The Government of India and Government of Rajasthan have launched a National Rural Health Mission to address the health needs of rural population, especially the vulnerable sections of the society. The sub center is the most peripheral level of contact with the community under the public health infrastructure. This caters to the population norm of 3000 - 5000. The worker in sub center is an ANM who is directly involved in all the health issues of this population, which is spreaded over the wide area of many kilometers and covering 5 to 8 villages. Many a times the villages are not connected by public or private transport system making her more difficult to achieve the objectives and goals of providing quality health care for the poor and oppressed sections of the society. So the new band of community based functionaries, named as Accredited Social Health Activist (ASHA) is proposed in the NRHM who will serve the population of 1000 and 500 in hilly and desert terrene.
ASHA is the first port of call for any health related demands of deprived sections of the population, especially women, children, old aged, sick and disabled people. She is the link between the community and the health care provider.
Department of Medical and Health at State and at Center is looking at ASHA as a change agent who will bring the reforms in improving the health status of oppressed community of India. The investment on ASHA will definitely result in to better health indicators of state and at large the country.
Convergence of DWCD and NRHM
In each Anganwadi Center apart from Anganwadi Worker and Sahayoka one additional worker named 'Sahyogini' is envisaged to provide door to door information and services of Nutrition, Health, preschool education. Her role is quite similar to the role of ASHA under NRHM. So to avoid duplication of workers providing same types of services in the same area, the decision was taken at State level, that there will be only one worker coterminous with Anganwadi, who will work with DWCD and DMHS. This worker is called as 'ASHA Sahyogini', selected by the community through Gram Panchayat and responsible to the community.
Criteria for selection
• One ASHA Sahyogini for each Anganwadi Center.
• Woman resident of that area, Married/ Widow/ Divorcee
• Age between 21 to 45 years
• ASHA Sahyogini should have effective communication skills, leadership qualities and be able to reach out to the community.
• ASHA Sahyogini should be literate woman with formal education up to eighth class, In tribal and desert areas the educational qualification may be relaxed if the 8th pass candidate is not available. This is permitted only after the approval of State level Committee.
• Adequate representation from disadvantaged population groups.
- Create awareness
Health, Nutrition, basic sanitation, hygienic practices, healthy living and working conditions, information on existing health services and need for timely utilization of health, nutrition and family welfare services
-CounselingBirth preparedness, importance of safe and institutional delivery, breast-feeding, immunization, contraception, prevention of RTI/STI. Nutrition and other health issues.
- MobilizationFacilitate to access and avail the health services available in the public health system at Anganwadi Centers, Sub Center, PHC , CHC and district hospitals.
- Village health planWork with the village Health and sanitation Committee to develop the village health plan
- Escorts/ AccompanyEscorts the needy patients to the institution for care and treatment. She will accompany the woman in labor to the institution and promote institutional delivery
-Provision of Primary Medical Health CareMinor ailments such as fever, first aid for minor injuries, diarrhea. A drug kit will be provided to ASHA- Provider for DOTS- Depot Holder ORS, IFA, DDK, chloroquine, oral pills and condoms- Care of new born and management of a range of common ailments
- Inform Births, deaths and unusual health problem or disease out break- Promote Construction of household toilets
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 Sahyogini is a continuous process. Considering her range of functions and task to be performed, her induction training is planned for 23 days in 4 rounds (10+4+4+5 days). The trainings are planned in cascade model. The non governmental organizations are involved in the training of ASHA Sahyoginis at grass root level.
Under NRHM ASHA Sahyogini is a voluntary worker who will get performance linked incentives. The honorarium is linked with the performance indicators of ASHA Sahyogini. The generic Compensation package made for ASHA Sahyogini by linking her with different health programmes.
The detailed compensation package is worked out at state level. If she works as per the expected standards she would earn approximate Rs. 1067 per month. ASHA will get the package on
Apart from the above package she may get prizes for extraordinary performance in cash or kind from the untied funds. Some of the selected ASHA Sahyoginis will visit different places in the State and outside State during exposure visits.
Drug Kit for ASHA Sahyogini - The drug Kit is provided to ASHA Sahyogini to provide primary Health Care to the community like minor elements like fever, pain, First Aid etc. The replenishment of medicines is made from PHC /Subcenter stocks.Monthly Meetings - The joint monthly meetings are conducted at PHCs by DWCD and DMHS. ASHA Sahyoginis are interacting with service providers in this monthly meeting. The replenishment of Medicines and payment of incentives are ensured during these meetings.
For strengthening ASHA- Sayogini Programme in the State a State Level Mentoring Group is constituted under the Chairpersonship of Mission Director, NRHM. This group will oversee the implementation of the scheme and facilitate in developing the policy guidelines. Mentoring Group will act as a think - tank for the programme. The mentoring group will provide technical inputs and support mechanism. The members of ASHA Mentoring Group are Director DWCD, PHED, RD,PRI, IEC, RCH, PH, AIDs, representatives from development partners and NGOs.
The Mentoring Group will meet once in three months to review and to provide inputs for the ASHA- Sahyogini Intervention. ASHA Resource Center is the Nodal Agency to organize the meetings and do the follow ups with the support of SPMU- NRHM.
9. ASHA Sahyoginis role in Village Health Plan - NRHM is promoting the down - up approach for implementation of different health programmes. It is proposed to form Village Health Societies and Village Health Teams to address the health needs of the Village. ASHA Sahyogini will be one of the important members of VHC and VHT. ARC will be responsible for capacity building of ASHA Sahyogini so that she could help in planning and implementation of Health Programmes in the Village.
Organize Quarterly meeting of Mentoring Group - A
Mentoring Group is constituted to provide overall guidance to the programme
and act as a think - tank for the programme. The mentoring group will provide
technical inputs and support mechanism. ASHA Resource Center will conduct
the quarterly meetings of the mentoring group and incorporate the valuable
inputs provided by the group in the programme.
11. Provision of services of Helpline -
ASHA Sahyogini in near future will work in entire state. There will be more
than 45,000 ASHA Sahyoginis in the State. Time to time trainings or monthly
meetings may not suffice the need of the ASHA Sahyogini. So the ARC will
form the helpline for the ASHA Sahyogini and associated functionaries. ARC
will respond to the queries or clarifications needed in the field. ARC will
ensure that the prompt help is provided to ASHA.
12. Organizing ASHA Sammelan, Exposure visits- There will be Sammelans at State level, Zonal level and District level to share the experiences of ASHA Sahyogini and for cross learning’s. ARC will organize such events with the help of State Health Society and District Health Society. ARC will also organize the exposure visits with in the state and outside the state.
13. Other issues related to the functioning of ASHA - Some of the functions of ARC is mentioned above. The role of ARC is multifaceted and visualized in broader sense. The functions of ARC could be revised as per the need and requirement of the programme. Some new roles could also be incorporated.
Linkages of ASHA Resource Center- ASHA
Resource Center is a Hub for ASHA Component under NRHM, which will work
in close association with Mission Director. The administrative control on
the ARC will be of the outsourced agency, but the Mission Director will
be involved in major decisions like recruitment of professionals, budget
etc. However day to day functioning will be the responsibility of outsourced
agency. ARC will provide support to the districts through NRHM and all the
administrative guidelines will be issued through NRHM.