What do Accredited Social Health Activists need to provide comprehensive care that incorporates non-communicable diseases? Findings from a qualitative study in Andhra Pradesh, India
Open accessAbstract
Background: 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. Methods: A 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. Results: This 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. Conclusion: ASHAs 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 registration: The study was registered with “Clinical Trials Registry – India” (identifier CTRI/2018/03/012425).
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ASHAs and Anganwadi teachers are instrumental in providing frontline health services in rural India, and both played important roles in combating the COVID-19 pandemic, including coordinating vaccination efforts.
“As trusted members of their local communities, ASHAs and Anganwadi teachers are instrumental in providing frontline health services in rural India, [66–68] and both played important roles in combating the COVID-19 pandemic, including coordinating vaccination efforts [68, 69].”
From Acceptability of HPV vaccination for cervical cancer prevention amongst emerging adult women in rural Mysore, India: a mixed-methods study (2024) · cites this paper as [67]
The Introduction (page not supplied) describes ASHAs as community health workers who connect people to public health services, including immunisation, and the Results describe their trusted role in their communities. The cited paper does not establish the corresponding role of Anganwadi teachers or address either group's work during COVID-19, including vaccination coordination. (LLM, conf=0.89)
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Coursey, K., Muralidhar, K., Srinivas, V., Jaykrishna, P., Begum, F., Ningaiah, N., Lee, S.-J., & Madhivanan, P. (2024) · BMC Public Health · doi:10.1186/s12889-024-19485-8 · Cited by 10 · see citing works
- Authors
- Abdel-All, M., Abimbola, S., Praveen, D., & Joshi, R.
- Affiliations
- The University of Sydney (AU)
- UNSW Sydney (AU)
- Corresponding author
- Abdel-All, Marwa
- Venue
- Human Resources for Health
- Published
- 2019-10-22
- Volume
- 17
- Issue
- 1
- Pages
- 73-73
- ISSN
- 1478-4491 (ISSN-L)
- PMC
- PMC6805300
- OpenAlex
- W2982267125
- Cited by
- 42
- References
- 5
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 6 · 2023: 5 · 2022: 8 · 2021: 10 · 2020: 6
- FWCI
- 8.81
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Human Resources for Health (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- UNSWorks (University of New South Wales, Sydney, Australia) (submittedVersion, cc-by)
- Funders
- the Australian National Heart Foundation Future Leader Fellowship (GNT100484)
- Topics
- Health Sciences › Health Professions › Emergency Medical Services › Global Health Workforce Issues
- Health Sciences › Health Professions › General Health Professions › Nursing Roles and Practices
- Social Sciences › Economics, Econometrics and Finance › Finance › Healthcare Systems and Reforms
- Keywords
- Accredited Social Health Activists, non-communicable diseases, primary care, community health workers, health system integration, Andhra Pradesh
- MeSH terms
- Noncommunicable Diseases, Community Health Workers, Health Policy, Humans, India, Interviews as Topic, Primary Health Care, Professional Role
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