Performance of accredited social health activists to provide home-based newborn care: a situational analysis.

OBJECTIVE: To assess Accredited social health activists' (ASHAs) ability to recognize illness in infants aged less than 2 months. METHODS: Investigators observed 25 ASHAs conducting 47 visits. RESULTS: ASHA-investigator agreement on the need to further assess infants was intermediate (kappa 0.48, P<0.001). Using IMNCI's color codes, ASHAs misclassified 80% of infants. ASHAs did not follow home-based newborn care formats and skipped critical signs. Overall ASHA-investigator agreement on diagnosis was poor (kappa=0.23, P=0.01). CONCLUSION: There is a need for improved training, tools, and supportive supervision.