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There is a significant body of international experience and evidence, gathered over three decades of experimentation, which demonstrates the potential of community-based health workers (CHWs) as one of the most cost-effective strategies to improve a range of primary health and nutrition outcomes. These workers or volunteers, generally local women, if sensitively selected, trained and supported can act as agents of health-related knowledge and dynamic links between resource-constrained primary health systems and the unreached communities that need their services.
 India has had a long history of innovation in this area, with civil society organisations having pioneered the development of successful community-based models in different parts of the country. More recently efforts at translating these models into large-scale programmes have resumed a renewed importance and urgency with the launch of the Government of India’s National Rural Health Mission (2005-2012), which has positioned the Community Health Worker – the Accredited Social Health Activist (ASHA) – as a cornerstone of its strategy.
Based on a detailed review of experiences and learning from ongoing efforts, ICCHN has defined a multi-leveled engagement to contribute to the discourse and practice of CHW programmes in India. The key dimensions for innovation and implementation include:
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Developing appropriate roles, profiles and selection processes, including the creation of a cadre of well-oriented and supported facilitators for positioning CHWs in different geographic, socio-economic and systemic contexts
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Developing an effective CHW training system, including innovative pedagogical approaches, training content and materials, decentralised training infrastructure and strong training teams, accreditation and evaluation and continuing support and supervision.
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Ensuring linkages with primary health systems and services, including integrating CHW programmes with decentralised health systems reform and local planning, role rationalization and convergence with Auxiliary Nurse/Midwives (ANMs) and Anganwadi Workers, and developing community-based accountability and feedback mechanisms.
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Building sustainability into CHW programmes, including introducing appropriate incentives and financing mechanisms, community-based support and management structures, and skill upgradation and further advancement opportunities for CHWs.
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Designing appropriate monitoring and evaluation systems using a sensitive set of process and outcome indicators, a mix of quantitative and qualitative methodologies, and generating internal ownership while ensuring adequate externality.
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Constructing new institutional arrangements, processes and partnerships to provide leadership, facilitation and resource support to CHW programmes at all levels and across government, civil society and donor agencies.
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Deepening and expanding impact by integrating further innovations into CHW functioning (such as low-cost appropriate technologies and social marketing) and developing lateral linkages between CHW programmes and initiatives in other development sectors, including water and sanitation, food and nutrition security, panchayat planning, and micro finance and livelihoods.
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