Table 1 Background on the ASHA programme

India has a long history of CHW programmes in both the governmental and non-governmental sectors, beginning before the country gained independence in 1947 [17]. Government commissions on health, such as the Bhore Committee in 1946 [61] and Srivastava Committee in 1975 [62], laid out frameworks for Indian primary health care that included training and supporting local people to serve as outreach workers, first aid providers, health educators, and health behaviour change promoters in their communities. However, government-run CHW programmes have come and gone, with several programmes initiated and then cancelled or left to languish due to changing priorities and cost concerns (e.g. Community Health Volunteers, later called Village Health Guides, in the 1980s) [34, 63].

Launched in 2005, the ASHA programme is the latest in this line of CHW programmes. ASHAs are female community members with at least 8 years education (e.g. have completed elementary school), who receive 23 days initial training and perform five key activities: home visits, community meetings, monthly meetings at the primary health centres, facilitating outreach services within the village, and maintaining records [16]. ASHAs are now in place across rural India at a ratio of one per 1000 population and are increasingly also selected in marginalized urban settlements.