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Before the introduction of Accredited Social Health Activists (ASHAs) in India, mid-level auxiliary nurse midwives (ANMs) were responsible for community health education and services such as antenatal care, delivery, IUCD insertion, and sterilization referrals. The Population Council studied how community extension work and some primary care responsibilities have been shifted to ASHAs, who are tasked with identifying pregnant women; facilitating ANC check-ups; motivating women for institutional deliveries during ANC checkups; and organizing child immunization. Establishing dual worker cadres in India by shifting community extension tasks from ANMs to local ASHAs has been well conceived. Task shifting has allowed ANMs, as trained paramedics, to devote more time to clinical work and ASHA supervision and guidance, and in principle, this scheme best utilizes available human resources. This case study, based on available literature, reports, and additional qualitative data, shows wide variations in the program’s implementation. The report recommends improvement in ASHA training to allow them to promote contraceptive use for child spacing, additional competency-based training to strengthen knowledge and counseling skills, and supportive supervision.





New Strategies for Expanding Access to Family Planning and Reproductive Health Services