Improving the Performance of Accredited Social Health Activists in India

The Accredited Social Health Activist (ASHA) represents the pivotal part in the whole design and strategy of the National Rural Health Mission (NRHM), which, in turn, is a critical initiative of the central government to fulfil its promise on inclusive growth. The performance of ASHAs is, therefore, crucial for the success of NRHM and hence of the inclusive growth strategy of the government in India. In the primary healthcare sector, NRHM is the principal programme of the government to achieve the health related millennium development goals such as infant mortality rate (IMR), maternal mortality rate (MMR); as well as control of specific diseases, and improvement of nutrition status of children and mothers. NRHM was introduced in the year 2005 in the 18 high focus states in India and has been expanding in its coverage ever since. Several mid-term appraisals of NRHM have been carried out, the last one having been done by the present team (2009). The present paper is devoted to identifying and suggesting ways in the short to medium term to improve performance of ASHAs under NRHM in India. The purpose of this investigation is not to question the strategy based on ASHAs in the rural setting but to explore and evaluate alternatives. We believe that under the given circumstances it is not only prudent but also most practical and meaningful to concentrate on improving the performance of ASHAs. The present paper, therefore, examines the whole question in terms of current and potential provisions of the recruitment, training and deployment of ASHAs in India. Our paper presents data collected through written questionnaires with ASHAs in Bihar, Chhattisgarh, Rajasthan, and UP. Where appropriate, we have also provided key qualitative insights from the state of Assam, where we conducted a focus group discussion with 25 ASHAs and 4 ASHA facilitators. All mid-term appraisals of NRHM in India have expressed concerns about role and performance of ASHAs. There is considerable literature and international experience in this regard. A brief review of the literature and international experiences is presented in the second section. The third section discusses current profile of ASHAs in the five selected states and their selection procedure. Further sections then consider the following five questions: a. Is the recruitment process for ASHAs appropriate to ensure proper selection? b. Are the roles and responsibilities assigned to ASHAs easily understood and appropriate? Are new responsibilities for ASHAs envisaged? c. Is the training that ASHAs receive adequate, appropriate for knowledge retention, and of high quality? d. Are ASHAs' current incentives and compensation structure consistent and adequate for them to perform as per expectations of NRHM? e. Are supervisory structures currently in place in the rural areas sufficiently detailed and do they effective monitor/track ASHA performance? The last section summarizes recommendations for the consideration of the International Advisory Panel. A quick sample survey of ASHAs, potential/actual beneficiaries (young mothers) and government officials was carried out during March-May, 2010 in selected states to get an idea about the ground reality for ASHA's role, training, incentives, supervision, effectiveness, etc. details about the sample survey are given in the appendix

Effect of participatory women's groups facilitated by Accredited Social Health Activists on birth outcomes in rural eastern India: A cluster-randomised controlled trial

Background: A quarter of the world's neonatal deaths and 15% of maternal deaths happen in India. Few community-based strategies to improve maternal and newborn health have been tested through the country's government-approved Accredited Social Health Activists (ASHAs). We aimed to test the effect of participatory women's groups facilitated by ASHAs on birth outcomes, including neonatal mortality. Methods: In this cluster-randomised controlled trial of a community interve

IDEAS project - Scaling-up innovations to improve maternal and newborn health - Uttar Pradesh case study resources

The IDEAS project sought to improve the health and survival of mothers and babies through generating evidence to inform policy and practice in Ethiopia, northeast Nigeria and Uttar Pradesh, India. This data collection contains interview field notes and supporting information produced as part of a case study to document and assess the process by which the State Government of Uttar Pradesh introduced and scaled-up mSehat, a mobile phone application used by community health workers (Accredited Social Health Activists (ASHAs)) to create and maintain electronic health records

Relationship Analysis between Socio-Economic Variables and Job Performance of Accredited Social Health Activists in Maharashtra

National Rural Health Mission (NRHM) was launched in India in 2005. It brought a new concept of Accredited Social Health Activist (ASHA) in to the arena of health sector of India. Since it is a new concept it is imperative to study the effect of socio economic variables on the job performance of ASHAs. Coefficient of correlation was applied to carry out the relational analysis between socio-economic variables and job performance of ASHAs. It was seen that age was positively related with job performance whereas all other independent variables were negatively and significantly related with job performance

SOSAS Study in Rural India: Using Accredited Social Health Activists as Enumerators

Background: Global estimates show five billion people lack access to safe, quality, and timely surgical care. The wealthiest third of the world’s population receives approximately 73.6% of the world’s total surgical procedures while the poorest third receives only 3.5%. This pilot study aimed to assess the local burden of surgical disease in a rural region of India through the Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey and the feasibility of using Accredited Social Health Activists (ASHAs) as enumerators. Material and Methods: Data were collected in June and July 2015 in Nanakpur, Haryana from 50 households with the support of Indian community health workers, known as ASHAs. The head of household provided demographic data; two household members provided personal surgical histories. Current surgical need was defined as a self-reported surgical problem present at the time of the interview, and unmet surgical need as a surgical problem in which the respondent did not access care. Results: One hundred percent of selected households participated, totaling 93 individuals. Twenty-eight people (30.1%; 95% CI 21.0–40.5) indicated they had a current surgical need in the following body regions: 2 face, 1 chest/breast, 1 back, 3 abdomen, 4 groin/genitalia, and 17 extremities. Six individuals had an unmet surgical need (6.5%; 95% CI 2.45%–13.5%). Conclusions: This pilot study in Nanakpur is the first implementation of the SOSAS survey in India and suggests a significant burden of surgical disease. The feasibility of employing ASHAs to administer the survey is demonstrated, providing a potential use of the ASHA program for a future countrywide survey. These data are useful preliminary evidence that emphasize the need to further evaluate interventions for strengthening surgical systems in rural India

A mixed methods study on evaluating the performance of a multi-strategy national health program to reduce maternal and child health disparities in Haryana, India

Background: A multi pronged community based strategy, known as National Rural Health Mission (NRHM), was implemented from 2005-06 to 2012-13 in India to curtail maternal and child health (MCH) disparities between poor and rich, rural and urban areas, and boys and girls,. This study aimed to determine the degree to which MCH plans of NRHM implemented, and resulted in improving the MCH outcomes and reducing the inequalities. Methods: An explanatory sequential mixed methods study was conducted, first to assess the degree of implementation of MCH plans by estimating the budget utilization rates of each MCH plan, and the effectiveness of these plans by comparing demographic health surveys data conducted post (2012-13), during (2007-08) and pre- (2002-04) NRHM implementation period, in the quantitative study. Then, perceptions and beliefs of stakeholders regarding extent and effectiveness of NRHM in Haryana were explored in the qualitative study during 2013. A logistic regression analysis was done for quantitative data, and inductive applied thematic analysis for qualitative data. The findings of the quantitative and qualitative parts of study were mixed at the interpretation level. Results: The MCH plans, like free ambulance service, availability of free drugs and logistics, accredited social health activists were fully implemented according to the budget spent on implementing these activities in Haryana. This was also validated by qualitative study. Availability of free medicines and treatment in the public health facilities had benefitted the poor patients the most. Accredited Social Health Activists scheme was also the most appreciated scheme that had increased the institutional delivery rates. There was acute shortage of human resources in-spite of full utilization of funds allocated for this plan. The results of the qualitative study validated the findings of quantitative study of significant (p < 0.05) improvement in MCH indicators and reduction in MCH disparities between higher and lower socioeconomic groups, and rural and urban areas. Conclusions: MCH plans of NRHM might have succeeded in improving the MCH outcomes and reducing the geographical and socioeconomic MCH inequalities by successfully implementing the schemes like accredited social health activists, free ambulance services, free treatment and medicines in hospitals for the poor and in rural areas

Supplementary Role of Health Metrics for Reducing Total Fertility Rate in a North-Indian State.

Reducing Total Fertility Rate (TFR) amongst rural Indian couples from the current level is a significant challenge to the population control policies relying solely on the Government efforts. REACH strategy, based on health metrics, succeeded in lowering the TFR below replacement levels in a rural population of more than 300,000 in Rajasthan. The REACH strategy was first developed and demonstrated success in decreasing TFR in a pilot project by SHARE India in Medchal region of Andhra Pradesh utilizing designated workers, and was replicated in Rajgarh District of Rajasthan in cooperation with Bhoruka Charitable Trust (supervisor of ICDS and NRHM health workers in Rajgarh) using Government health workers. The success of the REACH strategy in both Rajasthan and previously in Andhra Pradesh holds promise as a tool to reduce TFR in other areas of rural India

Implementing the Janani Suraksha Yojana: Perspectives and experiences of Accredited Social Health Activists in Rajasthan

This report is the result of an explanatory study of Accredited Social Health Activists (ASHAs) conducted as part of a large-scale evaluation of the Janani Suraksha Yojana in rural and urban settings in Rajasthan. The findings of the study suggest training ASHAs more comprehensively about their rights and responsibilities, raising awareness of lesser known best practices regarding maternal and newborn care, emphasizing ASHA’s engagement in promoting postpartum care, and making special efforts to increase the credibility of ASHAs in the community

Improving women’s reproductive health in India by educating men and families

This repository item contains a single issue of Issues in Brief, a series of policy briefs that began publishing in 2008 by the Boston University Frederick S. Pardee Center for the Study of the Longer-Range Future.In this Issues in Brief, 2015 Pardee Graduate Summer Fellow Maanasa Venkatesh argues that reproductive health care for women – as well as men – would improve in India if health care providers included men and marital family members in discussions and education about women’s reproductive health issues. She cites research that has shown that effective reproductive health programs consider cultural decision-making norms and include the partners and other family members who are directly involved in decisions about seeking reproductive health care. She writes “There is discomfort acknowledging that the role of traditional social norms and decision-making dynamics don’t fit with widely-held perceptions of modern female agency. Yet public health efforts have been found to be most effective with they understand and work with existing social structures to achieve change through education and dialogue.” Maanasa Venkatesh was a 2015 Graduate Summer Fellow at the Frederick S. Pardee Center for the Study of the Longer-Range Future. She completed her MBBS in India and earned a master’s degree in Public Health at the Boston University School of Public Health in 2016. She is presently working as a junior resident doctor in Chennai, India. Her research interests include women’s health and equity in international health

REDEFINING THE ROLE OF ASHA WORKERS IN INDIAN HEALTHCARE

Community health professionals are critical in filling the gap between traditional healthcare systems and marginalized populations. Accredited Social Health Activists (ASHA) workers have been an important workforce in providing essential healthcare services to rural and marginalized communities. ASHA workers have emerged as a cornerstone of India\u27s healthcare system, playing a pivotal role in bridging the gap between rural and marginalized communities and formal healthcare services. There is a need for expansion of the working of ASHAs to utilize them more efficiently. Through enhanced training, technological integration, and policy support, ASHA workers can transform into empowered agents of change, ensuring equitable healthcare access for all. Mobile applications for data collection, telemedicine for remote consultations, and AI-powered tools for diagnosis can enhance their capabilities and improve the accuracy of healthcare services. Reimagining the role of ASHA workers requires supportive policies and increased advocacy efforts. Adequate compensation, formal recognition, and regular skill upgradation should be integral to their roles. Engaging with policymakers and stakeholders can ensure that their voices are heard at the policy level. This review article aims to critically examine the existing role of ASHA workers, analyze their challenges and successes, and propose innovative strategies to reimagine their role in the Indian healthcare sector. By synthesizing current literature and drawing insights from various sources, this article highlights the potential for ASHA workers to contribute significantly to community-based healthcare delivery, health education, and disease prevention