Accredited Social Health Activist

Accredited social health activists (ASHAs) is community health workers instituted by the government of India's Ministry of Health and Family Welfare (MoHFW) as part of the National Rural Health Mission (NRHM).^[1] The mission began in 2005; full implementation was targeted for 2012. Once fully implemented, there is to be "an ASHA in every village" in India, a target that translates into 250,000 ASHAs in 10 states.^[2] The grand total number of ASHAs in India was reported in July 2013 to be 870,089.^[3] There are 859,331 ASHAs in 32 states and union territories as per the data provided by the states in December 2014. This excludes data from the states of Himachal Pradesh, Goa, Puducherry and Chandigarh, since the selection of ASHA is under way in these states.^[4]

Roles and responsibilities

ASHAs are local women trained to act as health educators and promoters in their communities. The Indian MoHFW describes them as:^[5]

...health activist(s) in the community who will create awareness on health and its social determinants and mobilize the community towards local health planning and increased utilization and accountability of the existing health services.

Their tasks include motivating women to give birth in hospitals, bringing children to immunization clinics, encouraging family planning (e.g., surgical sterilization), treating basic illness and injury with first aid, keeping demographic records, and improving village sanitation.^[6] ASHAs are also meant to serve as a key communication mechanism between the healthcare system and rural populations.^[7]

She will act as a depot holder for essential provisions being made available to all habitations like Oral Rehydration Therapy (ORS), Iron Folic Acid Tablet(IFA), chloroquine, Disposable Delivery Kits (DDK), Oral Pills & Condoms, etc.from http://nrhm.gov.in/communitisation/asha/about-asha.html

Selection

ASHAs must primarily be female residents of the village that they have been selected to serve, who are likely to remain in that village for the foreseeable future. Married, widowed or divorced women are preferred over women who have yet to marry since Indian cultural norms dictate that upon marriage a woman leaves her village and migrates to that of her husband. ASHAs preference for selection is they must have qualified upto 10, preferably be between the ages of 25 and 45, and are selected by and accountable to the gram panchayat (local government). If there is no suitable literate candidate, a semi-literate woman with a formal education lower than eighth standard, may be selected.

Remuneration

Although ASHAs are considered volunteers, they receive outcome-based remuneration and financial compensation for training days. For example, if an ASHA facilitates an institutional delivery she receives ₹600 (US$8.90) and the mother receives ₹1,400 (US$21). ASHAs also receive ₹150 (US$2.20) for each child completing an immunization session and ₹150 (US$2.20) for each individual who undergoes family planning.^[8] ASHAs are expected to attend a Wednesday meeting at the local primary health centre (PHC); beyond this requirement, the time ASHAs spend on their CHW tasks is relatively flexible.

Monitoring and Evaluation under National Rural Health Mission

A baseline survey is to be taken at the district level. It is for fixing decentralized monitoring goals and indicators. The community monitoring would be at the village level. Planning commission would be the eventual monitor of outcomes. External evaluation will be taken up in frequent intervals.

Impact of incentive based work on Health services

A study on Effectiveness of "ASHA INCENTIVE" on enhancing the functioning of ASHA in motivating couples having two or less children to undergo permanent sterilization in Surendranagar district of Gujarat, India by Nimavat Jh et al, shows contribution of ASHAs toward achievements in female sterilization shows that maximum motivation was done by ASHAs, and ASHAs performance was increased; 1.13 times for eligible couples and 1.14 times for couples having two or less children after introduction of an incentive, and incentive showed a significant impact on motivation of eligible couples (χ2 = 121.744, df = 1, P < 0.0001) and motivation couple having two or less children (χ2 = 74.893, df = 1, P < 0.0001) for female sterilization method by ASHAs.^[9]

See also

• Auxiliary Nurse Midwife (ANM)
• Vikas yojna
• Jawaharlal Nehru National Urban Renewal Mission
• Mahatma Gandhi National Rural Employment Guarantee Act

References