ASHA-A RAY OF HOPE FOR GOOD HEALTH
One of the key components of the National Rural Health Mission is to provide every village in the country with a trained female community health activist ASHA or Accredited Social Health Activist. Selected from the village itself and accountable to it, the ASHA will be trained to work as an interface between the community and the public health system.
Following are the key components of ASHA:
ASHA: The Haryana Scenario
ASHA: The Synergy Factor
The Importance of ASHA is being increasingly understood. ASHA has played a catalytic role in generating village based issues at greater level through different platforms. The interaction made by ASHA with different levels can be shown as below:-
Selection of ASHA:-
Selection Procedure :-
Support Mechanism of ASHA:-
Criteria for selection
Roles and Responsibilities of ASHA Facilitator
Capacity building of ASHA is critical in enhancing her effectiveness. It has been envisaged that training will help to equip her with necessary knowledge and skills. Training of ASHA Facilitator is a continuous process.
State ASHA Resource Center for providing support to ASHA Programme :
ASHA is at the base of NRHM pyramid and National Rural Health Mission is looking at ASHA as a change agent in Health Sector Reform. She will play a vital role in improving the health indicators of the State especially IMR and MMR. Hence it is very important to provide technical inputs and strong supportive mechanism to the programme so that expected results can be achieved. State Project Management Unit is established at state level under Director NRHM and is working as a technical and administrative body to implement the activities of NRHM in the State. State ASHA Resource Center (SARC) is conceptualized to improve the quality of ASHA programme and is established at state level which work under direction of Mission Director of NRHM
Functions of State ASHA Resource Center-
Village Health Sanitation & Nutrition Committee
National Rural Health Mission envisages the community to take leadership at local level, related to health and its related issues. It will be possible only when the community is sufficiently empowered to take leadership in health matters. Clearly, it requires involvement of Panchayati Raj Institutions in the management of the health system. This could be possible if a committee is formed in each village under the chairmanship of Gram Panchayat member and representative from the community such as women's group, and SC/ST/OBC / minority communities etc. Hence, for the development of every village, Village Health Sanitation & Nutrition Committee has been formed by providing untied grant for village level activities.
A. Role of the VHSNC
The VHSNC will be responsible for the overall health of the village. It will take into consideration the problems of the community and the health and nutrition care providers and suggest mechanism to solve it.
2. It will create public awareness about the essentials of health programmes, with focus on people's knowledge of entitlements to enable their involvement in the monitoring.
3. It will discuss and develop a village health plan based on an assessment of the village situation and priorities identified by the village community.
4. Analyze key issues and problems related to village level health and nutrition activities, give feedback on these to the Medical Officer of the PHC. 5. The committee will monitor all the health activities that are conducted in the village such as Village Health & Nutrition Day, mothers meeting etc. 6. VHSNC along with the ANM will be responsible to conduct household survey in the village. 7. It will maintain village health register and the health information board which will have information about the mandated services in the Sub Centre/PHC.
8. It will ensure that the ANM visit the village on the fixed days and perform the stipulated activity as per the Sub Centre workplan; oversee the village health and nutrition functionaries.
9. ANM will submit a bi monthly village report to the committee along with the plan for next two months. Formats and contents would be decided by the village health committee. Discuss the report submitted by ANM in the village level meeting and take appropriate action.
10. It will discuss every maternal or neonatal death that occurs in their village, analyze it and suggest necessary action to prevent such deaths. Get these deaths registered in the Panchayat.
11. The committee will organize regular monthly meeting to discuss various issues in the village and document the minutes of the meeting. The committee shall ensure that Public Dialogue is organized at regular intervals (once in six month) in the presence of Medical Officer of the Primary Health Care Centre. The committee shall ensure that all the issues discussed are recorded and action taken on the issues discussed.
12. The VHSNC will also play vital role for selecting and supporting the ASHA from the community Other than health related issues VHSNC will also be responsible for the development of the village.
13. The VHSNC will also take care of the Sub Centre.
14. The VHSNC will be responsible to inform the community about all the government schemes.
B. Utilization of the Untied Grant
1. The untied grant is a resource for community action at the local level.
2. The committee should utilize the fund after taking resolution in the VHSNC monthly meeting.
3. The committee can not withdraw the total amount of Rs. 10,000/- at one go.
4. The fund can be utilized for village level activities such as cleanliness and sanitation drive, school health activities, building transport communication link for transferring the patient to health facilities, health awareness activities, house hold surveys, improving the facilities of the Anganwadi Centre and any other developmental activities for the village/community.
5. During emergency like flood or any epidemic the committee will utilize the fund for the relief camps or supplies such as Halogen tablet for purification of water, ORS, Bleaching powder etc.
6. The committee can utilize the fund for making signboard in the meeting place of VHSNC.
C. Maintenance of Funds
1. The committee is entitled for annual grant of Rs. 10,000 for village level activities.
2. The VHSNC shall maintain a register of funds received and expenditure incurred.
3. The committee should manage the village health fund for various health activities.
4. The committee should maintain accounts and timely submit the utilization certificate and statement of expenditure for the money received to the Primary Health Centre.
D. Maintenance of Registers
1. Village Health Register
2. Birth & Death Register
3. Public Dialogue Register
4. Referral Register
5. Untied Grant Register
Village Health Nutrition Day
The VHND is to be organized once every month (preferably on Wednesdays, and for those villages that have been left out, on any other day of the same month) at the AWC in the village. VHND is also to be seen as a platform for interfacing between the community and the health system. On the appointed day, ASHAs, AWWs, and other will mobilize the villagers, especially women and children,to assemble at the nearest AWC. On the VHND, the villagers can interact freely with the health personnel and obtain basic services and information. They can also learn about the preventive and promotive aspects of health care, which will encourage them to seek health care at proper facilities. Following issues can be discussed on the day of VHND.
• Early registration of pregnancies.
• Focused ANC.
• Referral for women with signs of complications during pregnancy and those need emergency care.
• Referral for safe abortion to approved MTP centres.
• Counselling on: 1. Education of girls. 2. Age at marriage.
3. Care during pregnancy.
4. Danger signs during pregnancy.
5. Birth preparedness.
6. Importance of nutrition.
7. Institutional delivery.
8. Identification of referral transport.
9. Availability of funds under the JSY for referral transport.
10. Post-natal care.
11. Breastfeeding and complementary feeding.
12. Care of a newborn.
• Organizing group discussions on maternal deaths, if any, that have occurred during the previous month in order to identify and analyse the possible causes.
• Avoidance of breeding sites for mosquitoes.
• Mobilization of community action for safe disposal of household refuse and garbage.
• Diseases due to nutritional deficiencies can be prevented by giving information and counselling on:
1. Healthy food habits.
2. Hygienic and correct cooking practices.
3. Checking for anaemia, especially in adolescent girls and pregnant women; checking, advising, and referring.
4. Weighing of infants and children.
5. Importance of iron supplements, vitamins, and micronutrients
6. Food that can be grown locally.
7. Focus on adolescent, pregnant women and infants aged 6 months to 2 years.
Grievance Redressal Mechanism
List of Drugs being provided in ASHA Kit
Name of contents
Tab. Iron Folic Acid (L)
Gentian Violet Paint
Cotton Absorbent Roll
Bandages, 4cm X 4 meters
Oral Pills (In cycles)
ASHA's Having Bank Accounts
T O T A L