Concept Notes (Bhambed PHC)

Introduction:

The National Rural Health Mission (NRHM) is outcome to the decision of the May 2004 general
races which prompted the conceptualization of a lot of expert poor strategies under the Common
Minimum Program (1). The long standing need of urban wellbeing mission was acknowledged in
2013 by the Cabinet of the Government of India and country and urban wellbeing mission
converged to shape the National Health Mission in twelfth Five Year Plan. The NHM visualizes
achievement of universal access to equitable, affordable & quality health care services that are
accountable and responsive to people's needs (2).

In India, there is increase in role of community health worker in primary health care which
includes training and supporting local people to serve as outreach workers, first aid providers,
health educators, and health behavior change promoters in their communities. The ASHA
programme which was launched in 2005 is the latest one of CHW programme. In India there are
9, 37,107 ASHA Community Health Worker as per PIP 2018-19.
ASHAs are female Community Health Worker individuals with something like 8 years
education, who get 23 days training and perform six key roles: home visits, network gatherings,
month to month gatherings at the essential wellbeing focus, encouraging effort benefits inside the
town, counselor for women in reproductive age Group and looking after records. Overall, they
perceived the role of ASHA to be of mainly a link-worker or facilitator, to a moderate extent as a
community health worker and to a small degree as a social activist (3).

More than 60,092 women community health volunteers called the ‘Mitanins’ are working for the
improvement of the health care system and give health support at the village level in
Chhattisgarh under National health mission (4).

In rural area the ratio of ASHA are now 1 per thousand population. ASHA plays pivotal role to
the whole design and strategy of national health mission and that is why they are considered as
the backbone of the national health system. These CHWs are more likely to engage the society in
grass-roots health-related issues than the well-trained, but unpaid volunteers.

Aim of the Study:

To examine the challenges ASHAs face at various levels of the health services system and how
does it contribute to their overall performance. Specifically focus on the monetary as well as
implementation difficulties faced by ASHAs in the above process.

Literature Review:

We searched the electronic databases PubMed for articles published in last 10 year till 20-Feb-
2019. Searches were incorporated with keywords and free text for the concepts ASHA (e.g.
“accredited social health activist”, “ASHA”) under one string. Articles were excluded if it was
not clear whether the CHW programme being discussed was the Government of India’s ASHA
programme or if the article mentioned ASHAs only in passing. All primary research articles,
abstracts, and commentaries on the ASHA programme were included (n = 31).
Apart from this we also searched on Google whose links are mentioned below. The findings of
reviewed articles are:

1. Poor knowledge of ASHA, lack of motivation, poor disbursement of honorarium,

distance of patient,s home from asha home, difficult terrain (A.R. Singh et al. / Journal of
Epidemiology and Global Health 7 (2017) 219–225).
2. Problems faced by ASHA workers for malarial services under NVBDCP (Gohel A et al.
Int J Res Med Sci. 2015 Dec;3(12):3510-3513)
3. 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 (Ved et al. Human Resources for Health (2019) 17)
4. Community health workers in rural India: analysing the opportunities and challenges
Accredited Social Health Activists (ASHAs) face in realising their multiple roles (Saprii
et al. Human Resources for Health (2015) 13:95)
5. Deficiencies and difficulties in service provision (Bhanderi, et al.: Evaluation of
accredited social health activists)
6. Despite the training given to Mitanin, lacunae still exists in their knowledge regarding
various aspects of health care. Many of them were not aware about family planning,
diabetes, tuberculosis, danger signs for pregnancy & newborn that indicate the need for
immediate referral (Baghel A et al. Int J Community Med Public Health. 2017
May;4(5):1637-1643)
7. ASHAs worked within bounded socio-cultural, gender and religious contexts, they were
constantly challenged by norms existing within these contexts. ([online] 2019 February
20 [cited 2019 February] Available from: https://www.usaidassist.org/blog/challenges-
facing-asha-female-community-health-workers-vital-part-health-system-india
8. Delays in incentive payments to harassment from senior medical staff at district
level, Ashas in India are faced with several challenges which not only demotivate
them but hampers the implementation of health programme (([online] 2019
February 20 [cited 2019 February] Available from:
https://www.expresshealthcare.in/features/asha-workers-in-need-for-
empowerment/405878/

Methodology:

Qualitative Research- In-depth interview and FGD.

REFERENCE:
1. Kishore J, National Health Program Of India, 12th edition, century Publicacation, P.no
2. National Health Mission; [online] 2019 February 20 [cited 2019 February]. Available
from: http://nhm.gov.in/nhm.html
3. R. Ved, K. Scott, G. Gupta1, O. Ummer, S. Singh1, A. Srivastava1 and A. S. George;
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, (2019) 17:3
4. [online] 2019 February 20 [cited 2019 February] Available from:
http://www.cghealth.nic.in/cghealth17/Information/content/MediaPublication/MitaninPro
grammedraft.pdf