4.1 Purpose and Approach
To augment the FGDs and KIIs presented in the previous chapter (3), Project RISE extended the qualitative research effort to capture a deeper and more holistic view of the ASHA’s day-to-day lived experience. This included qualitative methods and techniques borrowed from ethnography: multiple in-depth one-on-one interviews with ASHAs, additional specialized FGDs, shadowing of ASHAs, participant observation, and the observation of community events. A cultural anthropologist and two field assistants conducted this extended qualitative fieldwork in the Samastipur district of Bihar from February to March of 2019, shortly after the completion of the FGDs and KIIs.
These further qualitative investigations included discussions with additional ASHAs, ASHA Facilitators, trainers, ANMs, Mamtas, Dais, and PHC (Primary Health Center) doctors and staff. A major component of this effort consisted of time spent in the ‘field’ with ASHAs, observing their daily activities, within their homes and outside in the community working. Thus, Project RISE observed the various kinds of exchanges ASHAs have with the community and at PHCs over the course of their working day. This included observations made at a 5-day residential ASHA training session and monthly meetings they attended at their panchayat-level health sub-centres and block-level PHCs.
By borrowing methods commonly used in ethnography, this added to the mixed-methods approach of Project RISE. This was important for ensuring that the data informing the design-phase included insights and other nuances that can only be gained with extensive interaction and direct observation of behavior, which are opportunities that can’t be gained with surveys alone. As explained by anthropologist Margaret MacDonald, who makes a strong case for the value of ethnography in global health MacDonald (2017, 3), “ethnography matters in global health because it produces distinctive, locally grounded knowledge that can contribute to the multi–disciplinary and inter–sectoral effort to create effective solutions to pressing and persistent global health problems.”
A series of short case-studies based on this extended ethnographic effort can be found in Appendix A.
In what follows we first present some excerpts as some of this ‘raw’ qualitative data. We then present some of the main themes from these extended qualitative efforts, emphasizing those themes which shaped the design-phase of Project RISE and which led to insights supported by other data streams.