The ever evolving role of ASHA demands an up-to-date comprehensive assessment of the workload, incentives and understanding of the work profile from the perspectives of the health system, community and ASHA herself in order to guide successful future implementation as well as sustainability of the programme. This study had a broad interest in both the full range of tasks and the different situations in which ASHA work and the changing context in which their role is interpreted. This study therefore used a mixed-methods approach (MMA) to assess and explore ASHAs’ perspectives of their workload alongside that of local healthcare colleagues in both rural and village contexts.

Background: Globally, Community Health Workers (CHWs) are integral contributors to many health systems. In India, Accredited Social Health Activists (ASHAs) have been deployed since 2005. Engaged in multiple health care activities, they are a key link between the health system and population. ASHAs are expected to participate in new health programmes, prompting interest in their current workload from the perspective of the health system, community and their family.

Methods: This MMA design was conducted in rural and tribal Primary Health Centers (PHCs), in Pune district, Western Maharashtra, India. All ASHAs affiliated with these PHCs were invited to participate in the quantitative study, those agreeing to contribute in-depth interviews (IDI) were enrolled in an additional qualitative study. Key informants’ interviews were conducted with the Auxiliary Nurse Midwife, Block Facilitators and Medical Officers of the same PHCs. Quantitative data were analysed using descriptive statistics. Qualitative data were analysed thematically.

Results: We recruited 67 ASHAs from the two PHCs. ASHAs worked up to 20 hours/week in their village of residence, serving populations of approximately 800-1200, embracing an increasing range of activities, despite a workload that contributed to feelings of being rushed and constant tiredness. They juggled household work, other paid jobs and their ASHA activities. Practical problems with travel added to time involved, especially in tribal areas where transport is lacking. Their sense of benefiting the community and respect and recognition in village brought happiness and job satisfaction. They were willing to take on new tasks. ASHAs perceived themselves as voluntary community health workers rather than as "health activists."

Conclusions: ASHAs were struggling to balance their significant ASHA workload, and domestic tasks. They were proud of their role as CHWs and willing to take on new activities. Strategies to recruit, train, enhance skills, incentivise, and retain ASHAs, need to be prioritised.

for more information, please see : https://www.ed.ac.uk/usher/respire/chronic-respiratory-disorders/asha-workload