Vol VII, Issue 4 Date of Publication: October 28, 2022
DOI: https://doi.org/10.20529/IJME.2022.078

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COMMENT: Capacity building of community health workers: One size does not fit both rural and urban settings

Anuj Prakash Ghanekar
Abstract:
The Accredited Social Health Activist (ASHA) programme in India is the world's largest all-female Community Health Workers (CHWs) programme. ASHAs are supposed to bridge the gap between community and health services by functioning as healthcare catalysts, service providers, and community-level health activists. This paper discusses the ethical challenges posed by using the same template for capacity building of ASHAs in rural and urban contexts, without accounting for the differences. Urban heterogeneity and rapidly growing urbanisation demand special attention for crucial programme activities like the capacity-building of ASHAs. When the relevant literature like policy and programme documents, training modules, and implementation guidelines were analysed, it was evident that the simple transplantation of rural models to urban contexts would not be a useful strategy. The recommended areas for improvement are the urban-specific customisation of ASHAs’ roles, the consideration of urban heterogeneity in the training content and pedagogy, utilising the advantages of the urban set-up, ensuring supportive supervision mechanisms for ASHAs, strengthening overall inter-sectoral convergence and community processes in urban areas.


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©Indian Journal of Medical Ethics 2022: Open Access and Distributed under the Creative Commons license ( CC BY-NC-ND 4.0),
which permits only non-commercial and non-modified sharing in any medium, provided the original author(s) and source are credited.

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Comments:
  1. James Phillips
    Columbia University , USA
    05 December 2022

    The observations in this important paper from India are relevant to Africa. I suggest reviewing:

    Adongo, Philip B., James F. Phillips, Moses Aikins, Doris Afua Arhin, Margaret L. Schmitt, Adanna U. Nwameme, Philip Teg-Nefaah Tabong, and Fred N. Binka. 2014. “Does the design and implementation of proven innovations for delivering basic primary health care services in rural communities fit the urban setting? The case of Ghana’s Community-Based Health Planning and Services (CHPS), Health Research Policy and Systems. DOI: 10.1186/1478-4505-12-16: http://www.health-policy-systems.com/content/12/1/16.

    • Affiliation: Columbia University
    • Country: USA
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