10.12 Co-design for HMW Theme 1A

‘Revisiting the ASHA role and crafting a clear value proposition for the community, health system, and for themselves.’

10.12.1 Objectives and Recruitment

The goal of the second set of co-design sessions in January 2021 was to:

  1. Understand the value perception of the ASHA role from their own perspective and from the community perspective.

  2. Explore how the value perception of the ASHA role can be improved for ASHAs by providing growth pathways beyond their current role.

  3. Explore how the image of ASHAs for community members can be made more positive and revered.

To this end we recruited one group of an ASHA facilitator, 2-3 ASHAs under her, a Jeevika leader, an Anganwadi worker (AWW), and a Panchayat leader (Mukhiya) all of whom worked in the same block. After initial rapport building calls to introduce the project, we held individual calls with each person to understand how they perceive the position of the ASHAs in the community, among the CHW cadre, and what respect they have (or don’t have). This co-design also ended with a group call which shared the outputs from the one-on-one discussions, and a discussion around possible solutions.

Diagram: The process of co-design 1A:

Link to the Activity Plan which contains details about each of these sessions.

10.12.2 Lessons Learned

Recruitment & Rapport - To avoid bias, participants were recruited in an area with lower smartphone penetration and digital access than those initially recruited in HMW 1B. This increased the ‘Distance to Participant’ for the interviewer, and led to difficulties in communication, organizing calls, and responsiveness. Because the group was mostly speaking on phone calls, there wasn’t the same ‘sense of community’ that occured with the 1B group, which came together on Whatsapp.

The PCI recruitment team was especially crucial to identifying participants, building participation and rapport, but building rapport still took time over multiple calls. Specifically, the Mukhiya that was recruited had to drop off due to other commitments, and therefore had to contact a larger pool of women across the roles to get this number of participants.

Activities - One of the tasks the participants were asked to do was to write a story based on a prompt and send it back to us, but without Whatsapp the participation rate was very low for this activity and much harder to follow up on.

Surprise - One thing that wasn’t expected was a participant with her own Youtube channel, creating self-made content on children’s health, education, and one video on immunization!

10.12.3 Synthesis

The co-design sessions were documented and translated to English for processing: 4. Transcription of all sessions to Google Docs. 5. Organization of all responses into broad themes in a Google Doc - each response was categorized responders’ role, and then topic. 6. Synthesis on to miro board - iteratively summarizing the theme clusters and sub-clusters.

The participants’ answers were documented and grouped loosely by 9 idea clusters and further nuance was captured in sub-clusters. These quotes were then sorted on a Miro board which narrowed the clusters into 5, based on the quotes’ affinity with each theme.

These 5 clusters are Respect and Value, Disrespect and Sacrifice, Change in Community, Logistics, and Community Worker Relationships, which capture the range of answers that were given by each participant about the ASHAs role and status within the community.

See Annex for Themes and Clusters

10.12.4 Emerging Ideas

From these clusters idea sparks emerged both from the quotes directly and also through brainstorming sessions with the team. Emerging ideas fall into five main categories: Payments, Relationships, What is hers’, Training, and Public Recognition. Within each of these categories there are many sub-ideas which can be combined or used in multiple ways to improve ASHAs workload, motivation, efficacy, and so forth. For example, ideas in the ‘What is Hers’ category respond to quotes and findings around the need for ASHAs to have a ‘home base’ through which to reach her, making her more reliably available for beneficiaries going into labor. While this could be a literal space or location, it could also be digital or a formalized way to contact her while she is about in the community.

From this brainstorm the team developed 5 specific concepts which combine the strongest aspects of the ideas. The priority was on ideas that addressed ASHA’s role and value proposition.

See Annex for all emerging ideas