ASHA and Community Health Workers

ASHA: Introduction - Village Health Stars

• ASHA: Accredited Social Health Activist.
• Female community health volunteer; vital link between community & public health system.
• Selection Criteria:
  • Woman resident of the village (married/widow/divorced).
  • Age: 25-45 years.
  • Education: Preferably literate, ideally up to 10th standard.
  • Good communication & leadership skills.
• Coverage Norm:
  • 1 ASHA per 1000 population (general areas).
  • Relaxed for tribal, hilly, desert areas (e.g., 1 ASHA per habitation).
• Accountable to the Village Panchayat/Gram Sabha.
• Launched under National Rural Health Mission (NRHM, 2005), now part of National Health Mission (NHM).

⭐ ASHA is primarily an honorary volunteer who receives performance-based incentives, not a fixed government salary.

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ASHA: Functions - Tasks & Triumphs

• Core Functions & Tasks:
  • Health education & counseling: Maternal & Child Health (MCH), nutrition, family planning, sanitation, hygiene.
  • Mobilize community for health services: Immunization, Antenatal Care (ANC), Postnatal Care (PNC).
  • Escort services: To facilities for institutional delivery, immunization, emergencies.
  • Home-Based Newborn Care (HBNC) visits.
  • DOTS provider for Tuberculosis; Malaria: RDTs, presumptive treatment.
  • Depot holder: ORS, Iron Folic Acid (IFA), contraceptives, basic medicines.
  • Report vital events (births, deaths); maintain essential records.
  • Facilitate Village Health, Sanitation & Nutrition Committee (VHSNC) meetings.
• Key Triumphs:
  • ↑ Institutional deliveries, comprehensive ANC/PNC coverage.
  • ↑ Full immunization coverage in children.
  • Significant ↓ in Infant Mortality Rate (IMR) & Maternal Mortality Ratio (MMR).
  • Improved community health awareness & health-seeking behaviors.

⭐ ASHA acts as a depot holder for essential provisions and typically serves a population of 1000.

ASHA: Support Systems - Training & Teamwork

• Training:
  • Initial: 23 days, structured in modules (e.g., 5 core modules).
  • Focus: MCH, immunization, family planning, nutrition, DOTS, first-aid, communication.
  • Periodic refresher training and skill enhancement.
• Teamwork & Support:
  • Mentoring & guidance: ANM, AWW, Medical Officer (MO).
  • Regular review meetings at Sub-centre/PHC.
  • Support from VHSNC/PRI.
  • Performance-based monetary incentives.

⭐ ASHA's training is competency-based, typically involving 23 days spread over several months in distinct modules.

CHWs: Linkages - ASHA & Allies

• ASHA (Accredited Social Health Activist): Primary community interface.
  • Coordinates with Anganwadi Worker (AWW): ICDS, nutrition, health education.
  • Supports ANM (Auxiliary Nurse Midwife): Immunisation, MCH, referrals, Sub-Centre activities.
  • Member of VHSNC (Village Health Sanitation and Nutrition Committee).
• Key Allies:
  • AWW: Focus on child development, maternal nutrition.
  • ANM: Skilled care, facility-based services.

⭐ ASHA acts as a crucial link between the community and the public health system, facilitating access to services and promoting health-seeking behaviours among rural populations for schemes like JSY and JSSK.

ASHA Program: Evaluation - Gains & Gaps

• Gains:
  • Improved access: ↑ Antenatal Care (ANC), institutional deliveries, immunization
  • Better maternal & child health (MCH) outcomes
  • Strengthened community-health system interface
• Gaps:
  • High workload; inadequate/delayed performance-based incentives
  • Insufficient training, irregular supplies
  • Weak supportive supervision
  • Overemphasis on curative tasks vs. promotive/preventive

⭐ ASHA (Accredited Social Health Activist) must be a woman resident of the village, preferably aged 25-45 years, with formal education up to class 8th, and good communication skills.

High‑Yield Points - ⚡ Biggest Takeaways

• ASHA (Accredited Social Health Activist): A trained female community health volunteer.
• Acts as a key link between the community and the public health system.
• Focuses on Maternal & Child Health (MCH), immunization, family planning, and basic care.
• Receives performance-based incentives, not a fixed salary.
• Norm: One ASHA per 1000 population (flexible for difficult areas).
• Crucial for JSY & JSSK success, promoting institutional deliveries and newborn care.
• AWW (Anganwadi Worker): Manages Anganwadi centers focusing on child nutrition and pre-school education (ICDS).