Table 1 Training and responsibilities of ASHAs to promote the health of mothers and children

Recruitment

- ASHAs must be female, between 21 and 45 years old with middle-school education (class eight or higher), and ideally should be a “daughter-in-law” of the village, either married, widowed, or divorced with a likelihood to live in the village for the foreseeable future.

- States have flexibility in selecting ASHAs with lower literacy levels to ensure adequate community representation and local residence

Training

- The ASHAs receive training supported by the Government of India for 23 days spread over 12 months. Training models may vary by state and may involve partnerships with various NGOs and other training centers.

- The ASHAs are expected to attend periodic review meetings and ongoing job training (12 additional days per year).

Primary responsibilities

- Expected to work about 2.3 h per day and 4 days per week, except during events such as training and immunization days.

- Create awareness and provide information to the community on the determinants of health such as nutrition, basic sanitation and hygiene, and existing health services.

- Counsel mothers on birth preparedness, safe delivery, feeding practices, immunization, prevention of common infections, and family planning.

- Registering all pregnant women, provide three antenatal visits and two postnatal visits, and facilitate access to health services for the mother and child.

- Rollout of other government programs such as the Janani Surakshna Yojana (JSY)—a cash entitlement program to incentivize women to give birth in health facilities.

- Arrange escort or accompany pregnant women and children requiring treatment to health facilities.

- Additional responsibilities of the ASHAs may vary by state.

- Act as a bridge between the rural population and the government health system.

Compensation

- The ASHAs are honorary volunteers and receive performance-based compensation based on reported activities.

- The compensation varies by the state and by the type of services provided. It ranges from INR 200 (~ $2.95) for registering a pregnant woman, providing 3 antenatal and 2 postnatal visits to INR 200–350 (~ $2.95–5) for facilitating institutional birth.

Supervision

- As per national guidelines, one ASHA facilitator is assigned for every 20 ASHAs, to help with selection, provide on-the-job mentoring, conduct regular supervisory meetings, and maintain records.

- During monthly performance monitoring meetings, ASHAs are to report on their activities, especially around critical tasks around visiting newborns on the first day for home deliveries, attending immunization camps, visiting households to discuss nutrition, and acting as DOT providers for tuberculosis treatment.