Evaluation of ASHA programme in Karnataka under the National Rural Health Mission

Introduction The Accredited Social Health Activist (ASHA) programme of the National Rural Health Mission (NRHM) is considered as being vital to achieving the goal of increasing community participation with the health system, and is one of the key components of NRHM, India’s flagship programme in health launched in 2005. The problem of evaluating ASHA is compounded by multiple and contesting narratives of what constitutes the legitimate role of an ASHA. The discourse on the ASHA’s role centres around three typologies: ASHA as an activist, ASHA as a link worker or facilitator, and ASHA as a community level health care provider. Another problem for evaluation is that the ASHA programme is implemented concurrently with a number of other components of the NRHM such as the Janani Suraksha Yojana (JSY) and the emergency transport (108) programme and it is impossible to isolate or attribute outcomes as being due to the ASHA programme alone. Methodologically, there is also no baseline status for comparison after the introduction of the ASHA programme in a classical ‘beforeand-after’ study mode. This paper explores the diversity within the ASHA programmes in different districts and overall within Karnataka.