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Supplemental Material for Effects of Various Financial and Non-financial Incentives on the Performance of Accredited Social Health Activist: Evidence from Two Selected Districts of Odisha by Saumya Ranjan Pani, Srinivas Nallala, Sarit Kumar Rout, Shyama Sundari, Maulik Chokshi, Tushar Mokashi, Arun Nair and Shridhar M. Kadam, in Journal of Health Management

Objective. To study the knowledge and practice of hand washing among mothers and children of shikharchandi slum of Bhubaneswar, Odisha and to recommend possible measures to improve the current practices. Methodology. Present cross-sectional study was carried out in the Shikharchandi slum located in the Bhubaneswar city of Orissa state in India. 150 women and 80 children were interviewed. Chil- dren questionnaire were prepared to suit to their age and accord- ing to local context. Components of sanitation like food handling and hand washing were covered in this questionnaire. Results. Hand washing before preparing food is being practiced by 85% of women. Of all women interviewed, 77% wash hands before serving food. Only 15% children said soap was available in their school to wash hands. Out of total children interviewed, 76% told that their teachers tell about sanitation and hand washing in the class. Only 5% children told they were consulted by doctor/health worker during last 3 months. As many as 81% children told that they wash their hands before taking food and 19% children said they take their food without washing hands. Though most of the children told that they wash hands before tak- ing food, but only 17.5% told that they use soap for hand washing. Only 29% children told that their teachers check hand washing in school. When asked about critical timing of hand washing, 44% children told about at least two critical timings and 56% were unaware about the critical timings of hand washing. Conclusion. Inadequate knowledge on this among our study par- ticipant is a point of concern. Systematic integration of health and hygiene education in schools through curricular modifications could be an appropriate strategy., Journal of Preventive Medicine and Hygiene, Vol 55, No 2 (2014)

Human resource management (HRM) policies and their effective implementation are expected to influence the attitude and behaviour of health workers favourably in providing effective health services to the people. However, within the Indian public health system, it is unclear which HRM policies are implemented effectively and how these influence health workers, especially at district level. This study aimed to explore how HRM policies and practices affect health workers in the Indian public health system. The state of Odisha was purposively selected. Four relevant HRM functions were examined: 1) posting and transfer, 2) in-service training (IST), 3) supervision and review and 4) performance appraisal (PA). Documents including human resources (HR) policies and plans were reviewed to identify intended HRM practices. In-depth interviews of policy makers, managers and health workers were conducted. Using the framework developed by Purcell and Hutchinson, (2007), we identified the relevant intended practices, the practices as reported by the managers and the health workers and their effect on the attitudes and behaviour of health workers. Qualitative data analysis used a ‘framework approach’.\ud An in-depth analysis of four HRM functions within the overall human resource management system, as operated at district level within Odisha, has shown that although there may be a weak positive effect on the attitudes and behaviour of public sector health workers, there remain many missed opportunities. Although the design of the majority of HRM systems is logical to achieve the objectives, there are problems in their implementation. The major issues are that either HRM sub-systems are not being operated as designed – with some elements totally missing; or the sub-system is inadequately implemented. Implementation is affected by three major factors: 1) insufficient autonomy of district and facility level managers, 2) lack of resources and skills of the managers and 3) contextual factors including geography, gender and sector reforms.\ud In addition to the inadequate implementation of the HRM system, there are issues in the way the systems are organised and operated, leading to the limited effect of HRM on the attitudes and behaviour of health workers. For instance, the HRM sub-systems are being implemented in isolation, with no connection between the sub-systems of all HRM functions and different ‘system owners’ at state and district level. With no overall coordination and significant oversights including the monitoring of the system as a whole, opportunities to make this system more efficient are missed.\ud However, the findings from this study provide a very useful starting point for improving the four HRM functions of posting and transfer, in-service training, supervision and review and performance appraisal. Considering these together should help to promote the view of HRM as an overall system, with co-ordinated sub-systems. Therefore, the study concludes that HRM systems can be made more effective to ensure that there is an effective health workforce to deliver the required health care services, and in turn, to contribute to the achievement of the goal of Universal Health Coverage.