This study of the operation of the Accredited Social Health Activist programme of the National Rural Health Mission in one of the tribal blocks of Thane district in Maharashtra fi nds that incentives given to ASHAs generate a bias in their work activities and shift the attention of these community health workers from the community to the health services system. Moreover, the poor socio-economic background of ASHAs makes them depend on the incentives offered since this is their main source of income. Additionally, due to the excessive focus of ASHAs on curative care, the community considers them more an extended arm of the health service system, not as change agents as envisaged in the programme.

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