Evaluation of Accredited Social Health Activist Services and Factors Influencing: A Rural–urban Comparison among Women of Reproductive Age Group in Tripura

Abstract Background: Community Health Workers (CHWs), especially Accredited Social Health Activists (ASHAs), play a pivotal role in bridging the gap between communities and health systems in India. Their contribution is crucial for improving reproductive and child health (RCH) outcomes in both rural and urban areas. Objectives: To assess service delivery by ASHAs among married women of reproductive age in rural and urban Tripura and compare differences between the two settings. Materials and Methods: A community-based cross-sectional study was conducted among 184 women (92 rural, 92 urban) selected through simple random sampling from field practice areas of Tripura Medical College. Data were collected using a pretested semi-structured interview schedule covering socio-demographic characteristics and service utilization domains (hygiene, family planning, antenatal and postnatal care (PNC), immunization, nutrition, menstrual hygiene, and other activities). Data were analyzed using the SPSS software version 16.0; descriptive statistics and independent t -tests were applied. Results: Rural respondents were more likely to belong to Scheduled Tribes (13.0%) and Below Poverty Line households (63.0%), while urban respondents were predominantly Scheduled Caste (59.8%) and nuclear families (67.4%). Mean scores for service delivery were significantly higher in rural areas compared to urban for the utilization of ASHA services, family planning, immunization, antenatal/PNC, reproductive counseling, pregnancy-related services, and infant care ( P < 0.05). No significant difference was observed for other community activities ( P = 0.780). Conclusion: ASHA service delivery was more effective in rural than urban settings, indicating a need to strengthen urban CHW engagement under NHM to ensure equitable access to RCH services.