The National Rural Health Mission (NRHM) was launched on 12 April 2005 with a view to bring about dramatic improvements in the health system and the health status of the people especially those who live in the rural areas of the country. The mission has strived to achieve progress in proving universal access to equitable, affordable and quality health care which is accountable as well as responsive to the needs of the people.
The NRHM is a dream come true for millions of people in the country. It augurs especially well for the country’s underprivileged, the women and children. The most important initiative of NRHM has been the choice of a female voluntary health activist named ASHA (Accredited Social Health Activist) to take care of the health problems in every village.
Accredited Social Health Activist or ASHA for every village will serve a population of 1000 and act as a link between the community and the rural health system. Implementation of the programme is to be done in selected blocks which are poor in RCH indicators or have a high degree of disease load.
KEY COMPONENTS OF ASHA
- ASHA must primarily be a woman resident of the village – married/ widowed/ divorced, preferably in the age group of 25 to 45 years.
- ASHA should be a literate woman with formal education up to class eight. This may be relaxed only if no suitable person with this qualification is available.
- ASHA will be chosen through a rigorous process of selection involving various community groups, self-help groups, Anganwadi Institutions, the Block Nodal officer, District Nodal officer, the village Health Committee and the Gram Sabha.
- Capacity building of ASHA isbeing seen as a continuous process. ASHA will have undergo series of training episodes to acquire the necessary knowledge, skills and confidence for performing her spelled out roles.
- The ASHAs will receive performance-based incentives for promoting universal immunization, referral and escort services for Reproductive & Child Health (RCH) and other healthcare programmes, and construction of household toilets.
- Empowered with knowledge and a drug-kit to deliver first-contact healthcare, every ASHA is expected to be a fountainhead of community participation in public health programmes in her village.
- ASHA will be the first port of call for any health related demands of deprived sections of the population, especially women and children, who find it difficult to access health services.
- ASHA will be a health activist 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.
- She would be a promoter of good health practices and will also provide a minimum package of curative care as appropriate and feasible for that level and make timely referrals.
- ASHA will provide information to the community on determinants of health such as nutrition, basic sanitation & hygienic practices, healthy living and working conditions, information on existing health services and the need for timely utilization of health & family welfare services.
- She will counsel women on birth preparedness, importance of safe delivery, breast-feeding and complementary feeding, immunization, contraception and prevention of common infections including Reproductive Tract Infection/Sexually Transmitted Infections (RTIs/STIs) and care of the young child.
- ASHA will mobilize the community and facilitate them in accessing health and health related services available at the Anganwadi/sub-centre/primary health centers, such as immunisation, Ante Natal Check-up (ANC), Post Natal Check-up supplementary nutrition, sanitation and other services being provided by the government.
- She will act as a depot older 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.
- At the village level it is recognized that ASHA cannot function without adequate institutional support. Women’s committees (like self-help groups or women’s health committees), village Health & Sanitation Committee of the Gram Panchayat, peripheral health workers especially ANMs and Anganwadi workers, and the trainers of ASHA and in-service periodic training would be a major source of support to ASHA.
- Create awareness on health and its social determinants.
- Mobilize the community towards local health planning.
- Increase utilization and accountability of the existing health services.
- Promote good health practices.
- Provide a minimum package of curative care as appropriate and feasible for that level.
- Undertaking timely referrals.
- The ASHA is appointed to take steps to create awareness and provide information to the community on determinants of health such as nutrition, basic sanitation & hygiene practices, healthy living condition for working conditions, information on existing health services and timely utilization of health & family welfare services.
- She will counsel women on birth preparedness, importance of safe delivery, breast feeding and complementary feeding, immunization, contraception and prevention of common infections including RTI/STI and care of young child.
- ASHA will mobilize the community and facilitate them in accessing health and its related services available at the Anganwadi/Sub-center/primary health centers.
- She will assist the Village health & sanitation committee of the Gram panchayat to develop a comprehensive village health plan.
- She will escort/accompany pregnant women & children requiring treatment / admission to the nearest pre-identified health facility i.e. PHC/CHC/FRU.
- ASHA will provide primary medical care for minor ailments such as diarrhoea, fever, and first aid for minor injuries, work as provider of DOTS under RNTCP. She will also act as depot holder for essential provisions which will be made available to every habitation.
She will inform about the births and deaths in her village and any unusual health problems/disease outbreaks in the community to the Sub-Center/Primary Health Centre. Besides, she will also promote construction of household toilets under Total Sanitation Campaign.
CAPACITY BUILDING PLAN OF ASHAs
|Round 1||M-1 7 days Basic OrientationM2, M3 Supervised Practice including field level implementation|
|Round 2||M-4 4 days on Job TrainingM5,M6 Supervised Practice including field level implementation|
|Round 3||M7 4 days on Job TrainingM-8 Supervised Practice including field level implementation|
|Round 4||M-9 4 days on Job TrainingM-10 Supervised Practice including field level implementation|
|Round 5||M-11 4 days on Job TrainingM-12 Supervised Practice including field level implementation|
HAND HOLDING SUPPORT
- The Coordinator & Co-facilitators gave hand holding support to the ASHAs acting as trainers for total 23 days of their training.
- During the House Hold Survey of the ASHAs the Co-facilitators of the respective Gram Panchayats went with the ASHAs and completed 10 Household Survey. Beside this the ASHAs who all had problems in Household Survey had done the Survey in the presence of Co-facilitators. After every 10 House Hold Survey the Co-facilitators called all the ASHAs at the Sub-centre and checked their House hold Survey.
- The Co-facilitators helped the ASHAs to differentiate from the House hold survey and enter into the Cohort register.
- The Co-facilitators visited the sub-centers alternately each Wednesday and other days and gave hand holding support in the areas where they had problems.
- The Coordinator & Co-facilitators helped the ASHAs in maintaining liaison with AWW and ICDS.
- The Co-facilitators helped the ASHAs in maintaining liaison with ANMs and Health Supervisors.
- The Co-facilitators attended and gave hand holding support for arrangement of Mother’s Meeting of the ASHAs.
- The Co-facilitators helped the ANMs in making the Compensation Package of the ASHAs.
- Beside the support mentioned above the Co-facilitators worked as Supervisors in Pulse Polio, Kalazar, Measles, etc alon with the ASHAs.
Visited all the GPs of respective Blocks for ASHA present situation
News paper advertisement for recruitment of Coordinators & Co-facilitators
Formation of Interview Board with consultation of State, District, Block authorities
Selection & recruitment of staff
TOT of selected staff at RRC
Organized refresher training for Coordinators & Co-facilitators at organization level
Conduct District level orientation about ASHA Training & Handholding support
Block level orientation about ASHA Training & Handholding support
GP level orientation / Pre training orientation about ASHA Training
Conduct Phase wise ASHA training
Block wise monthly meeting with higher authorities of organization
Participated all the meetings at Block & GP level
Regular contact with the State, District, Block & GP level stakeholders about the progress of the Programme