ASHA - World’s Largest All-female Frontline Community Health Worker: Features and Challenges
Abstract
India accounts for the second-highest number of maternal deaths all over the world. India has shown a remarkable decline in MMR (Maternal Mortality Ratio) during the last two decades. According to the SRS (Sample Registration System), MMR dropped from more than 556 per 100,000 in 1990 to 113 in 2018 and the proportion of deliveries attended by skilled health personnel has increased from 58% in the 1990s to 81% in 2019. In the year 2005, the Government of India launched the National Rural Health Mission (NRHM) with the purpose of improving the existing health facilities provided to the community with a special focus on the poor and vulnerable states and societies. NRHM identified ASHA (Accredited Social Health Activist), a voluntary community health worker, to provide services to the community on incentives. ASHA workers are the female health workers who have hailed from the same community where they serve. An ASHA worker
acts as a link person between the health system and the community. At present, ASHA services are utilised in a number of programmes including maternal and child health, Various studies have extensively documented about ASHAs dissatisfaction with their pay and workload. ASHA services are widely accepted by societies, especially the poor, but issues like sexual harassment, violence, unsafe working conditions, and cast discrimination were also reported.
ASHA programme plays a critical role in implementing Government health programmes, especially on MCH. Therefore keeping the ASHA updated and motivated is very important for performing her duties efficiently and effectively.
How to cite this article:
Babu C, Babu M. ASHA - World’s Largest Allfemale
Frontline Community Health Worker:
Features and Challenges. Ind J Holist Nurs.
2021;12(3):16-20.
References
Horwood G, Opondo C, Choudhury SS, Rani A, Nair M. Risk factors for maternal mortality among 1.9 million women in nine empowered action group states in India: secondary analysis of Annual Health Survey data. BMJ Open. 2020;10(8):e038910. [PubMed] [Google Scholar]
World Health Organization [Internet]. Maternal health; 2020 [cited 2021 Aug 18]. Available from: https://www.who.int/health-topics/maternal-health#tab=tab_2
World Health Organization [Internet]. Maternal mortality; 2019 Sep [cited 2021 Jul 20]. Available from: https://www.who.int/news-room/fact-sheets/detail/maternal-mortality
MoHFW [Internet]. Maternal and adolescent health care. Annual Report 2017-18; 2018 [cited 2021 Aug 16]. Available from: https://main.mohfw.gov.in/sites/default/files/03Chapter.pdf
Ved R, Scott K, Gupta G, Ummer O, Singh S, Srivastava A, George AS. How are gender inequalities facing India’s one million ASHAs being addressed? Policy origins and adaptations for the world’s largest all-female community health worker programme. Hum Resour Health. 2019;17(1):3. [PubMed] [Google Scholar]
Wang H, Juyal RK, Miner SA, Fischer E. Performance based payment system for ASHA’s in India: what does international experience tell us? USAID. 2012:1-36.
Panda M, Nanda S, Giri RC. A study on the work profile of ASHA workers in a district of Odisha in eastern India. Int J Comm Med Public Health. 2019 Feb;6(2):675-81. [Google Scholar]
Dholakia RH, Bajpai N. Improving the performance of accredited social health activists in India. Columbia: Academic Commons; May 2011. [Google Scholar]
Fathima FN, Raju M, Varadharajan KS, Krishnamurthy A, Ananthkumar SR, Mony PK. Assessment of ‘Accredited Social Health Activists’- a national community health volunteer scheme in Karnataka state, India. J Health Popul Nutr. 2015 Mar;33(1):137-45. [PubMed] [Google Scholar]
National Health Mission [Internet]. Guidelines on Accredited Social Health Activists (ASHA); [cited 2021 Jul 20]. Available from: https://nhm.gov.in/images/pdf/communitisation/task-group-reports/guidelineson-asha.pdf
Gopalan SS, Mohanty S, Das A. Assessing community health workers’ performance motivation: a mixedmethods approach on India’s Accredited Social Health Activists (ASHA) programme. BMJ Open. 2012;2(5):e001557. [PubMed] [Google Scholar]
Scott K, George AS, Harvey SA, Mondal S, Patel G, Sheikh K. Negotiating power relations, gender equality, and collective agency: are village health committees transformative social spaces in northern India? Int J Equity Health. 2017;16(1):84. [PubMed] [Google Scholar]
NHM [Internet]. Guidelines for accreditation of training sites and trainers for ASHA training under the National Health Mission; 2015 [cited 2021 Jul 20]. Available from: https://nhsrcindia.org/sites/default/files/2021-03/Certification%20of%20ASHA%20Guidelines18.05.2015.pdf
Press Information Bureau, Government of India, MoHFW [Internet]. Cabinet approves ASHA Benefit Package; 2018 Sep 19 [cited 2021 Aug 1]. Available from: https://pib.gov.in/Pressreleaseshare.aspx?PRID=1546619
Ministry of Health and Family Welfare [Internet]. Welfare of ASHA workers during COVID-19 pandemic; 2021 Jul 27 [cited 2021 Aug 18]. Available from: https://pib.gov.in/pressreleaseiframepage.aspx?PRID=1739461
NHM [Internet]. Update on ASHA programme; 2014 Jan [cited 2021 Aug 20]. Available from: https://nhsrcindia.org/sites/default/files/2021-03/Update%20on%20ASHA%20Program%20January%202014.pdf
NHM [Internet]. Update on ASHA Programme; 2019 Jul [cited 2021 Aug 1]. Available from: https://nhsrcindia.org/sites/default/files/2021-06/ASHA%20Update%20July%202019.pdf
NUHM [Internet]. ASHA payment implementation process; [cited 2021 Sep 5]. Available from: http://asha.mp.gov.in/User%20Manual/User%20Manual%20(ASHA%20incentive).pdf
Ministry of Health and Family Welfare [Internet]. ASHA workers, Lok sabha unstarred question no. 3418 to be answered on 13th March, 2020; [cited 2021 Sep 6]. Available from: http://164.100.24.220/loksabhaquestions/annex/173/AU3418.pdf
Garg PK, Bhardwaj A, Singh A, Ahluwalia SK. An evaluation of ASHA worker’s awareness and practice of their responsibilities in rural Haryana. Natl J Community Med. 2013;4(1):76-80. [Google Scholar]
Bhattacharya H, Luwang N, Sarkar M, Chakraborty T, Baidya S. Utilization of ASHA services by the pregnant women of rural Tripura, India. Int J Res Med Sci. 2015;3(9):2223-7. [Google Scholar]
Agarwal S, Curtis SL, Angeles G, Speizer IS, Singh K, Thomas JC. The impact of India’s accredited social health activist (ASHA) program on the utilization of maternity services: a nationally representative longitudinal modelling study. Hum Resour Health. 2019;17(1):68. [PubMed] [Google Scholar]
Bhatia K. Performance-based incentives of the ASHA scheme: stakeholders’ perspectives. Econ Polit Wkly. 2014;49(22):145. [Google Scholar]
Guha I, Raut AV, Maliye CH, Mehendale AM, Garg BS. Qualitative assessment of Accredited Social Health Activists (ASHA) regarding their roles and responsibilities and factors influencing their performance in selected villages of Wardha. Int J Adv Med Health Res. 2018;5(1):21-26. [Google Scholar]
Shet S, Sumit K, Phadnis S. A study on assessment of ASHA’s work profile in the context of Udupi Taluk, Karnataka, India. Clin Epidemiol Global Health. 2018;6(3):143-7. [Google Scholar]
Saxena V, Kakkar R, Semwal VD. A study on ASHA - a change agent of the society. Ind J Comm Health. 2012;24(1):15-8. [Google Scholar]
Agrima R. ASHA workers are hailed as COVID warriors but only 62% have gloves, 25% have no masks. The Print; 2020 Sep 21.
Gangotri, Pritisha, Bhargava R, Adib R, Velankar J, Dasgupta J. Report of independent fact-finding into the incident of gang-rape and death of an ASHA worker Somwati Tyagi in Muzaffarnagar District, Uttar Pradesh, India. National Alliance for Maternal Health and Human Rights & Healthwatch Forum Uttar Pradesh; 2016.
Sharma R, Webster P, Bhattacharyya S. Factors affecting the performance of community health workers in India: a multi-stakeholder perspective. Glob Health Action. 2014;7(1):1-8. [PubMed] [Google Scholar]
NHM [Internet]. Safety measures for ASHAs; 2016 [cited 2021 Sep 3]. Available from: https://nhsrcindia.org/sites/default/files/2021-03/Safety%20measures%20for%20ASHAs_29.01.2016.pdf
Guleri SK, Dixit S, Sakalle S, Bhagwat AK, Yesikar V, Pandey D. A rapid appraisal of training issues of ASHAs (Accredited Social Health Activist) in Madhya Pradesh. Int J Public Health Res. 2014;1(1):3-8. [Google Scholar]