile of the FHWs and also examines the resource and facilities available at SC level.

 

Demographic profile of FHW –

Age Distribution of FHW
Age in years	Distribution in %	Frequency
<30	9	4
30-35	13	6
36-40	24	11
41-45	33	15
46-50	11	5
51-55	4	2
>55	4	2
Total	100	45

 

Average Age:

The median age of FHW is 42.Maximum proportion of the FHW (70%) being in the age group of 30-45. N=45

 

Year of Experience:

If we see the percentage of distribution on number of years of experience of FHW’s, its not equally distributed between the 11-15 to 21-25. The Highest number of population having 6-15 years of experience.

Year of Experience
Years Of experience	Distribution in %	Frequency
0-5	16	7
6 to 10	27	12
10to15	33	15
16-20	13	6
21-25	7	3
>25	4	2
Total	100	45

N=45

 

In job such as of FHW‘s the number of years experience is an assets. As with experience their skills of communication improves with the community and they develop reputation in the community.

 

Marital Status:

82% of the FHW were married and 9% were unmarried .For about 22% of FHWs the Safety remains the major concern in case they stay alone at HQ or if they have to travel to remote field locations.

 

Marital Status of FHW
Marital status	Distribution in %	Frequency
Married	82	37
Single	7	3
Separated	2	1
Widow	9	4
Total		45

N=45

 

 

Socio Economic Profile of FHW:

Education Status:

More then 69% of the total FHW has done SSC+FHW course and 10% are Graduate.

 

Education Status of FHW
Education Level	Distribution in %	Frequency
SSC + FHW Course	69	31
Graduate +FHW Course	16	7
HSC+FHW course	11	5
SSC	4	2
Total		45

N=45

 

 

Caste distribution:

Caste wise Distribution
Caste	Distribution  in %	Frequency
GEN	20	9
OBC	13	6
SC	42	19
ST	25	11
Total		45

N=45

 

Majority of the FHW were Schedule caste (around 42%) and around 20% were from general category. The analysis of interview conducted with the FHW’s revealed that as the job profile of FHW involve lot of field visits, regular traveling and involvement with community .Women from upper caste were hesitant to join

 

Family back ground:

There are 4-5 average number of family member in the each family .More than 40% of the FHW, husband were in Government job. 12% were unemployed .The interview revealed that the FHW’s with husbands being un employed faced problem in dedicating time for job due to mental tension from household level. Compared to them those whose husbands were with govt. service worked more independently and could devote more time on job.

 

Husband's Occupation
Profession	Distribution in %	Frequency
Government job	49	22
Private Job	29	13
Business	16	7
No Job	7	3
Total		45

N=45

 

 

Availability of Infrastructure and Staff-

Status of the sub center building
	Distribution in %	Frequency
Sub Center has building	93	42
Sub Center has no building	7	3
Total		45

N=45

 

 

Physical Infrastructure:

Physical infrastructure is an important input for the quality of the service, moral of the workers as well as to make the centre look attractive for the probable users. Lack of such basic amenities reflects badly on the service quality.

 

Facilities and equipment available and Functional in Sub Center:

Most of the facility and instrument are adequate in number but there functionality is not the same. The equipments which were non functional in majority were hameoglobinometer and stethoscope.

 

Status of Sub centre building:

The building of sub center is a crucial factor in keeping the worker motivated towards her work. With a stable govt. building in place the FHW becomes answerable to open it in scheduled time and maintain it.

 

 

 

 

Status of Facilities and equipment in sub center
Facility or equipment	Available (in %)	Available ( infrequency)	Functional (In %)	Functional (in frequency)
Electricity	96	43	95	41
Water supply	100	45	100	45
Cupboard	100	45	100	45
Table	100	45	100	45
Chair	100	45	100	45
Weighing Machine	100	45	100	45
Stethoscope	100	45	51	23
BP instrument	100	45	51	23
Thermometer	100	45	78	35
Hemoglobin meter	100	45	27	12
Registers	100	45	100	45
Banners and poster	100	45	84	38
Medicine	100	45	91	41

N=45

 

Only 6% had no building for sub center. But not all the sub center were adequate for providing services and to be used for residential purpose.

 

Availability of support staff and manpower:

The work of FHW requires lots of effort and cannot be completed satisfactorily unless there is support from MPW’s and AWW workers.

 

Availability of MPW(M)
Availability	Distribution in %	Frequency
MPW  Present	93	42
MPW not present	7	3
Total		45

 

Availability of Aganwadi Worker
Availability	Distribution in %	Frequency
AWW present	97.78	44
AWW not present	2.222	1
Total		45

N=45

 

The district and PHC’s under study showed that the positions of AWW and MPW were filled in over 95% of centers.

Place of stay:

The place of stay of FHW gives a reflection of her work. If the worker stays at the HQ she can devote more time in working. Major issue relating the efficacy of health care delivery system is depends upon whether FHW stays on sub center or easily accessible to the people.

 

Place of stay
Place of stay	Distribution in %	Frequency
Sub center	9	4
HQ Village	13	6
Block City	24	11
District	53	24
Total		45

N=45

 

Only 17% FHW stays at sub center and 20% in Head quarter village.

 

Performance of FHW:

To measure the performance of FHW a checklist is prepared with have 10 dimension of her performance .

 

 

 

ü  Achievement of annual target of Family Planning

ü  Achievement of annual target of ANC

ü  Achievement of annual target of Institutional Delivery

ü  Achievement of annual target of Immunization

ü  Stay at head quarter

ü  Regular organization of Mamta Diwas

ü  Attendance of PHC meeting

ü  Regular record keeping

ü  Quality of record

ü  Regular Community visit.

 

 

Performance of FHW
Performance	Distribution in %	Frequency
1-5(Poor)	22	10
6-8(average)	38	17
8-10(Good)	40	18
		45

N=45

 

Only 40% are scored well. Many of them scored less in community visit and quality of record. The target of Family planning was achieved by almost every one. Assessment of Motivation in FHW in exiting Organization Culture (OCTAPACE Score)

 

ü  The value openness got mean value 15.4 which is a not high score. We can infer that there is lack of genuine information sharing within the department. Simple information like feedback other innovative idea of doing work is not shared with the FHW’s.

ü  The value Confrontation scored 14.9 which is again not high score. This shows that no sharing and acceptance of problem or mistake. The kind of supervisory system which exists in the department only tries to find mistakes of the FHW’s which is one reason why they do not share their problems. The value trust is scored 12 which is even less then low value. There is huge gap of trust between FHW and system.

ü  The value Authenticity scored 12 which is medium score. The same conclusion that there is gap between what you feel and what you say.

ü  The value Proaction scored 14 which is medium value. This gap is due to FHW was never oriented for planning of work they use to do. She is not even aware about the goal of each programme so its difficult for her to think about the outcome. It is also clear in priorities of task she given health education least priorities. She do the work assign by her supervisor with thinking about the outcome.

ü  The Value Autonomy 11.7 which is again a very low value .This scored again infer that she has very less freedom to plan her work.

ü  The Value Collaboration scored the 14.7 which is the medium score .Here they have collaboration means not only giving help but also asking for it .They have collaboration between them self but don’t ask help from supervisor this can be one gap for progress.

ü  The value experiment again scored very low value 10.9.This value direct has relation with proaction and autonomy. If she don’t have freedom to plan her work it is very difficult to aspect any innovation or experiment from her.

 

 

 

DISCUSSION:

The performance of FHW’s depends not only on her competency but on a range of factors which directly or indirectly affects her performance. The personal factors such as age, marital status and husbands occupation also affects to a large extent upon her performance in the field. In the current study, the FHW’s population has been that of older age group and although they brought immence amount of experience with them, but their roles in utilizing new technologies and trainings was questionable. As the functionality of hameoglobinometer and stethoscope suggest that this old carder is not using these equipments frequently that’s why its breakdown is not addressed promptly. Similarly the responses from the interviews when analyzed and studied revealed that although the work force in majority were married with husbands working in govt. sector , but those who had un employed husbands at home had problems in devoting 100% attention to work. Another factor was of caste and its effect on work. As majority of FHW’s were either SC, general or OBC with very few belonging to ST category, when asked individually responded that they avoid giving services to ST population.

 

The availability of infrastructure of SC was a motivating factor for FHW. Majority of them with SC had better performance and scored high in terms of motivation than those who didn’t had SC building. The octapace score on assessing the motivation of FHW’s revealed that in none of the eight areas under study the FHW’s scored high, it was medium for 6 and low for 2 out of the eight parameters. There is lack of We can infer that there is lack of genuine information sharing acceptance of problem or mistake , freedom for micro-planning , collaboration with supervisory staff, and goal settings within the department. The FHW’s are not clear on the goal that they intend to achieve after such high amount of work and due to lack of ownership and trust from the department, they have low motivation level towards her work.

 

ACKNOWLEDGEMENT:

The authors present there sincere gratitude and thanks to the Department of Health and Family Welfare, Government of Gujarat for allowing to conduct study in health department. Special thanks to Health Commissioner Dr. Amarjit Singh .The authors would also like to thank MR. A. J. Shah, DDO Ahmedabd for providing necessary support for conducting the study. The study could not have been completed without the immense cooperation of Block Health officers, MO’s and ANM’s of Ahmedabad district.

 

CONFLICT OF INTEREST:

The article entitled A Study on the factor affecting performance of FHW – A Study on FHW’s of Ahmedebad District is herewith submitted for publication in Asian Journal of management. It has not been published before, and it is not under consideration for publication in any other journals. We certify that we have obtained written permission for the use of text, tables, and/or illustrations from any copyrighted source, and we declare no conflict of interest.

 

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