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 must primarily be a woman resident of the village married/ widowed/ divorced, preferably in the age group of 25 to 45 years.
• She 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.
• ASHA will have to 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.
• 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.
• ASHA will be a health activist in the community who will create awareness on health and its social determinants and mobilise the community towards local health planning and increased utilisation and accountability of the existing health services.
• She would be a promoter of good health practices and make timely referrals.
• 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 mobilise the community and facilitate them in accessing health and health related services available at the Anganwadi/sub-centre/primary health centers.
• 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.
• ASHA cannot function without adequate institutional support. Women's committees like self-help groups, village Health & Sanitation Committee of the Gram Panchayat, ANMs and Anganwadi workers, and the trainers of ASHA would be a major source of support to ASHA.

ASHA: The Haryana Scenario

• 16506 ASHAs (out of targeted 18008) selected and positioned upto August, 2013.
• Induction training completed for all ASHAs.
• All ASHAs having Bank Accounts.
• 12000 ASHAs received Uniform (Coat).
• 11833 ASHAs having Drug Kits.
• ASHAs being provided with Nischay Kits.
• ASHAs attending monthly meetings at PHCs.
• Incentive payment directly to their bank accounts out of available fund.
• Best performing ASHAs are chosen at district level and awarded in quarterly award ceremony.
• State ASHA Resource Centre is established at State level.
• 21 District ASHA Coordinators and 119 Block ASHA Coordinators for supporting ASHA programme at Block and District level.
• ASHA Grievance Redressal Committee constituted in many districts.
• ASHA Grievance Redressal Cells framed at State, District and Block level.
• Toll free ASHA Helpline established at State HQ.
• CUG mobile numbers have been provided to ASHAs throughout the State.
• Best performing ASHA is selected as ASHA Facilitator at each PHC.

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:-

• One ASHA per 1000 population.
• ASHA is primary resident of village with formal education up to class 8th.
• Age group of 20-45 years.
• She should be married/divorced/widow women.

Selection Procedure :-

• As per guidelines, Gramsabha or VHNSC will recommend names of suitable candidates to the Medical Officer Incharge.
• A committee comprising of Medical Officer Incharge, Block ASHA Coordinator, ANM and Sarpanch of village will select one lady as ASHA amongst these shortlisted candidates.
• Appointment letter of ASHA will be issued by Medical Officer Incharge.

Support Mechanism of ASHA:-

• State ASHA Resource Center (SARC).
• One District ASHA Coordinator for one district.
• One Block ASHA Coordinator at CHC Level.
• One ASHA facilitator per PHC.
• State, District & Block Mentoring Committees are being constituted for supporting ASHAs.

ASHA Facilitator

Criteria for selection

• One ASHA Facilitator for each PHC.
• ASHA Facilitator should have effective communication skills, leadership qualities and be able to reach out to the community.
• Best performing ASHA in the area is selected as ASHA Facilitator.

Roles and Responsibilities of ASHA Facilitator

• Supervision of ASHAs in area under PHC.
• Provide on job training to weak/new ASHAs.
• Facilitate ASHAs in filling their self appraisal forms for incentive.
• Help ASHA for motivating marginalised community.
• Help in replenishment of drug kits.
• Organize cluster meetings of ASHAs.
• Help in VHSNC & VHND activities.

Training
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-

1. Technical backstopping in Training - SARC will develop user friendly training methodology and the training modules, print the modules in prescribed time, and disseminate the modules in the District.
2. Development of IEC material - SARC will be responsible for developing or collecting the IEC material including flip books, charts, posters etc on different related issues. Need based IEC material will be developed from time to time.
3. Development of Reporting formats and registers - ASHA is envisaged as a voluntary worker and to facilitate her work some very easy and basic reporting formats and registers will be developed by SARC.
4. Processing of Statistical Data and records- On the basis of reports and registers of ASHA and other sources of data’s. SARC will compile the statistical data, analyze the data and provide the feedback of the programme to the Mission.
5. Intersectoral Coordination pertaining to ASHA- The credibility of ASHA in the community could be used by other Development Departments to promote their objectives. SARC will coordinate with different departments and facilitate empanelment of ASHAs in various other programmes.
6. Involving NGOs to strengthen the programme- Involvement of NGOs is an important task in the implementation of ASHA programme. NGOs could support the ASHA to work at community level. In consultation of NRHM the NGOs should be involved in the programme.
7. Provision of Drug Kits- ASHA will provide the basic medical care to the community. The drug kit with basic medicines and supplies are provided to all the ASHAs under NRHM. The drug Kit contains medicines and contraceptives.
8. Provision of services of Helpline – A Tollfree helpline has been started at State HQ to deal with ASHAs Grievances. Team of call centre at HQ randomly call ASHAs to enquire about the payment status, drug kits refilling and other relevant matters. SARC ensures that the prompt help is provided to ASHA.
9. Organizing ASHA Sammelan- There will be Sammelans at District level to share the experiences of ASHA and for cross learning’s. SARC organizes such events with the help of District Health Society.

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.

Maternal Health
• 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.
13. Contraception.
• Organizing group discussions on maternal deaths, if any, that have occurred during the previous month in order to identify and analyse the possible causes.

Sanitation
• Avoidance of breeding sites for mosquitoes.
• Mobilization of community action for safe disposal of household refuse and garbage.

Nutrition
• 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

1. ASHA Help desk has been made at every Block CHC level.
2. MO I/c, LHV, PHN have been made In-charge at every Block/CHC to redress the issues raised by ASHAs
3. ASHA Helpline No 82880141418288014141 has been established at the Head Quarter to have complaint from across the State, between 9:00 AM to 5:00 PM.
4. Records of proceedings of ASHAs Grievance & Redressal have been started maintaining at each level.
5. Names and phone numbers of ASHA Grievance Desk have been notified to each and every ASHA.
6. The Process of the ASHA Grievance Redressal Committees has been initiated at every district.

List of Drugs being provided in ASHA Kit

Achievements: