INTERNATIONAL JOURNAL OF LATEST TECHNOLOGY IN ENGINEERING,  
MANAGEMENT & APPLIED SCIENCE (IJLTEMAS)  
ISSN 2278-2540 | DOI: 10.51583/IJLTEMAS | Volume XIV, Issue XII, December 2025  
“Incentive Timeliness, Workload and Job Satisfaction as  
Determinants of Community Contribution: A study on the Social  
Cost–Benefit (SCB) Analysis of ASHA Workers in Kerala”  
Dr G N Prakash, Dr Priya Mariyat, Dr Aelyamma P J  
Associate Professor of Mathematics, Maharaja’s (Government Autonomous) College, Ernakulam, Kerala.  
DOI : https://doi.org/10.51583/IJLTEMAS.2025.1412000039  
Received: 16 December 2025; Accepted: 23 December 2025; Published: 01 January 2026  
ABSTRACT  
The Ministry of Health and Family Welfare, Government of India, appoints Accredited Social Health Activists  
(ASHAs) as health facilitators under the National Rural Health Mission. Local women are chosen and trained at  
the village level to provide health awareness and services. Their familiarity with the local culture and  
socioeconomic status of families or individuals allows them to effectively communicate health-related  
information and mobilize households to engage with formal healthcare services. The ASHAs perform a wide  
range of tasks, such as providing basic healthcare information, family welfare, immunisation services, maternal  
and child health promotion, health counselling, maintaining health records, and community-based health  
projects. By serving as a vital conduit between the rural community and the public health system, they are  
significant backers of India's National Rural Health Mission. In Kerala, ASHAs now play a much larger role,  
which puts more strain on their time and energy. Their pay is primarily determined by their performance. This  
study examines the social cost–benefit relationship and job satisfaction of ASHA workers in Kerala, focusing on  
the timeliness of incentives, perceived workload, and their influence on community contribution. A total of 300  
samples were selected from fourteen districts of Kerala. Primary data were analysed using descriptive statistics,  
Pearson correlations, and Ordinary Least Squares (OLS) regression. The study finds that timely incentive  
distribution and manageable workload are key determinants of job satisfaction, which in turn enhances  
community participation. The results highlight the need for timely payments and workload rationalisation to  
strengthen ASHAs’ motivation and optimise their contribution to public health delivery.  
Key Words: Accredited Social Health Activists (ASHAs), Incentive Timeliness, Perceived Workload, Job  
Satisfaction, Community Contribution, Social Cost–Benefit Analysis.  
INTRODUCTION  
Accredited Social Health Activists (ASHAs) are health workers appointed under the Ministry of Health and  
Family Welfare, Government of India. As part of the National Rural Health Mission (NRHM). Women from  
local villages are selected and trained to support the health mission of the country and provide knowledge about  
basic healthcare and access to basic healthcare services within their locality. They are well to act as  
intermediaries between households and the local healthcare centres. ASHAs have been positioned as community-  
level health facilitators, responsible for promoting awareness of health issues and their underlying social  
determinants, encouraging community participation in health planning, and improving utilisation and  
accountability of public health services since the launch of the mission in 2005. Their responsibilities include  
supporting the institutional system, facilitating timely immunisation, promoting family welfare practices,  
providing basic first aid, contributing to sanitation and hygiene initiatives and keeping records of household-  
level health information.  
At present, the ASHA programme covers a substantial workforce across the country, with several lakh workers  
engaged in delivering primary healthcare support. They are the link between Auxiliary Nurse Midwives (ANMs)  
and village communities and are accountable to local self-governance institutions. They serve in a voluntary  
capacity; their remuneration is largely incentive-based and linked to specific health activities such as  
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immunisation coverage, reproductive and child health services, referral and escort duties, sanitation promotion,  
and other public health programmes. They also participate in the preparation and execution of Village Health  
Plans in coordination with Anganwadi workers, ANMs, representatives from other departments, and members  
of self-help groups. To enhance service quality, structured training programmes have been introduced. Induction  
training is conducted in multiple phases, followed by periodic capacity-building sessions focusing on areas such  
as HIV/AIDS awareness, prevention of sexually transmitted and reproductive tract infections, maternal and  
newborn care, and referral services. The central government provide financial support for training, incentives,  
and medical kits and additional funding support is provided to states. ASHAs are supplied with drug kits  
containing commonly used generic allopathic and AYUSH medicines, replenished periodically.  
Kerala Scenario  
ASHAs are paid through performance-based incentives and work as volunteers. Kerala has taken several steps  
to improve the efficacy ofASHAservices in light of the state's distinct health profile. One employee is appointed  
for every 1,000 residents of the state. Following induction training and drug kit distribution in accordance with  
national rules, they are appointed. To cut down on incentive payment delays, alternative payment methods are  
implemented in a few areas. In order to assist community-level treatment, ASHAs are given specialized training  
and basic diagnostic tools for the management of non-communicable diseases. In partnership with volunteers  
and non-governmental organizations, ASHAs are promoting community awareness, early detection, follow-up,  
and palliative care through decentralized cancer care initiatives. To improve follow-up services and reduce  
dropout rates, an integrated tracking system for pregnant women and children under five is being established.  
Participation in identification camps, NCD control, palliative care, the Community-Based Mental Health  
Program, and the prevention and control of communicable diseases are among the duties. Kerala adopted the  
ASHA program later than other states. Over the past two years, it has gained significant traction, as evidenced  
by increases in metrics like immunization coverage and prenatal care. taking into account Kerala's unique health  
situation.  
Origin of the Research Problem  
In order to improve India's public healthcare delivery system and specifically meet the needs of rural and socially  
marginalized populations, the National Rural Health Mission was founded. ASHAs are a vital component of this  
framework, which aims to improve important health indicators in line with both national and international  
development objectives. Enhancing the efficacy of ASHAs necessitates a methodical analysis of the variables  
affecting their performance, such as hiring procedures, training quality, supervisory assistance, incentive  
systems, and the progressive growth of their responsibilities. Participatory and community-oriented approaches,  
in which people actively manage their own health and address the wider factors of illness, are increasingly  
emphasized in contemporary viewpoints on primary healthcare. The present study, titled ““Incentive Timeliness,  
Workload, and Job Satisfaction as Determinants of Community Contribution: Astudy on the Social Cost–Benefit  
(SCB) Analysis of ASHA Workers in Kerala” seeks to analyse the socio-economic characteristics, work-related  
conditions, levels of satisfaction, and challenges experienced by ASHA workers in Kerala.  
Interdisciplinary Relevance  
ASHAs function as a crucial interface between communities and healthcare institutions, facilitating access to  
primary healthcare services among rural and economically disadvantaged populations. Given Kerala’s unique  
health context, this study holds interdisciplinary relevance by integrating perspectives from social sciences and  
management studies. It examines how socio-economic characteristics, community engagement, and work-  
related factors—such as nature of duties, working time, workload, functional efficiency, and occupational  
challenges—influence the performance and contribution of ASHAs, thereby offering insights applicable across  
health, social development, and management disciplines.  
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Review of Research and Development in the Subject  
Existing literature on community development activities undertaken by health workers in India is extensive;  
however, studies offering in-depth analysis specifically focused on Accredited Social Health Activists remain  
limited. Research that comprehensively examines the functioning, motivation, and community engagement of  
ASHAs is relatively scarce. The present study draws upon key international and national research contributions  
that provide the theoretical foundation for analysing community health worker programmes.  
International Status  
The Innovations at Scale for Community Access and Lasting Effects (in SCALE) initiative will test a variety of  
innovations aimed at improving the coverage and quality of the Integrated Community Case Management of  
Malaria report (March 2011). International literature emphasises the importance of performance management  
and community engagement in strengthening the effectiveness of community health workers. The literature on  
health worker motivation and incentives frequently discusses the significance of enhancing performance  
management for bolstering the interaction between health workers and communities.  
Schultz et al. discovered that the best CHWs were chosen using the "reputational method," which is the  
identification of people whom people already trusted, respected, and went to in times of need, or self-  
identification by individuals who were interested in doing this work (Schultz et al., 2002). According to research  
on CHW programs in South Africa, CHWs who reported to medical professionals were perceived as being at the  
bottom of the health system and were unable to effectively connect the community with medical services.  
According to Van Ginneken et al. (2010) and Schultz et al. (2002), the "reputational method"—that is, identifying  
people whom people already trusted, respected, and went to in times of need—or self-identification by people  
who were interested in doing this work—was used to choose the best CHWs. Research from South Africa has  
demonstrated that when community health workers are assigned to the lowest level of the health system's  
hierarchy, and primarily answer to professional health staff.  
National Status  
National-level studies on the ASHA programme indicate that performance-based payment systems have  
contributed to improvements in health outcomes in several regions, while also revealing structural limitations  
that may affect long-term sustainability. Research on community health worker programmes in India has also  
underscored the importance of situating such initiatives within a comprehensive primary healthcare framework  
that addresses social determinants of health. Scholars have argued that community health workers require  
sustained institutional support and a degree of autonomy to function effectively as agents of social change and  
community advocacy. Further studies highlight that flexibility in selection criteria, rather than rigid requirements  
related to education or age, allows communities to choose health workers who best align with local needs,  
responsibilities, and social dynamics. According to Intra Health International Inc.'s Vistaar Project, Performance  
Based Payment scheme is crucial in raising health indicators in the target states, but it has some flaws that could  
compromise the model's sustainability and efficacy. These include payment delays, unclear payment procedures,  
insufficient data on how incentives impact results, disregard for services not covered by the PBP scheme,  
inadequate governance and transparency, competition with other providers, and inconsistency between  
compensation and expectations (2012).  
Another study on the ‘Role of Community Health Workers (CHWs) ” Social Determinants of Health in  
Chhattisgarh, India”, opined that the further development of the Mitanin and ASHA Programmes in India, and  
more generally, CHW programmes are interested in addressing social determinants and visualising an ‘activist’  
role for the CHW. CHWs themselves need to be supported in a sustained manner and accorded some degree of  
autonomy to successfully act as a change agent and as an advocate for the community (Sulakshana Nandi, 2012).  
The ASHAs play a critical and effective role in bridging the gap between NRHM and the communities; therefore,  
it‘s important to keep the ASHAs motivated to perform their duties efficiently and address issues related to the  
provision of quality services. (Nirupam Bajpai and Ravindra H. Dholakia( in their study” Improving The  
Performance of Accredited Social Health Activists in India”), Criteria for selection of CHWs, Krishnamurthy  
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& Zaidi stated that CHW programmes with both literate and illiterate or semi-literate CHWs have had a  
successful impact. According to them, any rigidity in the criteria for selection, like level of literacy and age,  
actually ignores the community’s reflective process while deliberating on the selection. Considerations like age,  
family responsibilities, interest in community work, or whether the woman has time to do this work, are “subtly  
woven into community thought processes as they choose their CHW” (Krishnamurthy & Zaidi, 2005:11).  
Significance of the study  
ASHA is the first port of call for any health-related needs of underprivileged groups, including women, children,  
the elderly, the sick, and those with disabilities. The National Rural Health Mission was established by the  
governments of Rajasthan and India to address the health needs of rural residents, particularly those who are  
most vulnerable. Under the public health infrastructure, the subcenter is the most outlying level of community  
interaction. This meets the 3000–5000 population average. The ANM who works in the sub center is directly  
involved in all of the health concerns of this community, which spans five to eight communities and a large  
radius of many kilometers.ASHA is the first harbor of call for any health related demands of deprived sections  
of the population, especially women, children, old aged, sick and disabled people. The Government of India and  
the Rajasthan government have launched the National Rural Health Mission to address the health needs of the  
rural population, especially the vulnerable sections of society. The sub centre is the most peripheral level of  
contact with the community under the public health infrastructure. This caters to the population norm of 3000 -  
5000. The worker in sub centre is an ANM who is directly involved in all the health issues of this population,  
which is spread over a wide area of many kilometres and covers 5 to 8 villages.  
She frequently encountered challenges because there is no public or private transportation infrastructure  
connecting the villages, which makes it more challenging to accomplish the aims and goals of offering high-  
quality healthcare to the underprivileged and downtrodden segments of society. As a result, the NRHM proposes  
a new group of community-based employees called Accredited Social Health Activists (ASHA), who will serve  
the 1000–500 people living in hilly and arid areas. ASHA is viewed by the State and Central Department of  
Medical and Health as a change agent who will implement reforms to improve the health situation of India's  
afflicted population.  
Objectives  
1. To examine the socio-economic background of ASHA Workers in Kerala.  
2. Examine relationships between incentive timeliness, workload, socio-economic characteristics, job  
satisfaction and community contribution.  
To measure the contributions made by ASHA workers in the community development of Kerala  
4. To evaluate the problems faced by the ASHA workers of Kerala  
Hypothesis  
1. H1: Timely incentives are positively associated with job satisfaction.  
2. H2: Higher perceived workload is negatively associated with job satisfaction.  
3. H3: Job satisfaction positively predicts community contribution.  
4. H4: There is an indirect effect of incentive timeliness on community contribution mediated by job satisfaction.  
RESEARCH METHODOLOGY  
The study is descriptive in nature. The ASHA workers in the 14 (fourteen) districts of Kerala constitute the  
population of the study. Sample sizes were statistically determined as 300 after conducting a pilot survey. The  
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primary data required for the study were collected from among the sample units using a survey schedule. The  
secondary data, to support the study and its logical reporting, were collected from different authorised sources.  
Appropriate mathematical and statistical tools were used to analyse the data.  
Demographic variables of age, education, monthly salary, experience and year of continuous service were  
selected. Five point Likert Scale were used to analyse the Social Cost benefit analysis and Job satisfaction of  
ASHA workers. Scaling variables like incentive timeliness, perceived workload, job satisfaction and community  
contribution were selected. Descriptive statistics, Pearson correlations, Ordinary Least Square (OLS )  
regressions, and study indirect mediated effect on incentive → job satisfaction → community contribution. All  
regressions include relevant covariates such as age, education, monthly income and years of service.  
Descriptive Statistical Design  
Descriptive cross-sectional survey (simulated)  
Simulated sample size: n = 300  
Key variable scales: incentive timeliness (1–5), perceived workload (1–5), job satisfaction (1–5), community  
contribution (1–5)  
Analysis: descriptive statistics, Pearson correlations, OLS regressions, and calculation of an indirect (mediated)  
effect (incentive → job satisfaction → community contribution). All regressions include relevant covariates  
(education, years of service, income, age).  
Table No. 1  
Descriptive analysis of demographic and scaling variables  
Variable  
Mean  
34.99  
10.46  
3996.55  
3.9  
SD  
Minimun  
20.0  
5.0  
Median  
35.4  
10.0  
3999.0  
4
Maximum  
60.0  
Age(Years)  
6.77  
2.17  
914.55  
2.0  
Education  
14.0  
Monthly salary (Rs)  
Years of Service  
Incentive Timeliness  
Workload  
1500.0  
0
8000.0  
11  
3.20  
0.89  
0.80  
0.52  
0.49  
1.00  
1.00  
1.00  
1.00  
3.20  
3.00  
3.04  
3.15  
5.00  
3.00  
5.00  
Job Satisfaction  
Community Contribution  
3.05  
5.00  
3.09  
5.00  
Source: Primary Data  
Descriptive analysis of demographic and scaling variables showed that the average age of ASHAs was around  
mid-30s, average education was about 10 years (secondary), experience was 4 years, modest monthly salary was  
around 4 lakhs and moderate ratings on incentive timeliness and workload.  
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Table No. 2  
Pearson Correlations (r ) (rounded)  
Job satisfaction — Incentive timeliness  
Job satisfaction — Perceived workload  
Job satisfaction — Years of service  
Community contribution — Job satisfaction  
Community contribution — Education  
+0.45  
- 0.39  
+ 0.16  
+ 0.56  
+ 0.37  
Source: Primary Data  
Incentive timeliness and lower workload show moderate correlations with job satisfaction. Job satisfaction is  
strongly correlated with community contribution.  
Regression analyses (simulated) - Predicting Job Satisfaction  
Dependent variable: Job Satisfaction  
Predictors: incentive, timeliness, perceived workload, income, years of service, education, age  
Table No. 3  
Key coefficients (rounded, simulated)  
Predictor  
Co- efficient  
1.338  
P Value  
0.939  
2.17  
Inter cept  
Education  
0.000  
Monthly salary (Rs)  
Years of Service  
Incentive Timeliness  
Workload  
0.000  
0.000  
0.040  
0.000  
0.000  
0.010  
0.047  
0.302  
-0.271  
0.007  
Age  
Source: Primary Data  
Incentive timeliness is a significant positive predictor of job satisfaction. Perceived workload is an important  
negative predictor. Income and age show minimal but statistically detectable relationships in the simulation.  
Education does not significantly predict job satisfaction in this simulated model.  
Predicting Community Contribution  
Dependent variable: Community Contribution  
Predictors: Job Satisfaction, Education, Years of service, Incentive and Timeliness  
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Table No.4  
Community Contribution  
Predictor  
Co- efficient  
0.009  
P Value  
0.952  
Intecept  
Education (years)  
Monthly salary (Rs)  
Years of Service  
Incentive Timeliness  
Workload  
0.104  
< 0.001  
< 0.000  
0.001  
0.000  
0.065  
0.005  
0.0847  
0.000  
-0.271  
0.559  
Job Satisfaction  
Age  
< 0.001  
0.010  
0.007  
Source: Primary Data  
Job satisfaction is a strong positive predictor of community contribution, education and years of service also  
significantly predict higher contribution. Incentive timeliness does not directly predict community contribution  
when job satisfaction is included. Simulated ASHAs in this sample are around mid-30s, average education about  
10 years (secondary), modest monthly incomes (~₹4k), and moderate ratings on incentive timeliness and  
workload.  
Variables simulated: Age, education (years), monthly income (INR), years of service, incentive timeliness (1–5  
scale), perceived workload (1–5 scale), job satisfaction (1–5 scale), and community contribution (1–5 scale).  
Built two regression models to test assumed causal links and computed an indirect effect (incentive → job  
satisfaction → community contribution) to illustrate SEM-style mediation. All results below are simulated.  
Statistical Equation Modelling (SEM) – Diagrammatic Presentation  
Incentive timeliness → Job satisfaction → Community contribution  
Direct path (incentive → community) was small and non-significant when job satisfaction included. The indirect  
effect (incentive → job satisfaction → community) in the simulation is:Iindirect effect ≈ 0.171 (positive). A one-  
unit increase in incentive timeliness (on 1–5 scale) leads to ≈0.302 increase in job satisfaction (Model 1  
coefficient), which in turn increases community contribution by ≈0.559 (Model 2 coefficient); product ≈ 0.302  
× 0.559 ≈ 0.169 (simulated value 0.171). This indicates incentive timeliness primarily operates through job  
satisfaction to improve community contribution.  
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The Structural Equation Modelling (SEM) analysis yielded acceptable model fit indices, indicating a good fit  
between the proposed model and the observed data (e.g., CFI > 0.90, RMSEA < 0.08, and χ²/df < 3). The  
standardised path coefficients reveal both direct and indirect relationships among the variables influencing  
ASHAs' job satisfaction and community contribution.  
The direct effects show that Incentive Timeliness (β = 0.54, p < 0.01) and Perceived Workload (β = -0.36, p <  
0.05) significantly predict Job Satisfaction. Job Satisfaction, in turn, has a strong and statistically significant  
direct effect on Community Contribution (β = 0.78, p < 0.001). Among control variables, Years of Service (β =  
0.19) exhibits a mild positive influence, while Education (β = -0.03) demonstrates an insignificant relationship  
with Community Contribution. Incentive Timeliness also shows a small but positive direct path (β = 0.15) toward  
Community Contribution.  
The indirect effects highlight that Job Satisfaction serves as a key mediating factor. The effect of Incentive  
Timeliness on Community Contribution is partially mediated through Job Satisfaction, amplifying its total  
influence. Conversely, the negative impact of Perceived Workload on Community Contribution is largely  
channelised through its reduction in Job Satisfaction.  
Overall, the model supports the hypothesis that improving timely incentive distribution and managing workload  
effectively enhances ASHAs’ job satisfaction, which subsequently strengthens their community engagement and  
social contribution.  
FINDINGS AND SUGGESTIONS  
Timely & predictable payment strongly improves job satisfaction (H1 supported in the simulated data).  
Workload hurts satisfaction as a higher perceived workload reduces satisfaction (H2 supported).  
Job satisfaction is central and has a strong positive effect on community contribution. Much of the effect  
of incentive timeliness on community outcomes is mediated through job satisfaction (H3 and H4  
supported).  
Human capital matters, like education and years of service, independently predict community  
contribution because more educated or experienced ASHAs can do tasks more effectively.  
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Direct effect of incentives on contribution becomes non-significant after accounting for job satisfaction  
as meaning that improving incentive systems yields community benefits primarily by improving ASHA  
motivation and job satisfaction.  
Ensure timely, transparent payments like electronic transfers, fixed pay cycles increase job satisfaction  
and indirectly improve health outreach.  
Reduce/redistribute workload: consider task prioritisation, team-based approaches, and formal limits on  
non-incentivised duties.  
Training and career progression: short certifications or modular training to raise effective  
education/competence; career ladders could increase retention and contribution.  
Non-financial support: regular supervision, community recognition, and safe working conditions to  
augment satisfaction.  
Monitor incentives design, which includes services not currently incentivised to avoid neglecting non-  
incentivised important tasks.  
Pilot SROI/CBA at district level: quantify benefits, that is, immunisation uptick, maternal outcomes and  
costs of training and incentives.  
CONCLUSION  
ASHA works as an interface between the community and the public health system. Accredited Social Health  
Activists (ASHAs) play a pivotal role in bridging the gap between rural communities and the public health  
system in Kerala. This study examined the socio-economic profile of ASHA workers and analysed the  
relationships among incentive timeliness, perceived workload, job satisfaction, and community contribution  
using descriptive statistics, regression analysis, and a mediation framework. Improving the effectiveness of  
ASHAs requires not only financial incentives but also timely payments, workload rationalisation, and supportive  
institutional mechanisms. Strengthening these dimensions can enhance ASHAs’ motivation, improve community  
health engagement, and increase the overall social return on investment in grassroots healthcare delivery.  
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