Skip to main content

Advertisement

SpringerLink
Log in

Barriers to the Delivery and Uptake of Water Sanitation and Hygiene (WASH) Promotion and Infant Diarrhea Prevention Services: A Case Study in Rural Tribal Banswara, Rajasthan

  • Research Paper
  • Published:
Indian Pediatrics Aims and scope Submit manuscript

Abstract

Objective

We aimed to identify key barriers to Water Sanitation and Hygiene (WASH) promotion and infant diarrhea prevention services delivered by Accredited Social Health Activists (ASHAs) in rural India.

Methods

A case-study was conducted across nine tribal villages in Banswara district (Rajasthan), where in-depth observational and qualitative data was collected from frontline health workers and infant caregivers.

Results

ASHAs’ prioritization of their incentive-based link-worker tasks over their health activist roles, limited community mobilization, and lack of monitoring of such activities hindered the delivery of WASH promotion and infant diarrhea prevention services. Caregivers’ lack of trust in ASHA’s health knowledge and preference for private providers and traditional healers also hindered the uptake of ASHA’s health promotion services.

Conclusions

Strengthening ASHAs’ health activism roles and building trust on frontline health workers’ knowledge among tribal communities will be the key to address the determinants of child malnutrition and stunting and accelerate progress towards the national development agenda.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Lakshminarayanan S, Jayalakshmy R. Diarrheal diseases among children in India: Current scenario and future perspectives. J Nat Sci Biol Med. 2015;6:24–8.

    Article  Google Scholar 

  2. Mbuya MNN, Humphrey JH. Preventing environmental enteric dysfunction through improved water, sanitation and hygiene: An opportunity for stunting reduction in deve-loping countries. Matern Child Nutr. 2016;(Suppl 1): 106–20.

  3. Ministry of Health and Family Wellfare. Accredited Social Health Activist (ASHA) Operational Guidelines for ASHA under NRHM [Internet]; 2005. Accessed April 6, 2021. Available from: https://nhm.gov.in/images/pdf/communitisation/task-group-reports/guidelines-on-asha.pdf

  4. Sharma R, Webster P, Bhattacharyya S. Factors affecting the performance of community health workers in India: a multi-stakeholder perspective. Glob Health Action. 2014;7: 25352.

    Article  Google Scholar 

  5. NITI Aayog. Accelerating Progress on Nutrition in India: What will it take? Third Progress Report on POSHAN Abhiyaan. New Delhi [Internet]; 2020. Accessed March 30, 2021. Available from: http://www.niti.gov.in/sites/default/files/2020–10/AbhiyaanMonitoringReport.pdf

  6. Directorate of Census Operations. District Census Handbook: Banswara. Banswara, Rajasthan [Internet]; 2011. Accessed April 01, 2021. Available from: https://censusindia.gov.in/2011census/dchb/0827_PART_B_DCHB_BANSWARA.pdf

  7. International Institute for Population Sciences (IIPS). National Family Health Survey — 4: 2015–2016. District Fact Sheet Banswara, Rajasthan [Internet]; 2016. Accessed April 06, 2021. Available from: http://rchiips.org/nfhs/FCTS/RJ/RJ_FactSheet_125_Banswara.pdf

  8. National Health Systems Resource Centre (NHSRC). Which way forward? Evaluation of ASHA Programme. New Delhi [Internet]; 2011. Accessed April 06, 2021. Available from: https://nhm.gov.in/images/pdf/communitisation/asha/Studies/Evaluation_of_ASHA_Program_2010–11_Report.pdf

  9. Parikh P, Kwami C, Khanna R, et al. Linkages between environmental factors (WASH and Energy) and Infant and Young Child Feeding practices in rural India: implications for cross-sectoral interventions for child health. J Water Sanit Hyg Dev. 2021;11:902–15.

    Article  Google Scholar 

  10. Green J, Thorogood N. Qualitative methodology in health research. In: eds. Qualitative Methods for Health Research. 4th ed. 2004. p. 23–65.

  11. Kawade A, Gore M, Lele P, et al. Interplaying role of healthcare activist and homemaker: A mixed-methods exploration of the workload of community health workers (Accredited Social Health Activists) in India. Hum Resour Health. 2021;19:1–12.

    Article  Google Scholar 

  12. Pande B. Are health workers effective in tribal part? Results from evaluation survey of health workers from tribal community. Int J Adv Community Med. 2020;3:215–7.

    Article  Google Scholar 

  13. Dasgupta R, Roy S, Lakhanpaul M. An uphill task for POSHAN abhiyan: examining the missing link of ‘convergence’. Indian Pediatr. 2020;57:109–13.

    Article  Google Scholar 

  14. Sundararaman T, Ved R, Gupta G, Samatha M. Deter-minants of functionality and effectiveness of community health workers: results from evaluation of ASHA program in eight Indian states. BMC Proc. 2012; 6(Suppl 5):O30.

    Article  Google Scholar 

  15. Vir SC, Kalita A, Mondal S, Malik R. Impact of commu-nity-based mitanin programme on undernutrition in rural Chhattisgarh State, India. Food Nutr Bull. 2014;35: 83–91.

    Article  Google Scholar 

Download references

Acknowledgements

Mr Pramod Pandya and Mr Hemant Chaturvedi and other Rajasthan office staff for their support in data collection logistics. We thank the PANChSHEEEL team for the groundwork done on which this study builds up.

Funding

Funding: CHR-CIO PhD studentship at UCL GOS-ICH, with further travel funding from the UCL Chadwick Trust. ML was supported by NIHR-BRC based at UCL ICH/Great Ormond Street Hospital NHS Foundation Trust.

Author information

Authors and Affiliations

  1. Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK

    Julia Vila-Guilera & Monica Lakhanpaul

  2. Centre of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi, India

    Rajib Dasgupta

  3. Engineering for International Development Centre, The Bartlett, UCL Faculty of the Built Environment, London, WC1H 0QB, UK

    Priti Parikh

  4. Healthy Infrastructure Research Centre, UCL Department Civil, Environmental and Geomatic Engineering, London, WC1E 6BT, UK

    Lena Ciric

  5. The Whittington Health NHS Trust, The Whittington Hospital, Magdala Avenue, London, N19 5NF, UK

    Monica Lakhanpaul

Authors
  1. Julia Vila-Guilera
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rajib Dasgupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Priti Parikh
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lena Ciric
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Monica Lakhanpaul
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Contributors: ML, PP, RD and the PANChSHEEEL team: developed the initial project idea; JVG: carried out the data collection, while supervised by all other co-authors; JVG: analysed the data with contributions from RD; JVG: drafted the manuscript with inputs from RD, ML, PP, LC. All authors read, edited, and approved the final manuscript.

Corresponding author

Correspondence to Julia Vila-Guilera.

Ethics declarations

Ethics clearance: UCL Research Ethics Committee in the UK, No.4703/001; and the Institute of Health Management Research Ethics Committee in India, No. 04/05/2019-01.

Competing interests: None stated.

Additional information

Note: Supplementary matter related to this article is available at https://www.indianpediatrics.net

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vila-Guilera, J., Dasgupta, R., Parikh, P. et al. Barriers to the Delivery and Uptake of Water Sanitation and Hygiene (WASH) Promotion and Infant Diarrhea Prevention Services: A Case Study in Rural Tribal Banswara, Rajasthan. Indian Pediatr 59, 38–42 (2022). https://doi.org/10.1007/s13312-022-2418-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13312-022-2418-4

Keywords

Search

Navigation