ABSTRACT
The accredited social health activist (ASHA) programme, a core communitisation component of the National Health Mission, has undergone significant evolution since its launch in the year 2005. The ASHAs today represent the world’s largest all-women community health volunteer programme, acknowledged, both nationally and internationally, for their efforts to increase access to healthcare services and link the community with the health system, especially for maternal and newborn health and infectious diseases.
In this chapter, we focus on the various policy reforms enacted within the ASHA programme between 2005 and 2024 and analyse the underlying factors that influenced these policy choices. The chapter draws on published literature, including key policy documents, government reports, programme guidelines, progress updates, reports from assessments and evaluations, and peer-reviewed publications. Over the past 20 years, the ASHA programme has emerged as an exemplar of a centrally funded intervention designed for contextualising by states through flexible financing. It is characterised by a cycle of practitioner-led learning, facilitated by a technical support agency, feeding into policy formulation and modification. This is evident from the chronology of various policy interventions that were triggered by evidence, lessons from implementation, policy ecosystem, and local health contexts. Thus, guidance for most critical programme components (selection, training, supportive supervision, remuneration, institutional arrangements, and financing) has undergone several iterations to address emerging programme requirements. These systemic inputs, enabling agency building of the ASHA and spurring local action, have established them as an important community representative and a key member of the primary healthcare team, who are positioned to support India’s progress towards universal health coverage. The ASHA programme needs to be reconceptualised across all parameters of functionality so that she continues to be seen as a core element of the primary health system, continuing to serve the function of highlighting community needs and demands to the health system, and interfacing with the system to ensure delivery of high-quality services to the community.
