Understanding MANSI and ASHA Capacity Building
I spent the first full month of my Fellowship exploring India’s public health system and getting up to speed on my project, the Maternal and Newborn Survival Initiative (MANSI). Through field visits, I’ve witnessed the impressive community-based innovations spearheaded by community health workers known as Accredited Social Health Activists (ASHAs, or Sahiyas in Jharkhand). I also learned about the progress made on reducing maternal and infant mortality rates across MANSI+’s current implementing region, the Kolhan division of Jharkhand.
MANSI+’s aims to reduce preventable deaths among mothers and children under five by 50%. A major part of this work focuses on capacity building of ASHAs, who provide essential counseling and monitoring to resource-constrained and hard-to-reach communities. ASHAs play a major role in preventing deaths by educating families, tracking high-risk cases, and referring serious cases to health facilities when needed. Under the Home Based Newborn Care (HBNC) framework, ASHAs are trained to identify and manage conditions such as hypothermia and pneumonia from home, which is especially critical in areas that may be hours away from the nearest hospital.
Given the breadth of their responsibilities, ASHAs require extensive training on a wide variety of topics, including care for the first 1000 days, which spans from pregnancy through a child’s second birthday. Yet the current training system is time-intensive and burdensome: ASHAs often travel long distances to attend in-person sessions, and they have limited access to digital refreshers or assessments to reinforce skills over time (Yadav, 2017). As researchers note, “It is well established that the ASHA workforce…are in constant need of capacity building opportunities and innovative strategies to equip them with the requisite knowledge and skills to efficiently perform their tasks” (Tripathy et al., 2021). To address this need, the National Health Mission (NHM) has adopted an Incremental Learning Approach (ILA) to train ASHAs with an emphasis on supportive and gradual skill building (Chaudhery, 2024). In addition to formal training, small groups of ASHAs – known as “clusters” – hold monthly ILA meetings where trainers review a specific topic and lead ASHAs through hands-on practice. I recently attended an ILA meeting during which a Sahiya Saathi (ASHA supervisor) and MANSI staff led a discussion on hypothermia prevention and care. During the session, ASHAs practiced their baby-wrapping and kangaroo mother care (KMC) skills on a doll. Sitting in the circle, it quickly became clear that this opportunity for practice was vital to their skill retention – some of the women struggled to correctly wrap the doll, but their peers quickly jumped in to guide and correct them. Blanket wrapping may seem simple, yet it can be the difference between a baby staying warm or slipping into hypothermia.
Field Insights: ASHAs’ Need for Accessible Learning Tools
During that ILA meeting, my supervisor, Anupam Sarkar, asked the ASHAs what they do when they need quick guidance on a maternal or newborn care topic. While some of them keep training manuals at home, few have tools they can easily reference in the field for reminders on tasks like baby wrapping or pneumonia monitoring. When Anupam further prompted the ASHAs, they shared that having additional resources or tools readily accessible on their phones would be helpful. This conversation helped confirm the direction of my project.
I’ve now narrowed my focus to exploring the development of e-learning modules for ASHAs. As India becomes increasingly digitized, and an estimated 600,000 ASHAs have access to smartphones, joining a growing population categorized as “emergent smartphone users” (Majhi et al., 2023). Several initiatives have attempted to leverage this by introducing mobile-based training to supplement traditional in-person training courses. Findings from these efforts have shown that digital training is more cost-effective, efficient, and easier to scale than traditional in-person training (Sissine et al., 2014). Digital tools also accommodate various learning styles and literacy levels (Majhi et al., 2023) through multimedia formats such as audio, video, and interactive demonstrations. By providing flexibility for self-paced learning, digital modules can help ASHAs avoid the logistical challenges of traveling long distances for in-person sessions.
Digital Opportunities for ASHA Training
While e-ILA modules have been developed for Anganwadi workers (Chaudhery, 2024), who share several responsibilities with ASHAs, there are still few online job tools or aids specifically designed for ASHAs. MANSI has partially leveraged India’s digital shift through Operation Sunshine, an application which enables real-time tracking of high-risk pregnancies and newborns. Through the MANSI partnership, the government of Jharkhand has also developed its own Sahiya App, which is used by ASHAs on the ground across the state to track and monitor high-risk pregnancies and newborns (Tata Steel Foundation, 2019). Although the app includes a training section, our field visits revealed that the modules are not currently available, and it remains unclear when they will go live. During our field visit, I also witnessed Sahiyas’ frustrations with the app, including login difficulties and data entry bugs. An internet connection is required for data upload and syncing, which are common barriers in remote villages without consistent internet and/or mobile data. Witnessing these challenges has served as a helpful reminder that one can’t simply implement a new digital tool in such a resource-constrained environment and assume smooth integration – building a usable tool requires collaborative conceptualization, design, and testing with all relevant partners, especially frontline workers.
Designing Effective E-learning Modules
As I develop these modules, I plan to incorporate best practices from previous health communication efforts, which show that simple explanations, interactive demonstrations, and engaging multimedia tools can effectively reinforce key skills for community health workers (Majhi et al., 2021). I also intend to draw from MANSI+’s recent midline evaluation, which identifies areas where ASHAs would benefit from strengthened knowledge and practical skills.
Ultimately, my goal is to strike the right balance between feasibility, efficacy, and usability—creating digital learning modules that not only support ASHAs in their day-to-day work, but also contribute meaningfully to reducing maternal and newborn morbidity and mortality.
References
Chaudhery, D. N. (2024, April 23). Incremental Learning Approach – A transformational approach to build capacities and skills [Case study]. The World Bank. https://thedocs.worldbank.org/en/doc/6d323a1fb982e0ce6f984de5b491e632-0310012024/original/ILA-POSHAN-Abhiyaan.pdf?_gl=1*kpp41w*_gcl_au*MTYwNDg2MjQ3NS4xNzI1MzQ2MzU0
Majhi, A., Joshi, A., Agnihotri, S. B., & Mondal, A. (2021). Refresher Training through Quiz App for capacity building of Community Healthcare Workers or Anganwadi Workers in India. Asian CHI Symposium 2021, 80–88. https://doi.org/10.1145/3429360.3468186
Majhi, A., Agnihotri, S., & Mondal, A. (2023). Physical and Augmented Reality based Playful Activities for Refresher Training of ASHA Workers in India. 16-22. 10.1145/3516492.3558788.
Sissine, M., Segan, R., Taylor, M., Jefferson, B., Borrelli, A., Koehler, M., & Chelvayohan, M. (2014). Cost comparison model: Blended eLearning versus traditional training of community health workers. Online Journal of Public Health Informatics, 6(3), e61481. https://doi.org/10.5210/ojphi.v6i3.5533
Tata Steel. (2019). Tata Steel’s “Operation Sunshine” – reducing neonatal maternal mortality under Project MANSI, a public-private partnership initiative, receives accolades [Press release]. Tata Steel.
Tripathy, T., Das, S., Tripathy, A., Dwivedi, R., & Gautam, M. (2021). Capacity Building of ASHA at the Monthly Meeting Platforms IN PHC and CHC in Uttar Pradesh, India. In Dr. R. Singh (Ed.), Selected Topics in Humanities and Social Sciences Vol. 2 (pp. 99–107). Book Publisher International (a part of SCIENCEDOMAIN International). https://doi.org/10.9734/bpi/sthss/v2/2651F
Yadav, D. (2017). Low-Cost Mobile Learning Solutions for Community Health Workers. Proceedings of the 26th International Conference on World Wide Web Companion, 729–734. https://doi.org/10.1145/3041021.3053377
