Background

In India, Accredited Social Health Activists (ASHAs) play a vital role in providing healthcare services to rural communities, particularly in maternal and child healthcare. Acting as the crucial link between the health system and rural populations, ASHAs are local women who undergo training to become health promoters in their communities.

ASHAs undertake various responsibilities, including generating health awareness, mobilizing communities for local health planning, and promoting the use of healthcare services. From encouraging hospital births to facilitating immunizations and family planning, ASHAs play a pivotal role in improving community health outcomes.

Despite their essential role, ASHAs face numerous challenges in executing their duties effectively. Covering vast populations with limited resources poses a significant obstacle, with each ASHA responsible for a target population of 1,000 in plains areas and 500 in more challenging terrains such as deserts, hills, or tribal areas.

Supervision by Auxiliary Nurse Midwives (ANMs) is scarce, with one ANM typically overseeing the work of multiple ASHAs. While ASHAs receive training and support from ANMs and village-based Aangan-Wari-Workers (AWWs), practical difficulties such as traversing difficult terrain and carrying essential materials hinder their ability to deliver services efficiently.

The burden of paperwork and the lack of effective communication tools further impede ASHAs' ability to provide timely and comprehensive care. Despite their dedication, some ASHAs struggle to maintain standards of service delivery, particularly in counseling eligible couples and identifying individuals in need of medical attention.