See related article by Smittenaar et al.
Now in its fifteenth year, India’s accredited social health activist (ASHA) community health worker (CHW) program demonstrates all the opportunities and challenges that come with operating CHW programs at a massive scale, in this case with close to a million ASHAs. In this article, we discuss the tensions and benefits associated with ASHAs being both health system actors and community members and how policy and social relationships can support or undermine ASHA ability to improve community health.
The ASHA program is a part of a global re-emergence of national CHW programs,1,2 with the potential of CHWs to contribute to the Sustainable Development Goals around primary health care now well established in the academic literature3 and enshrined in World Health Organization guidelines.4
The article by Smittenaar et al.5 in this issue of GHSP is an important contribution to our understanding of CHW performance and impact for 2 reasons. First, this research examines a mature …