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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