Abstract
BackgroundThe Indian National Program for Cardiovascular Disease, Diabetes, Cancer and Stroke (NPCDCS) was introduced to provide non-communicable disease (NCD) care through primary healthcare teams including Accredited Social Health Activists (ASHAs). Since ASHAs are being deployed to provide NCD care on top of their regular work for the first time, there is a need to understand the current capacity and challenges faced by them.MethodsA desktop review of NPCDCS and ASHA policy documents was conducted. This was followed by group discussions with ASHAs, in-depth interviews with their supervisors and medical officers and group discussions with community members in Guntur, Andhra Pradesh, India. The multi-stakeholder data were analysed for themes related to needs, capacity, and challenges of ASHAs in providing NCD services.ResultsThis study identified three key themes—first, ASHAs are unrecognised as part of the formal NPCDCS service delivery team. Second, they are overburdened, since they deliver several NPCDCS activities without receiving training or remuneration. Third, they aspire to be formally recognised as employees of the health system. However, ASHAs are enthusiastic about the services they provide and remain an essential link between the health system and the community.ConclusionASHAs play a key role in providing comprehensive and culturally appropriate care to communities; however, they are unrecognised and overburdened and aspire to be part of the health system. ASHAs have the potential to deliver a broad range of services, if supported by the health system appropriately.Trial registrationThe study was registered with “Clinical Trials Registry – India” (identifier CTRI/2018/03/012425).
Highlights
During the last decade, many low-income and middleincome countries (LMICs) have invested in community health worker (CHW) programmes due to their distinctive capacity to reach under-served populations [1]
In order to strengthen health services for non-communicable diseases (NCDs) control at the community level, there is a need to understand the current capacity, working conditions, and challenges faced by Accredited Social Health Activists (ASHAs)—this study aims to achieve these objectives
While ASHAs are identified as part of the NPCDCS team at the policy level, they are not recognised as part of the formal NPCDCS service delivery team on the ground
Summary
Many low-income and middleincome countries (LMICs) have invested in community health worker (CHW) programmes due to their distinctive capacity to reach under-served populations [1]. Other responsibilities include linking the community to the health system, community sensitization to new initiatives, health education, referral to health centres, and supporting medication adherence for infectious diseases such as tuberculosis through the directly observed treatment short-term programme [11]. They support the auxiliary nurse midwives (ANMs) in delivering maternal and child healthrelated services. The Indian National Program for Cardiovascular Disease, Diabetes, Cancer and Stroke (NPCDCS) was introduced to provide non-communicable disease (NCD) care through primary healthcare teams including Accredited Social Health Activists (ASHAs). Since ASHAs are being deployed to provide NCD care on top of their regular work for the first time, there is a need to understand the current capacity and challenges faced by them
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
