Launched in 2005, it now has close to 1 million workers and is the backbone of India's public health infrastructure, particularly in rural areas. Several studies have shown that ASHAs have played a crucial role in improving maternal and child health, increasing immunisation rates, and raising awareness about family planning.
But their reach still needs to include the most under-served sections of the community. We believe this requires interventions that can psychologically empower ASHAs to effectively operate as change agents.
ASHAs' role is an 'activist'—going beyond basic healthcare delivery and promoting health awareness, mobilising local community participation in public health planning, and increasing the use of existing services. Bringing about this behaviour change requires significant persuasion, perseverance, and a proactive approach.
However, despite the high expectations, policymakers and formal health staff often attribute a low capacity for independent action to ASHAs, frequently marginalised both socially and economically. This perception manifests in punitive systems and design features that emphasise record-keeping, daily monitoring and performance evaluation focused on compliance rather than outcomes. This system of constant monitoring leads to a 'check-box' approach, creating a vicious cycle where they are further pushed into behaviours that undermine their projected capacity for independent action.
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