"Want a Job with a Safer Future" Findings from an Exploratory Qualitative Inquiry with Community Health Officers Using Time-Motion Study.

Abstract

Background: Community Health Officer (CHO) is a newer cadre of health-care providers introduced under the Ayushman Bharat Program to enhance the functioning of Health and Wellness Centres by taking health-care services closer to the community.

Objectives: The objectives of this study were to assess the work pattern and workload of CHOs and understand the barriers and challenges faced by them during delivery for improving their efficiency.

Materials and methods: An exploratory qualitative inquiry was done with six purposively chosen CHOs from all the primary health centres of a rural community development block in Central India using time-motion study as a tool. Each CHO's work pattern, workload was studied for 1 week using 24-h recall method. Validation of the information provided by CHOs was done by asking them to submit activity photographs. Semi-structured interviews were conducted with CHOs and analyzed using thematic analysis to understand their perspectives, barriers, and challenges.

Results: They were found to spend roughly 64.2% of their time on curative work, 21.3% on managerial work, and around 14.5% on promotive, preventive work. On data triangulation, a knowledge-application gap was observed. The major barriers and challenges found were focus on clinical care, lack of microplanning, insufficient resources, and no job security.

Conclusion: The work distribution of the CHOs is focused more on curative and managerial aspects with minimal focus on promotive, preventive aspects. To foster "Wellness" of the community through a holistic approach as envisaged under the Ayushman Bharat Program, strategies need to be devised with greater emphasis on health promotion, addressing the challenges raised by this new cadre.