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Table 2 CHW–health system interface topics discussed in publications on ASHAs

From: Taking stock of 10 years of published research on the ASHA programme: examining India’s national community health worker programme from a health systems perspective

Main topic

Sub-topics

Application to ASHA programme

Number of publications with content on sub-topic

Programme inputs

Training and capacity-building

Descriptions of training and capacity-building provided to ASHAs, challenges associated with ASHA training, how ASHAs feel about training, percentages of ASHAs receiving training

62

Supplies and supply chain

The type and amount of supplies ASHAs receive (including their routine drug kids and extra supplies from small scale interventions, such as mHealth programmes), how ASHAs feel about their supplies, issues of resupply and stock outs

42

Support and monitoring

ASHA relationships with frontline workers (such as auxiliary nurse midwives, medical officers, ASHA facilitators), including how they work together and the extent to which they receive monitoring and supportive supervision (routinely and in small-scale interventions)

41

Incentives and remuneration

Financial incentives provided and changes to them, timeliness and access to remuneration, ASHA satisfaction with remuneration

38

Roles and role clarity

The roles ASHAs have been given, including the evolution of routine roles and roles given in special interventions, and the extent to which ASHAs understand their roles

35

CHW record keeping

What records ASHAs maintain (such as monthly reports, village registers), how they feel about these records, challenges related to ASHA record keeping such as completeness and correctness

16

Programme outcomes

CHW performance

Functionality, effectiveness, skills, practice – what services ASHAs provide, what tasks they perform, and/or how well they provide these services or perform these tasks, including coverage of services (but not in terms of equity or which households they cover, which is counted in ‘CHW equity’)

79

CHW knowledge

How much ASHAs know about various health topics

30

CHW motivation

ASHA job satisfaction, how motivated ASHAs are to do their work, what their sources of motivation are (but not their motivation to continue working as an ASHA, which is counted below under ‘retention and attrition’)

30

CHW equity

Which households ASHAs reach in terms of marginalisation, social distribution of services

17

CHW retention and attrition

Intention to remain an ASHA, drop-out rates

9

CHW–community interface

Community engagement with CHWs

Community knowledge of their ASHA, trust in their ASHA and satisfaction with their ASHA, factors that influence this relationship

34

Resonance of CHW activities

Extent to which ASHA activities align and resonate with community needs

22

Community selection of CHW

Extent and manner through which the community was involved in deciding who should be their ASHA

16

Link to local government

Involvement of the local government structure (panchayat) in any aspect of the ASHA programme

15

Health committees

ASHA role in convening village health and sanitation committee meetings, activities undertaken by the committee in relation to the ASHA

13

Community oversight of and support for CHW

Community oversight of the ASHA, ASHA accountability to the community, community provision of support for the ASHA

10

CHW as community voice or representative

ASHA as a representative of the community’s perspectives, voices and needs to health system functionaries

8

Programme governance

CHW policy design and development

Policy recommendations to strengthen the ASHA programme, discussions about how policy was set or should be set, critiques of ASHA-related policy

27

CHW programme oversight and guidance

Formal oversight and guidance systems to shape the ASHA programme, particularly the role of national and state health resource centres

8

CHW political support

Political buy-in to the ASHA programme at the national and state levels; ASHA political engagement and advocacy, such as through unionisation

7

Role of NGO actors in CHW policy

Role of NGO actors in shaping the ASHA programme, such as NGOs, academics and private sector interest groups

6

Grievance redressal for CHWs

The development and functioning of formal government mechanisms through which ASHAs could register grievances

5

Programme financing

How much money is budgeted to fund the ASHA programme and how these decisions are made, release of funding, comments on financing issues

5

CHW programme reporting

Systematic programme management records that the government system creates about the ASHA programme (such as national or state level reports, annual nodal officer meeting minutes)

2

CHW social profile and agency

CHW demographics

ASHA demographic information such as ASHA age, caste, marriage, and literacy statistics, or comments on these issues (e.g. caste dominance among ASHAs)

41

Empowerment and personal growth

Comments or research on ASHA well-being, personal growth, rights-related challenges and opportunities including for leadership, career progression or educational advancement

14

Communication between CHWs

Opportunities and nature of ASHA-to-ASHA communication, such as through meetings, radio shows or newsletters

3

Impact

Health outcomes

ASHA programme-related changes in community healthcare-seeking, health-related behaviour and knowledge, and wellbeing/illness outcomes (including the health-related outcomes of small-scale special interventions involving ASHAs)

41

Social outcomes

ASHA programme-related changes in non-health outcomes such as community-level environmental health and gender relations or programmatic/out-of-pocket costs (including the social-related outcomes of small-scale special interventions involving ASHAs)

6

Health services context

Health system infrastructure and functionality

The quality and availability of drugs, transportation, diagnostics, infrastructure, and health workers in the government health sector, including behaviour of health workers towards patients, and how this context influences the ASHA’s work

24

Private sector

The quality and availability of the informal (such as traditional birth attendants) and formal private healthcare sector and how this influences the ASHA’s work, including public–private partnerships within the National Health Mission

17

Linkages to other programmes

Intersectoral linkages between the ASHA programme (within the Ministry of Health and Family Welfare) and nutrition/anganwadi services through the Integrated Child Development Scheme, water and sanitation

12