Functioning and time utilisation by female multi-purpose health workers in South India: a time and motion study
Abstract Background Auxillary nurse midwives (ANMs) are the most important frontline multi-purpose workers in rural India. This study was conducted to assess the spectrum of service delivery, time utilisation, work planning, and factors affecting functioning of ANMs in South India. Methods We conduc...
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| Format: | Article |
| Language: | English |
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BMC
2018-11-01
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| Series: | Human Resources for Health |
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| Online Access: | http://link.springer.com/article/10.1186/s12960-018-0327-3 |
| _version_ | 1818131363821256704 |
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| author | Samiksha Singh Neha Dwivedi Amol Dongre Pradeep Deshmukh Deepak Dey Vijay Kumar Sanjeev Upadhyaya |
| author_facet | Samiksha Singh Neha Dwivedi Amol Dongre Pradeep Deshmukh Deepak Dey Vijay Kumar Sanjeev Upadhyaya |
| author_sort | Samiksha Singh |
| collection | DOAJ |
| description | Abstract Background Auxillary nurse midwives (ANMs) are the most important frontline multi-purpose workers in rural India. This study was conducted to assess the spectrum of service delivery, time utilisation, work planning, and factors affecting functioning of ANMs in South India. Methods We conducted a time and motion study in three districts across two states in South India. The districts selected in such a manner that they had a considerable tribal population. We conducted multi-stage sampling to select ANMs. We directly observed 43 ANMs consecutively for six working days and in-depth interviewed all selected ANMs, their supervisors, medical officers, and district health officials. We conducted an FGD to substantiate the findings from observations and interviews. Observation findings were analysed under three broad domains: (i) programme activities, (ii) programme support activities, and (iii) other work. Time spent was calculated in median (interquartile range, IQR) minutes/ANM per week or day. Qualitative data were coded and analysed using grounded theory, and appropriate themes and sub-themes were identified. Results ANMs worked for median 7 h a day (7:10 h, non-tribal; 6:20 h, tribal). There is variation in the hours of work, the pattern of service provided and time utilisation across days of a week. ANMs spent 60% of their on-job time on programmatic activities (median 22:38 h; IQR, 20:48–27:01 h) in a week. Emphasis is more on home visits, universal immunisation, antenatal care, school health, and seasonal diseases. ANMs spent negligible time on non-communicable diseases, adolescent health, nutrition, etc. ANMs spent the remaining time in program support activities, such as meetings with seniors, community meetings, and other non-health related work. There are no renewed job description, work plans, and supervision guidelines, even with newly added programs and tasks. ANMs prioritised work as per the priorities set by the supervisors and leaders. Health administration often disrupts the regular functioning of ANMs for training, meetings and other ad hoc work. Conclusion ANMs are overworked; they often multi-task and fail to deliver efficiently. The administration needs to re-assess the workload. The administration may reduce expected work, provide strong supervisory support, and make conscious efforts to pose fewer disruptions in regular working of ANMs. |
| first_indexed | 2024-12-11T08:19:45Z |
| format | Article |
| id | doaj.art-45ae4d419d4b438296405b143dcb3e72 |
| institution | Directory Open Access Journal |
| issn | 1478-4491 |
| language | English |
| last_indexed | 2024-12-11T08:19:45Z |
| publishDate | 2018-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Human Resources for Health |
| spelling | doaj.art-45ae4d419d4b438296405b143dcb3e722022-12-22T01:14:40ZengBMCHuman Resources for Health1478-44912018-11-0116111110.1186/s12960-018-0327-3Functioning and time utilisation by female multi-purpose health workers in South India: a time and motion studySamiksha Singh0Neha Dwivedi1Amol Dongre2Pradeep Deshmukh3Deepak Dey4Vijay Kumar5Sanjeev Upadhyaya6Indian Institute of Public Health-Hyderabad, Public Health Foundation of IndiaUNICEF Hyderabad Field OfficeDepartment of Community Medicine, Sri Manakula Vinayagar Medical College and HospitalDepartment of Community Medicine, All India Institute of Medical SciencesUNICEF Hyderabad Field OfficeCentre for Economic and Social Studies (CESS)UNICEF Hyderabad Field OfficeAbstract Background Auxillary nurse midwives (ANMs) are the most important frontline multi-purpose workers in rural India. This study was conducted to assess the spectrum of service delivery, time utilisation, work planning, and factors affecting functioning of ANMs in South India. Methods We conducted a time and motion study in three districts across two states in South India. The districts selected in such a manner that they had a considerable tribal population. We conducted multi-stage sampling to select ANMs. We directly observed 43 ANMs consecutively for six working days and in-depth interviewed all selected ANMs, their supervisors, medical officers, and district health officials. We conducted an FGD to substantiate the findings from observations and interviews. Observation findings were analysed under three broad domains: (i) programme activities, (ii) programme support activities, and (iii) other work. Time spent was calculated in median (interquartile range, IQR) minutes/ANM per week or day. Qualitative data were coded and analysed using grounded theory, and appropriate themes and sub-themes were identified. Results ANMs worked for median 7 h a day (7:10 h, non-tribal; 6:20 h, tribal). There is variation in the hours of work, the pattern of service provided and time utilisation across days of a week. ANMs spent 60% of their on-job time on programmatic activities (median 22:38 h; IQR, 20:48–27:01 h) in a week. Emphasis is more on home visits, universal immunisation, antenatal care, school health, and seasonal diseases. ANMs spent negligible time on non-communicable diseases, adolescent health, nutrition, etc. ANMs spent the remaining time in program support activities, such as meetings with seniors, community meetings, and other non-health related work. There are no renewed job description, work plans, and supervision guidelines, even with newly added programs and tasks. ANMs prioritised work as per the priorities set by the supervisors and leaders. Health administration often disrupts the regular functioning of ANMs for training, meetings and other ad hoc work. Conclusion ANMs are overworked; they often multi-task and fail to deliver efficiently. The administration needs to re-assess the workload. The administration may reduce expected work, provide strong supervisory support, and make conscious efforts to pose fewer disruptions in regular working of ANMs.http://link.springer.com/article/10.1186/s12960-018-0327-3Multi-purpose health workersHealth workersCommunity health servicesPersonnel managementTime and motion studyIndia |
| spellingShingle | Samiksha Singh Neha Dwivedi Amol Dongre Pradeep Deshmukh Deepak Dey Vijay Kumar Sanjeev Upadhyaya Functioning and time utilisation by female multi-purpose health workers in South India: a time and motion study Human Resources for Health Multi-purpose health workers Health workers Community health services Personnel management Time and motion study India |
| title | Functioning and time utilisation by female multi-purpose health workers in South India: a time and motion study |
| title_full | Functioning and time utilisation by female multi-purpose health workers in South India: a time and motion study |
| title_fullStr | Functioning and time utilisation by female multi-purpose health workers in South India: a time and motion study |
| title_full_unstemmed | Functioning and time utilisation by female multi-purpose health workers in South India: a time and motion study |
| title_short | Functioning and time utilisation by female multi-purpose health workers in South India: a time and motion study |
| title_sort | functioning and time utilisation by female multi purpose health workers in south india a time and motion study |
| topic | Multi-purpose health workers Health workers Community health services Personnel management Time and motion study India |
| url | http://link.springer.com/article/10.1186/s12960-018-0327-3 |
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