Counseling Is a Relationship Not Just a Skill: Re-conceptualizing Health Behavior Change Communication by India’s Accredited Social Health Activists

Rajani Ved; Kerry Scott

doi:10.9745/GHSP-D-20-00426

Key Messages

As both community members and health system functionaries, the capacity of India’s community health workers—accredited social health activists (ASHAs)—to improve health outcomes depends on their relationships with families and the support they receive from the health system.
Training ASHAs on interpersonal communication, such as how to convey the right messages in a persuasive manner, is an important step to improve their impact as health behavior change communicators. However, it is not sufficient.
Effective counseling also requires that ASHAs have strong positive relationships with community members. These relationships are developed over time as ASHAs link communities to high quality health services and showcase their capacity to directly meet key health needs.

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 …

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