“…Significant numbers of published articles came from Andhra Pradesh [ 41 , 44 , 78 – 85 ], Haryana [ 86 – 94 ], Uttarakhand [ 40 , 95 – 101 ], Maharashtra [ 37 , 45 , 102 – 106 ], Rajasthan [ 37 , 40 , 44 , 45 , 107 – 109 ], Karnataka [ 110 – 116 ], Jharkhand [ 42 – 44 , 47 , 117 , 118 ], and Gujarat [ 38 , 39 , 41 , 119 – 121 ]. In contrast, fewer articles were published on the ASHA programme in Kerala [ 44 , 122 – 125 ], Chhattisgarh [ 126 – 130 ], Madhya Pradesh [ 131 – 134 ], Delhi [ 135 – 137 ], Assam [ 44 , 138 , 139 ], West Bengal [ 44 , 48 ], Manipur [ 140 ], Punjab [ 141 ], and Tamil Nadu [ 37 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…Amongst qualitative explanatory studies, case study research was used for an in-depth understanding of the ASHA programme [ 100 , 126 , 130 ]. In-depth ethnographies included those on integration and teamwork [ 57 ], notions of citizenship [ 108 ], incentives [ 127 ] and community participation [ 103 ].…”
Section: Resultsmentioning
confidence: 99%
“…Chhattisgarh’s Mitanin programme emerged as a strong success story, wherein Mitanins performed as socio-political actors on the social determinants of health [ 126 , 128 , 130 ]. However, in other states, ASHAs have generally been more successful in performing a link-worker role, without significant action on community mobilisation or the social determinants of health [ 43 , 44 , 98 , 100 , 152 ].…”
Background: As India's accredited social health activist (ASHA) community health worker (CHW) programme enters its second decade, we take stock of the research undertaken and whether it examines the health systems interfaces required to sustain the programme at scale. Methods: We systematically searched three databases for articles on ASHAs published between 2005 and 2016. Articles that met the inclusion criteria underwent analysis using an inductive CHW-health systems interface framework. Results: A total of 122 academic articles were identified (56 quantitative, 29 mixed methods, 28 qualitative, and 9 commentary or synthesis); 44 articles reported on special interventions and 78 on the routine ASHA program. Findings on special interventions were overwhelmingly positive, with few negative or mixed results. In contrast, 55% of articles on the routine ASHA programme showed mixed findings and 23% negative, with few indicating overall positive findings, reflecting broader system constraints. Over half the articles had a health system perspective, including almost all those on general ASHA work, but only a third of those with a health condition focus. The most extensively researched health systems topics were ASHA performance, training and capacity-building, with very little research done on programme financing and reporting, ASHA grievance redressal or peer communication. Research tended to be descriptive, with fewer influence, explanatory or exploratory articles, and no predictive or emancipatory studies. Indian institutions and authors led and partnered on most of the research, wrote all the critical commentaries, and published more studies with negative results. Conclusion: Published work on ASHAs highlights a range of small-scale innovations, but also showcases the challenges faced by a programme at massive scale, situated in the broader health system. As the programme continues to evolve, critical comparative research that constructively feeds back into programme reforms is needed, particularly related to governance, intersectoral linkages, ASHA solidarity, and community capacity to provide support and oversight.
“…Significant numbers of published articles came from Andhra Pradesh [ 41 , 44 , 78 – 85 ], Haryana [ 86 – 94 ], Uttarakhand [ 40 , 95 – 101 ], Maharashtra [ 37 , 45 , 102 – 106 ], Rajasthan [ 37 , 40 , 44 , 45 , 107 – 109 ], Karnataka [ 110 – 116 ], Jharkhand [ 42 – 44 , 47 , 117 , 118 ], and Gujarat [ 38 , 39 , 41 , 119 – 121 ]. In contrast, fewer articles were published on the ASHA programme in Kerala [ 44 , 122 – 125 ], Chhattisgarh [ 126 – 130 ], Madhya Pradesh [ 131 – 134 ], Delhi [ 135 – 137 ], Assam [ 44 , 138 , 139 ], West Bengal [ 44 , 48 ], Manipur [ 140 ], Punjab [ 141 ], and Tamil Nadu [ 37 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…Amongst qualitative explanatory studies, case study research was used for an in-depth understanding of the ASHA programme [ 100 , 126 , 130 ]. In-depth ethnographies included those on integration and teamwork [ 57 ], notions of citizenship [ 108 ], incentives [ 127 ] and community participation [ 103 ].…”
Section: Resultsmentioning
confidence: 99%
“…Chhattisgarh’s Mitanin programme emerged as a strong success story, wherein Mitanins performed as socio-political actors on the social determinants of health [ 126 , 128 , 130 ]. However, in other states, ASHAs have generally been more successful in performing a link-worker role, without significant action on community mobilisation or the social determinants of health [ 43 , 44 , 98 , 100 , 152 ].…”
Background: As India's accredited social health activist (ASHA) community health worker (CHW) programme enters its second decade, we take stock of the research undertaken and whether it examines the health systems interfaces required to sustain the programme at scale. Methods: We systematically searched three databases for articles on ASHAs published between 2005 and 2016. Articles that met the inclusion criteria underwent analysis using an inductive CHW-health systems interface framework. Results: A total of 122 academic articles were identified (56 quantitative, 29 mixed methods, 28 qualitative, and 9 commentary or synthesis); 44 articles reported on special interventions and 78 on the routine ASHA program. Findings on special interventions were overwhelmingly positive, with few negative or mixed results. In contrast, 55% of articles on the routine ASHA programme showed mixed findings and 23% negative, with few indicating overall positive findings, reflecting broader system constraints. Over half the articles had a health system perspective, including almost all those on general ASHA work, but only a third of those with a health condition focus. The most extensively researched health systems topics were ASHA performance, training and capacity-building, with very little research done on programme financing and reporting, ASHA grievance redressal or peer communication. Research tended to be descriptive, with fewer influence, explanatory or exploratory articles, and no predictive or emancipatory studies. Indian institutions and authors led and partnered on most of the research, wrote all the critical commentaries, and published more studies with negative results. Conclusion: Published work on ASHAs highlights a range of small-scale innovations, but also showcases the challenges faced by a programme at massive scale, situated in the broader health system. As the programme continues to evolve, critical comparative research that constructively feeds back into programme reforms is needed, particularly related to governance, intersectoral linkages, ASHA solidarity, and community capacity to provide support and oversight.
“…Since then, health systems have looked into various opportunities to engage the alternative workforce to cover the human resource crisis. 3,4 In line with these initiatives, the scheme of Accredited Social Health Activist (ASHA) under the National Rural Health Mission (NRHM) was implemented by the Government of India. 5 Until 2019, around 1.33 million ASHAs had been recruited all over India and were more concentrated in the states with relatively poor maternal and child health indicators.…”
Objective:
Due to constraints in the dedicated health work force, outbreaks in peri-urban slums are often reported late. This study explores the feasibility of deploying Accredited Social Health Activists (ASHAs) in outbreak investigation and understand the extent to which this activity gives a balanced platform to fulfil their roles during public health emergencies to reduce its impact and improve mitigation measures.
Methods:
Activities of ASHAs involved in the hepatitis E outbreak were reviewed from various registers maintained at the subcenter. Also, various challenges perceived by ASHAs were explored through focus group discussion (FGD). During March to May 2019, 13 ASHAs involved in the hepatitis outbreak investigation and control efforts in a peri-urban slum of Nagpur with population of around 9000. In total, 192 suspected hepatitis E cases reported.
Results:
During the outbreak, ASHAs performed multiple roles comprising house-to-house search of suspected cases, escorting suspects to confirm diagnosis and referral, community mobilization for out-reach investigation camps, risk communication to vulnerable, etc. During the activity, ASHAs faced challenges such as constraints in the logistics, compromise in other health-related activities, and challenges in sustaining behavior of the community.
Conclusions:
It is feasible to implement the investigation of outbreaks through ASHAs. Despite challenges, they are willing to participate in these activities as it gave them an opportunity to fulfil the role as an activist, link worker, as well as a community interface.
BackgroundIndia’s accredited social health activist (ASHA) programme consists of almost one million female community health workers (CHWs). Launched in 2005, there is now an ASHA in almost every village and across many urban centres who support health system linkages and provide basic health education and care. This paper examines how the programme is seeking to address gender inequalities facing ASHAs, from the programme's policy origins to recent adaptations.MethodsWe reviewed all publically available government documents (n = 96) as well as published academic literature (n = 122) on the ASHA programme. We also drew from the embedded knowledge of this paper’s government-affiliated co-authors, triangulated with key informant interviews (n = 12). Data were analysed thematically through a gender lens.ResultsGiven that the initial impetus for the ASHA programme was to address reproductive and child health issues, policymakers viewed volunteer female health workers embedded in communities as best positioned to engage with beneficiaries. From these instrumentalist origins, where the programme was designed to meet health system demands, policy evolved to consider how the health system could better support ASHAs. Policy reforms included an increase in the number and regularity of incentivized tasks, social security measures, and government scholarships for higher education. Residential trainings were initiated to build empowering knowledge and facilitate ASHA solidarity. ASHAs were designated as secretaries of their village health committees, encouraging them to move beyond an all-female sphere and increasing their role in accountability initiatives. Measures to address gender based violence were also recently recommended. Despite these well-intended reforms and the positive gains realized, ongoing tensions and challenges related to their gendered social and employment status remain, requiring continued policy attention and adaptation.ConclusionsGender trade offs and complexities are inherent to sustaining CHW programmes at scale within challenging contexts of patriarchal norms, health system hierarchies, federal governance structures, and evolving aspirations, capacities, and demands from female CHWs. Although still grappling with significant gender inequalities, policy adaptations have increased ASHAs’ access to income, knowledge, career progression, community leadership, and safety. Nonetheless, these transformative gains do not mark linear progress, but rather continued adaptations.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
