Voices From The Frontline: A Qualitative Study Of ASHA Workers’ Experiences, Challenges, Expectations And Perceived Gaps In Healthcare Delivery System At Ayushman Arogya Mandir- Sub Health Centres Of Jalgaon District Of Northern Maharashtra

Theme 1. Work experiences of ASHAs

Subtheme

Code

(No of Respondents)

Representative Quotes

1. Expanding Scope of Responsibilities

Multiplicity of programme responsibilities (32)

Earlier our work was mostly related to mother and child health, like immunization and antenatal care, but now every new government programme is given to us, including NCD screening, TB follow-up and different surveys. All responsibilities at the village level come to ASHA, so our workload has increased a lot

Lack of clearly defined work boundaries (29)

We are expected to be available 24 hours in the village, and people think ASHA is like a government doctor who can solve every health problem. Because of this expectation, we are always on call and under pressure

Absence of fixed working hours (27)

We do not have any fixed duty hours like other jobs; if someone calls us at night for a delivery case or any emergency, we have to go immediately. Even during festivals or family functions, we cannot refuse because the community depends on us

2. Emotional Burden and Occupational Stress

Pressure from community and Health system (19)

Sometimes I feel very stressed. In our village, everyone comes to us with their problems, and the officers from the health department also keep asking for reports and targets. As an ASHA worker, it feels like both sides expect too much from me.

Work-life imbalance (30)

After spending the whole day going door to door for surveys, immunization follow-ups, and counselling mothers, my work is still not over. When I return home, I have to cook, clean, and take care of my family. Balancing ASHA duties and household responsibilities becomes very tiring.

Mental exhaustion (08)

During the COVID-19 pandemic, our situation was very difficult. Many people in the village were scared and avoided us, and some even blamed us for bringing infection. That time was extremely stressful for me as an ASHA worker

3. Commitment to Community and Sense of Responsibility

Intrinsic motivation (40)

Sometimes the job is exhausting, but when I see families following health advice, children getting vaccinated, or mothers recovering well after childbirth, I feel that my efforts are meaningful. That satisfaction keeps me going, even on the toughest days.

Community trust (32)

Villagers trust me, and they often call me first during an emergency. That trust makes all the hard work worthwhile, whether it is helping a sick child, assisting in a delivery, or counselling families. It feels rewarding to be someone the community can rely on at any time.

Personal satisfaction (33)

Helping the community gives me satisfaction beyond money. Even if the incentives are small or delayed, the joy of seeing healthier families and happier children motivates me to continue my work as an ASHA worker every day

Theme 2. Operational and systemic challenges

1. Financial Constraints and Incentive-Based Payment Structure

Delay in payments (12)

Our incentive payment comes only after many months, and by that time we have already spent our own money for work-related expenses. It becomes difficult for us to manage because we do not get timely financial support.

Inadequate incentives (17)

For the amount of work and responsibility we handle in the village, the payment we receive is very little. Sometimes we feel that our hard work and effort are not properly valued.

Financial stress at household level (13)

Our family members often tell us that we work the whole day in the field but earn very less income. This creates pressure at home and makes us feel discouraged

2. Community Resistance and Sociocultural Barriers

Vaccine hesitancy (24)

Some families refuse vaccination because they are afraid the child will get fever or weakness, and sometimes they even hide the child when we come for immunization. We try to counsel them patiently, but due to myths and fear, it becomes very difficult to convince them

Gender-related barriers in counselling (31)

During family planning counselling, many husbands do not allow their wives to speak openly or take their own decisions. Because of this, women cannot freely discuss their health concerns, and we face challenges in providing proper guidance.

Influence of traditional beliefs (23)

In tribal villages, people first prefer to visit traditional healers and local faith practitioners, and they call us only when the condition becomes serious. By that time, the health problem is often complicated and harder to manage

3. Infrastructural Deficiencies at Sub-Health Centres

Lack of medicines and supplies (39)

Many times, essential medicines are out of stock at the sub-centre, but villagers think it is our mistake and say we are not doing our duty properly. Even though supply is not in our control, we have to face their complaints and anger.

Poor building condition (12)

We try our best to convince and motivate the community to use government health services, but the available facilities and resources are not sufficient. Without proper support and infrastructure, our efforts alone are not enough

Inadequate counselling space (25)

There is no private space in home or at sub-centre to counsel women about sensitive issues like family planning or reproductive health. Because of lack of privacy, many women feel shy and hesitate to speak openly about their problems

4. Support and Supervision Mechanisms

Target-oriented supervision (07)

Supervisors mostly ask us about targets and numbers, but they rarely ask about the difficulties we face in the field. Our challenges and ground realities are often not understood.

Lack of emotional support (11)

If we are not able to achieve the given target, we get scolded immediately, but nobody tries to understand the reasons behind it. Many times, the problem is due to community resistance or lack of facilities, not our lack of effort

Infrequent review meetings (06)

We need proper guidance, support and encouragement from our seniors, not only checking of registers and records. Motivation and understanding will help us work better and feel respected

5. Safety and Mobility Concerns

Travel in remote areas & Night visits (05)

In some villages we have to walk long distances alone to reach the households. There is no proper path or street lighting, and during rains, it becomes even more difficult. Carrying medicines or supplies on foot makes the work exhausting, yet we cannot leave the families unattended

Personal safety issues (09)

At night, when there is a delivery case, we often feel unsafe because roads are deserted and there are no streetlights. Despite our fears, we go because the mother needs help, and there is no one else available in the village. Sometimes, even wild animals or stray dogs on the way add to the worry, but duty comes first

Theme 3. Expectations of ASHAs

Recognition and Respect

Lack of formal recognition (03)

We are working at the grassroots level, visiting every household and helping people with health issues, yet our efforts hardly get recognized. People often take our work for granted, and it feels like our contribution goes unnoticed as ASHA workers.

Desire for social respect (05)

In official meetings with supervisors and health officials, our voice is not always heard. Even when we have important insights from field experience, decisions are made without considering our perspective, which can be frustrating.

Feeling undervalued (01)

If the government acknowledges our efforts publicly, it really boosts our morale. Simple recognition, awards, or appreciation can make us feel that our hard work as ASHA workers is valued and motivates us to do even more

Theme 4. Perceptions regarding gaps of health care delivery system

1. Training Gaps and Skill Development Needs

Irregular refresher training (23)

We receive training only once in the beginning, but later many new updates and programmes are added to our work. For this new work, we are not always given proper training, so we feel confused and underprepared

Lack of training for new programmes (34)

If regular refresher training and practical guidance are given, we can understand new responsibilities better and work with more confidence. Proper training will help us serve the community more effectively

Need for digital literacy (45)

Now most of the reporting work has become online through mobile apps, but many of us are not fully comfortable using smartphones and digital platforms. Network problems in villages, app errors, phone storage issues, and lack of proper technical support make it even more difficult to upload data on time

2. Expectation–Reality Mismatch

Expectations from health administration & Gap between policy and ground reality (03)

Government schemes and health programs look good, but when we try to implement them at the field level, it becomes very difficult. Sometimes the supplies don’t reach on time, or villagers do not understand the procedures. It feels like a gap between policy and reality, and we are the ones caught in between

Mismatch between responsibilities and authority (05)

We are given targets to achieve, like immunizing all children or visiting every pregnant woman, but we are not provided with enough resources. Medicines, kits, or transport support are often missing, which makes it very hard to meet expectations. The pressure is there, but the tools to complete the work are not