Remember Me
Or use your Academic/Social account:


Or use your Academic/Social account:


You have just completed your registration at OpenAire.

Before you can login to the site, you will need to activate your account. An e-mail will be sent to you with the proper instructions.


Please note that this site is currently undergoing Beta testing.
Any new content you create is not guaranteed to be present to the final version of the site upon release.

Thank you for your patience,
OpenAire Dev Team.

Close This Message


Verify Password:
Verify E-mail:
*All Fields Are Required.
Please Verify You Are Human:
fbtwitterlinkedinvimeoflicker grey 14rssslideshare1
Saprii, L; Richards, E; Kokho, P; Theobald, S (2015)
Publisher: BioMed Central
Journal: Human Resources for Health
Languages: English
Types: Article
Subjects: Incentives and disincentives, wa_546, Public Administration, Qualitative, Community health workers, Accredited Social Health Activist, Roles and responsibilities, India, Research, wa_100, wa_540, Public Health, Environmental and Occupational Health
Background: Globally, there is increasing interest in community health worker’s (CHW) performance; however, there are gaps in the evidence with respect to CHWs’ role in community participation and empowerment. Accredited Social Health Activists (ASHAs), whose roles include social activism, are the key cadre in India’s CHW\ud programme which is designed to improve maternal and child health. In a diverse country like India, there is a need to understand how the ASHA programme operates in different underserved Indian contexts, such as rural Manipur.\ud \ud Methods: We undertook qualitative research to explore stakeholders’ perceptions and experiences of the ASHAscheme in strengthening maternal health and uncover the opportunities and challenges ASHAs face in realising their multiple roles in rural Manipur, India. Data was collected through in-depth interviews (n = 18) and focus group\ud discussions (n = 3 FGDs, 18 participants). Participants included ASHAs, key stakeholders and community members. They were purposively sampled based on remoteness of villages and primary health centres to capture diverse and relevant constituencies, as we believed experiences of ASHAs can be shaped by remoteness. Data were analysed\ud using the thematic framework approach.\ud \ud Results: Findings suggested that ASHAs are mostly understood as link workers. ASHA’s ability to address the immediate needs of rural and marginalised communities meant that they were valued as service providers. The programme is perceived to be beneficial as it improves awareness and behaviour change towards maternal care.\ud However, there are a number of challenges; the selection of ASHAs is influenced by power structures and poor community sensitisation of the ASHA programme presents a major risk to success and sustainability. The primary health centres which ASHAs link to are ill-equipped. Thus, ASHAs experience adverse consequences in their ability to inspire trust and credibility in the community. Small and irregular monetary incentives demotivate ASHAs. Finally,ASHAs had limited knowledge about their role as an ‘activist’ and how to realise this.\ud \ud Conclusions: ASHAs are valued for their contribution towards maternal health education and for their ability toprovide basic biomedical care, but their role as social activists is much less visible as envisioned in the ASHA\ud operational guideline. Access by ASHAs to fair monetary incentives commensurate with effort coupled with the poor functionality of the health system are critical elements limiting the role of ASHAs both within the health system and within communities in rural Manipur.
  • The results below are discovered through our pilot algorithms. Let us know how we are doing!

    • 1. World Health Organisation (WHO). Alma Ata Declaration. Geneva: World Health Organization; 1978. http://www.who.int/publications/almaata_ declaration_en.pdf (Accessed on 10 June 2015).
    • 2. Greenspan JA, McMahon SA, Chebet JJ, Mpunga M, Urassa DP, Winch PJ. Sources of community health worker motivation: a qualitative study in Morogoro Region, Tanzania. Hum Resour Health BioMed Central. 2013;11(1):52.
    • 3. World Health Organization (WHO). Community health workers: What do we know about them. Policy briefs Geneva WHO. 2007. http://www.who.int/hrh/ documents/community_health_workers.pdf [Accessed on 10 June 2015].
    • 4. Frankel S. The community health worker: effective programmes for developing countries. New York: Oxford University Press; 1992.
    • 5. Bhattacharyya K, Winch P, LeBan K, Tien M. Community Health Worker Incentives and Disincentives: How They Affect Motivation, Retention, and Sustainability. Published by the Basic Support for Institutionalizing Child Survival Project (BASICS II) for the United States Agency for International Development. Arlington, Virginia, October 2001.
    • 6. Scott K, Shanker S. Tying their hands? Institutional obstacles to the success of the ASHA community health worker programme in rural north India. AIDS Care. 2010;22 Suppl 2:1606-12.
    • 7. Haines A, Sanders D, Lehmann U, Rowe AK, Lawn JE, Jan S, et al. Achieving child survival goals: potential contribution of community health workers. Lancet. 2007;369(9579):2121-31.
    • 8. Walt G. Community health workers in national programmes: just another pair of hands? Milton Keynes: Open University; 1990.
    • 9. World Health Organisation (WHO). Task shifting: rational redistribution of tasks among health workforce teams: global recommendations and guidelines. 2008. Geneva: WHO; 2008. http://www.who.int/healthsystems/ TTR-TaskShifting.pdf.
    • 10. Lehmann U, Friedman I, Sanders D. Review of the Utilisation and Effectiveness of Community-Based Health Workers in Africa. University of the Western Cape, South Africa; SEED Trust, South Africa. 2004. http://www. rmchsa.org/wp-content/resources/resources_by_theme/MNCWH% 26NSystemsStrengthening/ReveiwUse%26EffectivenessOfCHWsInAfrica.pdf [Accessed on 2 December 2015]
    • 11. Witmer A, Seifer SD, Finocchio L, Leslie J, O'Neil EH. Community health workers: integral members of the health care work force. Am J Public Health American Public Health Association. 1995;85(8_Pt_1):1055-8.
    • 12. Lewin S, Munabi-Babigumira S, Glenton C, Daniels K, Bosch-Capblanch X, van Wyk BE, et al. Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases. Cochrane Database Systematic Reviews. Volume (3)2010: CD004015.
    • 13. Bhutta, ZA, Lassi, ZS, Pariyo G, Huicho L. Global experience of community health workers for delivery of health related millennium development goals: a systematic review, country case studies, and recommendations for integration into national health systems. Global Health Workforce Alliance, 1, 2010;249-261.
    • 14. Perry H, Zulliger R. How effective are community health workers. An overview of current evidence with recommendations for strengthening community health worker programs to accelerate progress in achieving the health-related Millennium Development Goals. Baltimore: John's Hopkins Bloomberg School of Public Health; 2012.
    • 15. Shakir FK. Community health worker programs: a review of recent literature. [Bethesda Maryland] University Research Company [URC] Health Care Improvement Project [HCI] 2010. http://chwcentral.org/sites/default/files/ Community Health Worker Programs- A Review of Recent Literature_0.pdf [Accessed on 8 June 2015]
    • 16. Liu A, Sullivan S, Khan M, Sachs S, Singh P. Community health workers in global health: scale and scalability. Mt Sinai J Med A J Transl Pers Med. 2011;78(3):419-35.
    • 17. Abbatt F. Scaling up health and education workers: community health workers. Literature review. London: Department for International Development Health Resource Centre; 2005. p. 23. http://www. hrhresourcecenter.org/node/616 [Accessed on 8 June 2015]
    • 18. Prasad BM, Muraleedharan VR. Community health workers: a review of concepts, practice and policy concerns. A review as part of ongoing research of International Consortium for Research on Equitable Health Systems (CREHS). August 2007. http://www.hrhresourcecenter.org/hosted_ docs/CHW_Prasad_Muraleedharan.pdf [Accessed on 2 December 2015]
    • 19. Bajpai N, Dholakia RH. Improving the performance of accredited social health activists in India. New York: Columbia Global Centers-South Asia, Columbia University; 2011. Report No.: 1.
    • 20. NHSRC. ASHA Which Way Forward: Evaluation of ASHA program 2010-11. New Delhi; 2011. http://nhsrcindia.org/index.php?option=com_ content&view=article&id=286 [Accessed on 9 June 2015]
    • 21. Joshi S, Mathews G. Healthcare through community participation: role of ASHAs. Econ Polit Wkly. 2012;47(10):70.
    • 22. NHSRC. ASHA Evaluation: Nagaland [Internet]. 2012. http://nhsrcindia.org/index. php?option=com_content&view=article&id=286 [Accessed on 9 June 2015]
    • 23. Gopalan SS, Varatharajan D. Addressing maternal healthcare through demand side financial incentives: experience of Janani Suraksha Yojana program in India. BMC Health Serv Res BioMed Central. 2012;12(1):319.
    • 24. Gopalan SS, Mohanty S, Das A. Assessing community health workers' performance motivation: a mixed-methods approach on India's Accredited Social Health Activists (ASHA) programme. BMJ Open 2, no 5, 2012; doi:10. 1136/bmjopen-2012-001557.
    • 25. Ministry of Health and Family Welfare. About Accredited Social Health Actvist (ASHA). http://nrhm.gov.in/communitisation/asha/about-asha.html [Accessed on 9 June 2015]
    • 26. Wang H, Juyal RK, Miner SA, Fischer E. Performance-based payment system for ASHAs in India: what does international experience tell us? Bethesda, MD: The Vistaar Project, IntraHealth International Inc., Abt Associates Inc; 2012.
    • 27. Singh MK, Singh JV, Ahmad N, Kumari R, Khanna A. Factors influencing utilization of ASHA services under NRHM in relation to maternal health in rural Lucknow. Indian J community Med Off Publ Indian Assoc Prev Soc Med. 2010;35(3):414.
    • 28. Mony P, Raju M. Evaluation of ASHA programme in Karnataka under the National Rural Health Mission. BMC Proc BioMed Central. 2012;6 Suppl 5:12.
    • 29. MoDoNER. Manipur At a glance. 2014. http://www.mdoner.gov.in/content/ manipur-glance [Accessed on 9 June 2015]
    • 30. Office of the Registrar General & Census Commissioner. Provisional Population Totals Paper 1 of 2011: Manipur, Census of India. Ministry of Home Affairs, Government of India; New Delhi; 2011
    • 31. Kikon, D Engaging Naga Nationalism: Can Democracy Function in Militarised Societies?. Economic and Political Weekly (2005): 2833-37.
    • 32. Kumar A, Kamei A, Thangjam H, Singh KB. Situating conflict and poverty in Manipur. Margin-New Delhi-. National Council Of Applied Economic Research. 2007;38(4/1):107.
    • 33. Government of India Planning Commission. 2013. Poverty estimates for 2011-12. http://planningcommission.nic.in/news/pre_pov2307.pdf [Accessed on 02 December 2015]
    • 34. Ministry of Health and Family Welfare. DLHS IV State Fact Sheet Manipur. http://www.rchiips.org/pdf/dlhs4/report/MN.pdf [Accessed on 9 June 2015]
    • 35. Ritchie J, Lewis J. Qualitative research practice: a guide for social science students and researchers. London: Sage; 2003.
    • 36. Malterud K. The art and science of clinical knowledge: evidence beyond measures and numbers. Lancet. 2001;358(9279):397-400.
    • 37. Smith J, Firth J. Qualitative data analysis: the framework approach. Nurse Res. 2011;18(2):52-62.
    • 38. Lim SS, Dandona L, Hoisington JA, James SL, Hogan MC, Gakidou E. India's Janani Suraksha Yojana, a conditional cash transfer programme to increase births in health facilities: an impact evaluation. Lancet. 2010; 375(9730):2009-23.
    • 39. Peters DH. Better health systems for India's poor: findings, analysis, and options. Washington DC: World Bank Publications; 2002.
    • 40. Aldana JM, Piechulek H, Al-Sabir A. Client satisfaction and quality of health care in rural Bangladesh. Bull World Health Organ. 2001;79(6):512-7.
    • 41. Fomba S, Yang Y, Zhou H, Liu Q, Xiao PM. Patient's utilization and perception of the quality of curative care in community health centers of the fifth commune of Bsamako. Indian J community Med Off Publ Indian Assoc Prev Soc Med. 2010;35(2):256.
    • 42. Schaay N, Sanders D. International perspective on Primary Health Care over the past 30 years: In Barron P, Roma-Reardon J, editors. South African Health Review. Durban: Health Systems Trust; 2008. p3-16.
    • 43. Editors PlM. Health care systems and conflict: a fragile state of affairs. PLoS Med. 2011;8:7.
    • 44. Acerra JR, Iskyan K, Qureshi ZA, Sharma RK. Rebuilding the health care system in Afghanistan: an overview of primary care and emergency services. Int J Emerg Med. 2009;2(2):77-82.
    • 45. Pérez LM, Martinez J. Community health workers: social justice and policy advocates for community health and well-being. Am J Public Health. 2008;98(1):11.
    • 46. Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health: final report of the commission on social determinants of health. Geneva: World Health Organization; 2008.
    • 47. Ingram M, Sabo S, Rothers J, Wennerstrom A, de Zapien JG. Community health workers and community advocacy: addressing health disparities. J Community Health. 2008;33(6):417-24.
  • No related research data.
  • No similar publications.

Share - Bookmark

Funded by projects

  • WT

Cite this article