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

Fiber optics based surface plasmon resonance for label-free optical sensing

349-362With the advancement in the laser technology and availability of low cost optical fibers, there is an increasing trend towards adoption of optical fibers as sensing element for development of optical sensors probes especially point-of-care sensing for environmental, biomedical and clinical application. Refractive index measurement through surface plasmon resonance has evolved to be, one of the most sensitive transducer for label-free sensing with high sensitivity. Surface plasmon resonance is a surface sensitive optoelectronic phenomenon, where light incident on a plasmonic metal surface at a given angle can excite a surface-bound electromagnetic wave, a surface plasmon. Associated with the surface plasmon is an evanescent field that probes local changes in the refractive index of the ambient medium that are used for monitoring analyte- supramolecular/ bio-molecular ligand interactions. Present review outlines a concise view on theoretical aspects of fiber optics based surface plasmon resonance phenomenon and comprehensive updated review on research and development for progression in the design of fiber optics based SPR sensors

Fiber optics based surface plasmon resonance for label-free optical sensing

349-362With the advancement in the laser technology and availability of low cost optical fibers, there is an increasing trend towards adoption of optical fibers as sensing element for development of optical sensors probes especially point-of-care sensing for environmental, biomedical and clinical application. Refractive index measurement through surface plasmon resonance has evolved to be, one of the most sensitive transducer for label-free sensing with high sensitivity. Surface plasmon resonance is a surface sensitive optoelectronic phenomenon, where light incident on a plasmonic metal surface at a given angle can excite a surface-bound electromagnetic wave, a surface plasmon. Associated with the surface plasmon is an evanescent field that probes local changes in the refractive index of the ambient medium that are used for monitoring analyte- supramolecular/ bio-molecular ligand interactions. Present review outlines a concise view on theoretical aspects of fiber optics based surface plasmon resonance phenomenon and comprehensive updated review on research and development for progression in the design of fiber optics based SPR sensors

Fiber optics based surface plasmon resonance for label-free optical sensing

With the advancement in the laser technology and availability of low cost optical fibers, there is an increasing trend towards adoption of optical fibers as sensing element for development of optical sensors probes especially point-of-care sensing for environmental, biomedical and clinical application. Refractive index measurement through surface plasmon resonance has evolved to be, one of the most sensitive transducer for label-free sensing with high sensitivity. Surface plasmon resonance is a surface sensitive optoelectronic phenomenon, Where light incident on a plasmonic metal surface at a given angle can excite a surface-hound electromagnetic wave, a. surface plasmon. Associated with the surface plasmon is an evanescent field that probes local changes in the refractive index of the ambient medium that are used for monitoring analyte- supramolecular/ bio-molecular ligand interactions. Present review outlines a concise view on theoretical aspects of fiber optics based surface plasmon resonance phenomenon and comprehensive updated review on research and development for progression in the design of fiber optics based SPR sensors

Long-term yield trend and sustainability of rainfed soybean–wheatsystem through farmyard manure application in a sandy loam soil of the Indian Himalayas

A long-term (30 years) soybean–wheat experiment was conducted at Hawalbagh, Almora, India to study the effects of organic and inorganic sources of nutrients on grain yield trends of rainfed soybean (Glycine max)–wheat (Triticum aestivum) system and nutrient status (soil C, N, P and K) in a sandy loam soil (Typic Haplaquept). The unfertilized plot supported 0.56 Mg ha−1 of soybean yield and 0.71 Mg ha−1 of wheat yield (average yield of 30 years). Soybean responded to inorganic NPK application and the yield increased significantly to 0.87 Mg ha−1 with NPK. Maximum yields of soybean (2.84 Mg ha−1) and residual wheat (1.88 Mg ha−1) were obtained in the plots under NPK + farmyard manure (FYM) treatment, which were significantly higher than yields observed under other treatments. Soybean yields in the plots under the unfertilized and the inorganic fertilizer treatments decreased with time, whereas yields increased significantly in the plots under N + FYM and NPK + FYM treatments. At the end of 30 years, total soil organic C (SOC) and total N concentrations increased in all the treatments. Soils under NPK + FYM-treated plots contained higher SOC and total N by 89 and 58% in the 0–45 cm soil layer, respectively, over that of the initial status. Hence, the decline in yields might be due to decline in available P and K status of soil. Combined use of NPK and FYM increased SOC, oxidizable SOC, total N, total P, Olsen P, and ammonium acetate exchangeable K by 37.8, 42.0, 20.8, 30.2, 25.0, and 52.7%, respectively, at 0–45 cm soil layer compared to application of NPK through inorganic fertilizers. However,the soil profiles under all the treatments had a net loss of nonexchangeable K, ranging from 172 kg ha−1 under treatment NK to a maximum of 960 kg ha−1 under NPK + FYM after 30 years of cropping. Depletion of available P and K might have contributed to the soybean yield decline in treatments where manure was not applied. The study also showed that although the combined NPK and FYM application sustained long-term productivity of the soybean– wheat system, increased K input is required to maintain soil nonexchangeable K level

Costing Analysis of a Pilot Community Health Worker Program in Rural Nepal.

Community health workers (CHWs) are essential to primary health care systems and are a cost-effective strategy to achieve the Sustainable Development Goals (SDGs). Nepal is strongly committed to universal health coverage and the SDGs. In 2017, the Nepal Ministry of Health and Population partnered with the nongovernmental organization Nyaya Health Nepal to pilot a program aligned with the 2018 World Health Organization guidelines for CHWs. The program includes CHWs who: (1) receive regular financial compensation; (2) meet a minimum education level; (3) are well supervised; (4) are continuously trained; (5) are integrated into local primary health care systems; (6) use mobile health tools; (7) have consistent supply chain; (8) live in the communities they serve; and (9) provide service without point-of-care user fees. The pilot model has previously demonstrated improved institutional birth rate, antenatal care completion, and postpartum contraception utilization. Here, we performed a retrospective costing analysis from July 16, 2017 to July 15, 2018, in a catchment area population of 60,000. The average per capita annual cost is US$3.05 (range: US$1.94 to US$4.70 across 24 villages) of which 74$51.00 per capita) to 7.0% of the 2030 gross domestic product, paired with recent health care systems decentralization leading to expanded fiscal space in municipalities, this CHW program provides a feasible opportunity to make progress toward achieving universal health coverage and the health-related SDGs. This costing analysis offers insights and practical considerations for policy makers and locally elected officials for deploying a CHW cadre as a mechanism to achieve the SDG targets