Enablers and Barriers to Work Performance: A Mixed-methods Assessment of Ayushman Bharat—Health and Wellness Centres in Punjab State of India

Comprehensive primary healthcare through Ayushman Bharat Health and Wellness Centres (AB-HWCs) was initiated by the Government of India in 2018. The present study explores performance variations among HWCs and the reasons behind these variations from a provider’s perspective. A sequential mixed-methods study was conducted in Punjab state between April and September 2021. The quantitative facility assessments of the eight selected health facilities based on a standardised tool were followed by 16 in-depth interviews with the community health officers (CHOs) and auxiliary midwives (ANMs) to understand their perceptions about service delivery. A descriptive data analysis was carried out to identify variations in infrastructure and human resources between the high- and low-performing HWCs. A framework analysis was applied to qualitative data using the ‘capacity, opportunity, motivation, behaviour’ (COM-B) model. We found a significant difference in infrastructure in the high- and low-performing HWCs. The qualitative findings informed that capacity, communication, opportunity and motivation affected work performance. The micro level impediments to collaborative care were variations in understanding and valuing of team roles, perceived job fit of counterparts, underlying resentments due to fear of diluted personal identity, duplication of data maintenance, differences in accountability and payments, and job satisfaction. It is essential to focus on adequate capacity building, effective supportive supervision and information flows, adequate monetary policies, and reduction in duplication to achieve teamwork and greater resource efficiency.