Abstract
Abstract
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).
Funder
the Australian National Heart Foundation Future Leader Fellowship
Publisher
Springer Science and Business Media LLC
Subject
Public Health, Environmental and Occupational Health,Public Administration
Reference33 articles.
1. Perry H, Zulliger R, Scott K, et al. Case studies of large-scale community health worker programs: examples from Bangladesh, Brazil, Ethiopia, India, Iran, Nepal, and Pakistan. 2013.
2. Freeman PA, Schleiff M, Sacks E, et al. Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 4. child health findings. J Glob Health. 2017;7(1):010904.
3. Khetan AK, Purushothaman R, Chami T, et al. The effectiveness of community health workers for CVD prevention in LMIC. Glob Heart. 2017;12(3):233–43.e6.
4. Joshi R, Thrift AG, Smith C, et al. Task-shifting for cardiovascular risk factor management: lessons from the Global Alliance for Chronic Diseases. BMJ Glob Health. 2018;3(Suppl 3):e001092.
5. Kakuma R, Minas H, van Ginneken N, et al. Human resources for mental health care: current situation and strategies for action. Lancet (London, England). 2011;378(9803):1654–63.
https://doi.org/10.1016/s0140-6736(11)61093-3
[published Online First: 2011/10/20].
Cited by
23 articles.
订阅此论文施引文献
订阅此论文施引文献，注册后可以免费订阅5篇论文的施引文献，订阅后可以查看论文全部施引文献