Focus group discussion of urban ASHAs. Photo credit: Dr. Karvande

Urban ASHAs referring to picture cards used during focus group discussion. Photo credit: Dr. Karvande

Urban ASHAs with the PEER team. Photo credit Dr. Karvande

 

In India scientific research about assessment of urban ASHAs’ preparedness in general and particularly in TB as a vertical health program is limited. Their counterpart, rural ASHAs have been relatively more studied and reviewed. This research project was intended to provide insight  about urban ASHAs in terms of their training needs, monitoring and supervision, reporting structure, remuneration schedule, workload, motivation, e-literacy, family support, performance appraisal. Importantly, it has provided pointers about preparedness of ASHAs to work for TB control in terms of their knowledge related to TB- symptoms, prevention, diagnosis, treatment, referral and support, government schemes and their expected role; current practices for TB control, TB specific training needs, perceptions regarding provision of people centric TB care and suggestions for building their capacity. 
 

The research pointed towards health system related challenges such as gaps in coordination between community health workers and health system, challenges for them in working as a link worker and skills required by other health staff to provide supportive supervision to ASHAs. In terms of their preparedness to deliver TB care, the study has shown specific knowledge gaps and poor clarity in their roles for provision of TB care which is being implemented as a vertical program. It has highlighted needs in terms of building capacity of trainers, supervisors and the urban ASHAs using adult learning principles, continuous learning approach and use of digital platform. The TB specific training required trained trainers and dedicated time for better absorption of knowledge.  Subjects such as adverse drug reactions, nutrition needs of TB patients, dealing with stigma and people centered TB care need more focus in the TB training. The urban ASHAs need to be better oriented about TB program in general and roles expected from them in particular. 

This research is a situation analysis of the urban ASHA program from the two major cities with specific recommendations for improvisation of the delivery of TB program, for building capacity of urban ASHAs and for better placement of her within the primary health system. As of their rural counterparts U-ASHAs are also a key resource for fast-tracking universal health coverage, achieving an adequate quality of service delivery and ensuring comprehensive and accessible primary healthcare. Instead of imposing the rural ASHA model in urban areas its appropriate adaptation would be a useful strategy. It thus highlights an urgent need for the customized approach oriented towards the urban context, challenges and opportunities for enhancing ASHA program in urban areas. This piece of exploratory research work has opened several avenues for developing and research and intervention ideas for the TB patients and/ or urban community health workers and contribute towards health system strengthening for delivery of comprehensive primary healthcare.

 

According to the PI Dr. Shilpa Karvande, the PEER seed grant had a gender-sensitive lens for undertaking research activities which reflected during the project journey from recruitment of research staff. She was  mindful in choosing women researchers who were enthusiastic and committed towards their research career. Conscious efforts were made to plan and implement need-based formal mentoring sessions for improving their TB knowledge, research and other skills.  Day-to-day interactions with all the women mentees was a platform of mutual learning, problem-solving and team-spirit. All women mentees appreciated the work environment and the process of learning throughout the project period. This grant gave Dr. Karvande an opportunity to be instrumental in the lives of these five women researchers for having a balance in their personal and professional life. According to Dr. Karvande,  a true blend of mentoring and research activities could be demonstrated during this short period of the grant. At a larger society and health program level, according to the PI, this research has generated robust evidence about challenging lives of female health workforce who are incentivized volunteers with poor role clarity, inadequate remuneration and higher expectations to delivery primary healthcare including TB care. This grant was instrumental in inspiring and encouraging the women researchers who are charting their path for making health system responsive to the needs of people.