Determinants of functionality and effectiveness of community health workers: results from evaluation of ASHA program in eight Indian states

Introduction In 2005, Accredited Social Health Activist (ASHA, a female community health worker), program was launched as part of the National Rural Health Mission (NRHM), a flagship program of the government of India. With 846,809 ASHAs across 31 states and union territories, the program has grown to become the most important facet of the NRHM. The ASHA is a woman selected by the community, who is trained and deployed to function in her own village to improve the health status of the community. However, despite being hailed as the face of the NRHM, several operational issues lack clarity and hinder her functions. These include clarity on her role, expected outcomes, adequacy and quality of training and support systems, and defining her future role.