Taking stock of 10 years of published research on the ASHA programme: Examining India’s national community health worker programme from a health systems perspective

Background: As India’s accredited social health activist (ASHA) community health worker (CHW) programme enters its second decade, we take stock of the research undertaken and whether it examines the health systems interfaces required to sustain the programme at scale. Methods: We systematically searched three databases for articles on ASHAs published between 2005 and 2016. Articles that met the inclusion criteria underwent analysis using an inductive CHW–health systems interface framework. Results: A total of 122 academic articles were identified (56 quantitative, 29 mixed methods, 28 qualitative, and 9 commentary or synthesis); 44 articles reported on special interventions and 78 on the routine ASHA program. Findings on special interventions were overwhelmingly positive, with few negative or mixed results. In contrast, 55% of articles on the routine ASHA programme showed mixed findings and 23% negative, with few indicating overall positive findings, reflecting broader system constraints. Over half the articles had a health system perspective, including almost all those on general ASHA work, but only a third of those with a health condition focus. The most extensively researched health systems topics were ASHA performance, training and capacity-building, with very little research done on programme financing and reporting, ASHA grievance redressal or peer communication. Research tended to be descriptive, with fewer influence, explanatory or exploratory articles, and no predictive or emancipatory studies. Indian institutions and authors led and partnered on most of the research, wrote all the critical commentaries, and published more studies with negative results. Conclusion: Published work on ASHAs highlights a range of small-scale innovations, but also showcases the challenges faced by a programme at massive scale, situated in the broader health system. As the programme continues to evolve, critical comparative research that constructively feeds back into programme reforms is needed, particularly related to governance, intersectoral linkages, ASHA solidarity, and community capacity to provide support and oversight

Role of interfacial phenomena in determining adsorption of Bacillus polymyxa onto hematite and quartz

Utility of microorganisms as surface modifiers in flotation and flocculation has generated great interest in recent times. The surface properties of the minerals and the microorganisms such as zeta-potential ($\zeta$-potential) and hydrophobicity play a major role in determining adsorption of the microorganisms to the minerals and hence the efficiency of flocculation and flotation. These properties are also dependent on the solution conditions such as pH and ionic strength. In the present investigation, the role of ionic strength and pH in determining the surface properties and hence adsorption of the bacterium Bacillus polymyxa to hematite and quartz has been studied in detail. Results indicate that increasing the ionic strength changes the $\zeta$-potential of hematite and the bacterium without changing the point-of-zero-charge (PZC). Contact angle measurements showed that hematite was the most hydrophobic when compared with both quartz and the bacterium. Adsorption tests demonstrated that conditioning time, pH and ionic strength are all important in controlling adsorption of B. polymyxa on to both quartz and hematite. Adsorption of bacteria on to hematite was more compared with quartz. Flocculation tests demonstrated that in the presence of bacteria and electrolyte, hematite settled very rapidly in the pH range of 2–8. However, quartz settled much slower under the same indicating that the quartz particles are being dispersed. Thus selective flocculation of hematite can be used effectively in separating hematite from quartz. Interaction energies calculated using the extended DLVO theory were found to be in good agreement with the adsorption and flocculation tests