India's one million Accredited Social Health Activists (ASHA) win the Global Health Leaders award at the 75th World Health Assembly: Time to move beyond rhetoric to action?

Asthana, Sumegha; Mayra, Kaveri

doi:10.1016/j.lansea.2022.100029

Cited by 6 publications

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“…Health services globally were disrupted by the COVID-19 pandemic, including in India [ 18 ], as limited resources were diverted to the management of the pandemic [ 13 ] and the population avoided accessing routine health care because of fear of infection. During this time, India’s resilient ASHAs maintained frontline health care, despite increased workload and stress.…”

Section: Discussionmentioning

confidence: 99%

“…During this time, India’s resilient ASHAs maintained frontline health care, despite increased workload and stress. Their award as Global Health Leaders [ 13 ] formally acknowledges their contribution at the highest levels. ASHAs’ long-term role in improving health indicators (especially related to maternity and child health [ 33 ]) is well recognized, but the pandemic has highlighted the need to understand evolving ASHA roles and address the persistent challenges.…”

Section: Discussionmentioning

confidence: 99%

“…Their roles and responsibilities, mandated by operational guidelines [ 8 ], have evolved over time. ASHAs work as health educators and promoters, linking workers (between population and government health care services) and service providers [ 8 ], raising health awareness (nutrition, sanitation) to address barriers to health care, and participating in surveillance [ 13 ].…”

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confidence: 99%

“…We previously explored the ASHA role in a rural area of Maharashtra state, India [ 18 ], concluding that ASHAs perceived themselves as voluntary community health workers rather than health activists. During the COVID-19 pandemic, they were given multiple additional responsibilities of screening, identifying high-risk populations, referring patients to treatment centres, monitoring isolated patients, and supporting families of people with COVID-19 [ 13 ]. There was limited training before taking on these new roles, and despite the increased workload, there were no systems for timely remuneration.…”

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confidence: 99%

“…There was limited training before taking on these new roles, and despite the increased workload, there were no systems for timely remuneration. [ 13 ]. The lack of personal protective equipment meant that ASHA and their families were contracting COVID-19.…”

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Working as frontline health facilitators, service providers, program supporters, and social health activists in Indian hilly terrain areas: A qualitative study of accredited social health activists’ experiences before and during the COVID-19 pandemic

et al. 2022

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Background Community health workers (CHW) contribute to achieving health targets of the Sustainable Development Goals (SDG) and Universal Health Care (UHC) in low- and middle-income countries (LMICs). In India, accredited social health activists (ASHAs) function as health facilitators, service providers, and programme supporters for rural and tribal communities and are at the frontline during the COVID-19 pandemic. We aimed to describe the ASHAs’ work roles both before and during the COVID-19 pandemic, explore the tasks ASHAs performed throughout the pandemic, and understand its effects on the evolving role of ASHAs. Methods We used qualitative data from a pre-COVID-19 study conducted in 2018-2019 including face-to-face interviews with purposively sampled ASHAs and their health care supervisors (n = 18) from rural Maharashtra state (India), and a follow-up study during the COVID-19 pandemic using telephonic interviews with a subset of participants from the pre-COVID-study (n = 8). Data were analysed thematically using MAXQDA v11.00. Results The primary theme in the pre-COVID-19 study was ASHAs’ role as described above, except as social health activists, linking beneficiaries to the local maternal and child health care services, distributing medicines for common illnesses, access to government schemes, and engaging in multiple health surveys. During the pandemic, raising awareness, screening of at-risk populations, arranging referrals, providing treatment and follow-up to COVID-19 patients, and supporting their family members. These activities increased the workload and health risks to ASHAs and their family, causing stress and tension among them. However, they had effectively carried out the new duties. ASHAs have improved their status, earning praise from families, society, and the government. They were honoured with the Global Health Leaders Award at the 75th World Health Assembly. Conclusion ASHAs’ contribution to the health system improved the indicators related to maternal and child health during the pre-COVID-19 pandemic. Additionally, they maintained frontline health care during the COVID-19 pandemic, demonstrating resilience despite the challenges of increased workload and stress. However, the COVID-19 pandemic highlights the need to respond to and understand the implications of ASHAs’ evolving roles.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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