Management Of Childhood Diarrhea And Pneumonia Amongst Public And Private Frontline Workers: Assessing Know-Do Gap



India's Annual Health Survey-3 documented that around 85% of diarrhea and 90% of pneumonia cases are seen by a frontline worker. 473 accredited social health activists (ASHAs), the public frontline workers, and 447 rural medical practitioners (RMPs), the private frontline workers, were interviewed to understand their knowledge, and subsequently shown a video vignette developed by World Health Organization to understand their skills related to managing childhood diarrhea and pneumonia. While 41% ASHAs and 43% RMPs reported sunken eyes as a sign of dehydration, only 33% ASHAs and 35% RMPs identified sunken eyes in the video. While 39% ASHAs and 27% RMPs reported that loss of skin turgor indicates dehydration, only 3% ASHAs and 7% RMPs diagnosed dehydration based on the skin pinch test shown in the video. While 30% ASHAs and 28% RMPs reported fast breathing as a sign of pneumonia, only 3% ASHAs and 16% RMPs correctly counted the respiratory rate in the video. Similarly, 43% ASHAs and 28% RMPs reported chest in-drawing as a sign of pneumonia, but only 18% ASHAs and 12% RMPs correctly identified it in the video vignettes. While the self-reported knowledge of childhood diarrhea and pneumonia is moderate amongst ASHAs and RMPs, their ability to apply that knowledge to a video based case study was a lot lower. Future programs in the domain of childhood pneumonia and diarrhea, two major killers of under five children, should be directed toward strengthening assessment skills of frontline workers through enhanced training and regular, high-quality supportive supervision. Keywords: Child health, Evaluation, Research methodologies and methods Key Messages 1. High level of knowledge does not always transform to appropriate behavioral skills 2. Huge know-do gap exists amongst public and private frontline health workers in relation to the management of childhood pneumonia and diarrhea 3. Strong need of innovative training methodologies like the use of role plays, case studies, video-vignettes, etc. to build capacities of frontline health workers


Ashutosh Mishra

Research Triangle Institute Global India Private Limited

Ashutosh Mishra is the Chief-of-Party for RTI International’s Research and Evaluation for Action in Child Health project. He has significant expertise in developing monitoring and evaluation frameworks for large-scale public health programs. Prior to this, he worked at Clinton Health Access Initiative to improve the management of childhood diarrhea. Dr. Mishra’s research interests’ lie in health impact assessment and the integrated maternal, neonatal, and child health strategy. He has been actively involved in designing interventions to reduce maternal and under the age of five morbidity and mortality.