Accredited Social Health Activists (ASHAs)

In News: The World Health Organisation (WHO) has recognized the contribution of India’s 1 million Accredited Social Health Activists (ASHAs) during the Covid-19 pandemic.

• It is acknowledged that ASHAs facilitate linking households to health facilities, and play pivotal roles in house-to-house surveys, vaccination, public health and Reproductive and Child Health measures.

Genesis & evolution of the ASHA programme

• The ASHA programme was based on Chhattisgarh’s successful Mitanin programme, in which a Community Worker looks after 50 households.
• The National Health Mission was launched to provide effective health care to the entire rural population in the country – The core strategy of the mission is to provide well trained female health activist (Accredited Social Health Activist- ASHA) in each village (1/1000 population) to fill the gap of unequal distribution of health services in rural area.
• Accredited Social Health Activist (ASHA) is a trained female community health activist.
• Selected from the community itself and accountable to it, the ASHA will be trained to work as an interface between the community and the public health system.
• At present there are over 9 Lakh ASHAs.

Roles and responsibilities

• The role of an ASHA is that of a community level care provider.
• This includes a mix of tasks: facilitating access to health care services, building awareness about health care entitlements especially amongst the poor and marginalized, promoting healthy behaviours and mobilizing for collective action for better health outcomes and meeting curative care needs as appropriate to the organization of service delivery in that area and compatible with her training and skills.

Success of the programme

• The World Health Organisation (WHO) has recognized the contribution of India’s 1 million Accredited Social Health Activists (ASHAs) during the Covid-19 pandemic.
• ASHAs facilitate linking households to health facilities, and play pivotal roles in house-to-house surveys, vaccination, public health and Reproductive and Child Health measures thus help in keeping track and monitoring of diseases, outbreak, MMR and IMR etc
• In many states, ASHAs are involved in national health programmes
• With newly acquired skills in health care and the ability to connect households to health facilities, ASHAs were able to secure benefits for households.
• In a way, it became a programme that allowed a local woman to develop into a skilled health worker.

Issues

• They get performance-based payments, not a fixed salary like government servants. There have been agitations demanding employee status for ASHA workers.
• In many states, the payout is low, and often delayed.
• The original idea was never to deny the ASHA a compensation that could be even better than a salary — it was only to prevent “governmentalisation”, and promote “communitisation” by making her accountable to the people she served.
• There is a strong argument to grant permanence to some of these positions with a reasonable compensation as sustaining motivation.

Way forward

• It is important to ensure that compensation for performance is timely and adequate.
• Provide opportunities for moving up the skill ladder in the formal primary health care system as an ANM/ GNM or a Public Health Nurse
• Upgrading skill sets and providing easy access to credit and finance will ensure a sustainable opportunity to earn a respectable living while serving the community.
• Strengthening access to health insurance, credit for consumption and livelihood needs at reasonable rates, and coverage under pro-poor public welfare programmes will contribute to ASHAs emerging as even stronger agents of change.

National Health Mission

• National Health Mission (NHM) was launched by the government of India in 2013 subsuming the National Rural Health Mission and the National Urban Health Mission.
• The main programmatic components include Health System Strengthening in rural and urban areas for – Reproductive-Maternal- Neonatal-Child and Adolescent Health (RMNCH+A), and Communicable and Non-Communicable Diseases.
• The NHM envisages the achievement of universal access to equitable, affordable & quality health care services that are accountable and responsive to people’s needs.

The National Health Mission seeks to ensure the achievement of the following indicators:

• Reduce Maternal Mortality Rate (MMR) to 1/1000 live births
• Reduce Infant Mortality rate (IMR) to 25/1000 live births
• Reduce Total Fertility Rate (TFR) to 2.1
• Prevention and reduction of anemia in women aged 15–49 years
• Prevent and reduce mortality & morbidity from communicable, non-communicable; injuries and emerging diseases
• Reduce household out-of-pocket expenditure on total health care expenditure
• Reduce annual incidence and mortality from Tuberculosis by half
• Reduce the prevalence of Leprosy to <1/10000 population and incidence to zero in all districts
• Annual Malaria Incidence to be <1/1000
• Less than 1 percent microfilaria prevalence in all districts
• Kala-azar Elimination by 2015, <1 case per 10000 population in all blocks.

Source: Indian Express