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

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Not AvailableAgricultural land degradation due to nutrient deficiencies is a threat to agricultural sustainability. As nutrients availability is influenced by soil heterogeneity, climatic conditions and anthropogenic activities; hence, delineation of nutrient management zones (MZs) based on spatial variability could be an effective management option at regional scale. Thus, the present study was carried out to delineate MZs in the Shiwalik Himalayan region of India by capturing spatial variability of soil properties and secondary and micronutrients status because of the emerging nutrient deficiencies. For the study, a total of 2575 geo‐referenced representative surface (0–15 cm depth) soil samples were collected from the study region covering an area of 53,483 km2. The soils were analysed for pH, electrical conductivity, soil organic carbon, available sulphur (S) and micronutrients (Zn, Fe, Cu, Mn, B and Mo) concentrations. There was a wide variation in soil properties with coefficient of variation values of 14 (for pH) to 86% for available Mo. Geostatistical analysis revealed spherical, Gaussian, exponential, stable, circular and K‐Bessel best‐fit models for soil properties. Most of the soil properties were having moderate spatial dependence except soil pH and S (strong spatial dependence) and Zn (weak spatial dependence). About 49%, 10%, 2%, 13%, 11%, 12% and 8% area of the study region were found to be deficient (including acute and marginal deficiency) in S, Zn, Fe, Cu, Mn, B and Mo, respectively. The principal component analysis and fuzzy c‐mean clustering were performed to develop the MZs. Four principal components with eigenvalues greater than 1 and accounting 65·4% of total variance were retained for further analysis. On the basis of fuzzy performance index and normalized classification entropy, four potential MZs were identified. Analysis of variance confirmed the heterogeneity in most of the studied soil properties among the MZs. The study indicated that the methodology of delineating MZs can be effectively used in site‐specific S and micronutrients management in the Shiwalik Himalayan region of India.Not Availabl