Exploring the Hamlet ASHA (Oorumithram) Programme in Kerala: Genesis, Implementation, Stakeholder Experiences, and Opportunities for Improvement

The Hamlet ASHA Programme popularly known as Oorumithram, meaning 'Friend of the Settlement’ was launched in 2016 under the National Health Mission, Government of Kerala. Its mandate is simple: to place a trained health worker from within the tribal community itself at the centre of healthcare delivery to some of Kerala's most geographically isolated, culturally distinct, and historically underserved settlements.

This study was guided by four overarching objectives, each addressing a distinct dimension of the Hamlet ASHA Programme's design, implementation, and impact:

• To document the genesis, process of implementation, and achievements of the Hamlet ASHA Programme in Kerala, including the facilitators and barriers to its implementation.

• To explore the perceptions and lived experiences of tribal community beneficiaries, Hamlet ASHAs, healthcare providers, and other key stakeholders involved in programme execution

• To explore the existing support systems available to Hamlet ASHAs at the levels of the formal health system, the family, the community, and intersectoral partners and to understand stakeholder perceptions of the role, scope, and contribution of Hamlet ASHAs.

• To identify opportunities for improvement of the Hamlet ASHA Programme from the diverse perspectives of tribal community members, Hamlet ASHAs, and programme implementers. The study adopts an overarching qualitative approach, with each objective addressed through a specific methodological design suited to the nature of the inquiry.

The study was conducted across multiple districts where the Hamlet ASHA Programme is operational, with primary fieldwork in Wayanad, Idukki, Ernakulam, and Palakkad the districts with the highest tribal concentrations and the longest and most effective programme history. Within each district, both accessible and highly remote settlement types were included to ensure geographic and ecological diversity. Purposive sampling was used to select participants across all stakeholder categories, ensuring representation across roles, tenures, geographic locations, tribal community types, and levels of engagement with the programme. For tribal community members, a combination of purposive and snowball sampling was applied.