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. 2018 Nov 26;16(1):64.
doi: 10.1186/s12960-018-0327-3.

Functioning and time utilisation by female multi-purpose health workers in South India: a time and motion study

Samiksha Singh  1 , Neha Dwivedi  2 , Amol Dongre  3 , Pradeep Deshmukh  4 , Deepak Dey  2 , Vijay Kumar  5 , Sanjeev Upadhyaya  2
Affiliations

Functioning and time utilisation by female multi-purpose health workers in South India: a time and motion study

Samiksha Singh et al. Hum Resour Health. .

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.

Keywords: Community health services; Health workers; India; Multi-purpose health workers; Personnel management; Time and motion study.

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Conflict of interest statement

Ethics approval and consent to participate

The Institutional Review Board of the Centre for Economic and Social sciences granted ethical approval for this study. A written informed consent was obtained from all the participants before recruiting them for observation or conducting the interview. Permission was sought of the administration of the respective locations before initiation of the study (District Medical & Health Officers).

Consent for publication

All the authors have reviewed the final manuscript and provide consent for publication.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Median time spent by ANM from home to home, on job and on designated work in hours per ANM by day of the week
See this image and copyright information in PMC

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