ARTH conducted a study to understand how ANMs in Rajasthan decide about residing within their work areas and to suggest policy and programmatic changes to encourage ANMs to reside in their work areas. A key finding was that the personal, family and security needs of ANMs deeply impact their availability on the ground, and hence their productivity and efficiency. Thus, efforts to encourage ANMs to reside in their work area should aim to enhance their ease of staying as well as enforcing accountability.
The study put forth the following recommendations to encourage ANMs to reside within their work areas :
- Shift administrative control over and responsibility of the ANMs to the local panchayats
- Form complaint committees at district level for women health workers.
- Implement human resource policy guidelines for ANMs (which includes the issues of recruitment and posting, matching transfers with changing needs, meeting personal needs, location of accommodation and amenities).
- Encourage non-governmental organizations to support ANMs.
The study found that the ANM takes an “economic” decision about whether or not to reside within her work area. This decision is taken after weighing the “ease of staying” and the “inconvenience of not staying” in the area. The study revealed that the ANMs were more likely to stay in their sub-centre villages if they had spent their growing years in a village, and if their sub-centre village was far from a city.