Bihar is one of India’s largest states, home to almost 100 million people. It is also one of its poorest states, affected with high maternal and infant mortality rates, malnutrition, anemia, poor family planning services and a plethora of diseases claiming lives. The lack of motivation in Community Health Workers (CHWs) is a critical barrier in the delivery of relevant health services and messages to clients. This lack of motivation is compounded by the fact that a CHW has to solely survive on incentives for services provided, or is paid a nominal honorarium. Amplifying the problem is the absence of functional integration of health programs. In Bihar, there are three cadres of CHWs – Auxiliary Nurse & Midwifes, Accredited Social Health Activists from Department of Health, and Anganwadi Workers from Department of Integrated Child Health Services under the Social Welfare ministry – who are supposed to be serving the same clients. Yet these three groups function disparately and do not coordinate or collaborate with each other since they belong to different departments.
Drawing from the business world, CARE developed an innovation that aimed to strengthen the teamwork and motivation of the CHWs, called Team-Based Goals and Incentives (TBGI). It integrated both the motivational power of incentives and the virtues of teamwork. We facilitated the formation of a ‘team’ that brings all three cadres of CHWs together on a single platform. We let the team mutually decide and set goals for the provision of services in their catchment area with specific numeric targets on predetermined health indicators for each quarter. The team then worked together to meet the targets. All operational challenges were alleviated through mutual support and leveraging of individual competencies.
TBGI was piloted in 76 Health Sub Centers (38 treatment + 38 control) in the Begusarai district of Bihar. An independent randomized controlled trial showed encouraging results after just one year of implementation in exclusive breastfeeding (71 percent in treatment area versus 61 percent in control) and use of modern contraceptives (26 percent in treatment area versus 15 percent in control), among other areas.
Meet the Team
HEMANTKUMAR G. SHAH | Chief of Party, Bihar Technical Support Project | CARE India
Dr. Hemant Shah was the Director of the State RMNCH+A Unit, Bihar, prior to being promoted to the COP position. He has successfully established the biggest State RMNCH+A Unit in India and has helped the Government of Bihar develop various policies/ revise existing policies on public health for the state, rationalize deployment of specialist doctors, assisted the government in gap analysis of procurement systems, helped prepare specifications for equipment and provided guidance in the preparation of state PIPs etc. Being the main interface with the government, Dr. Shah’s role is critical in establishing buy-ins, planning and implementing the scale-up.
AMITAVA BANERJEE| Communications Specialist | CARE India
Amitava Banerjee heads all communications for the program and is an expert on IEC/BCC strategies and advocacy communications. He is responsible for positioning, branding and dissemination of all program initiatives to different national and global stakeholders, and the media by translating complex implementation and impact data into comprehensible creative outputs for diverse audiences. Amitava joined the social sector after spending close to 17 years heading marketing and communications for multi-million dollar businesses in the Indian sub-continental and APMEA markets. He has been supporting advocacy efforts for scale up of TBGI since last 1 year through the strategic use of the media. His communication skills will prove invaluable when advocating the need of addressing the “motivation” barrier and the potential of TBGI to impact lives and transform the health landscape.
SUNIL MOHANTY | Program Manager, Gaya | CARE India
Sunil Mohanty has more than 14 years of experience in managing large scale health programs and implementing them at scale through the government. Sunil has been associated with Team Based Goals and Incentive Pilot Program (TBGI) right since conceptualization and design of the innovation. He was involved in preparing the concept notes, tools and sharing of the concept with government counterparts and securing the necessary approvals. Also, Sunil was the Manager of the pilot district of Begusarai and led project implementation and assisted the CML team in conducting the baselines assessments for Begusarai.
MOHAMMED AFTAB ALAM | Program Manager, Saharsa | CARE India
Aftab has been working in the project since inception and has more than 7 years of experience working with the government health system. He is skilled at mentoring and managing teams, collaborating with the government, implementation on ground and anticipating barriers to implementation. He brings in the experience of implementing the pilot for the first year and having supported the formative phase with development of indicators, identifying factors driving motivation of FLWs, designing and testing of tools, budgeting costs and identifying possible barriers to implementation and finding ways around them. During implementation, Aftab had built the capacity of other team members involved in the pilot.
AMARJEET PRABHAKAR | District Manager, Begusarai | CARE India
Amarjeet Prabhakar has more than 12 years of experience in managing health and ICDS programs. His skills lie around mentoring and managing teams, collaborating with government counterparts and program implementation. Amarjeet has been working with this innovation since last two years in Begusarai. He is responsible for inclusion of TBGI in the government PIP. He has been involved in many research and evaluations for the innovation including supporting the end line assessment by Mathematica.