ASHA Scheme

Accredited Social Health Activist
(ASHA)
State Institute of Health & Family Welfare, Jaipur
1
SIHFW: an ISO 9001: 2008 certified Institution
ASHA
ASHA is the first port of call for any health
related
l t d demands
d d off deprived
d i d sections
ti off the
th
population especially women & children,

population, children who
find it difficult to access health services.
2
ASHA
Accredited
Recognized by the community
Social
From the community, By the community and
For the community.
community
Health Activist
Spreading awareness for health concerns
Promoting change in health related practices
3
ASHA-Sahyogini: Convergence
Brought in
¾ Convergence of ICDS and Health Dept.

¾ Sahyogini
y g as 3rd worker at AWC already
y
existed before NRHM
¾ To
T avoid
id D
Duplication-
li ti S h
Sahyogini
i i ttaken
k as
ASHA (in Rajasthan)
¾ Nomenclature devised as ASHA-Sahyogini
4
ASHA-Sahyogini:
ASHA Sahyogini: Selection
¾ Listing of interested and eligible women by
ANM and LS
¾ Panel of three names
¾ Approval through Gram Sabah- Community
empowerment
5
ASHA-Sahyogini: Selection
Eligibility
g y
¾ Intensive mobilization to get active ASHA-
Sahyogini.
Sahyogini
¾ Any woman can not be the ASHA-Sahyogini.
• Age - 21years to 45 years
• Qualification - 8th Pass Minimum (relaxation for tribal
and desert areas))
• Married/divorcee/separated
• Must be ‘BAHU’ of the community
• Resident of the village
• Active/Vocal/leadership qualities
6
p
Roles & Responsibilities
¾ Total information of the community
¾ Village
Vill H
Health
lth Pl
Plan
¾ Create Awareness
¾ Coordination with AWW/TBA/ANM/MPW
¾ Counseling/Mobilization
¾ Escorts/Accompany
¾ Provision of Primary Medical Health Care
¾ Maintain Drug Kit
¾ Record and Registration
7
S Sa yog
ASHA-Sahyogini: a gs
Trainings
GOI norms- 23 days and 5 phases

Phase Days
1st 6 days
2nd 4 days
3rd 4 days
4th 5ddays
5th 4 days
8
¾ 4 rounds of 23 days (10+
(10 44+5+4
5 4 days)
¾ Presentlyy 3rd p
phase rolled out
¾ DTT for 15 days

y integrated
g training
g for fresh
ASHAs started from Oct. 2009
9
ASHA-Sahyogini
ASHA S h i i : Trainings
T i i
State Training Team NIHFW
District Trainer Team (DTT) SIHFW
Block Trainers Team (BTT) DTT
ASHA-Sahyoginis BTT & NGOS
10
Support
pp Structure
¾ ASHA mentoring group State Level

¾ ASHA Resource centre Earlier at
SIHFW,, now
at SPMU
¾ Joint Strengthening
g g Committee
¾At State level- ACS/PHS/Secretaries
¾At District level
level- CMHO/DD
CMHO/DD-ICDS
ICDS
¾At Block level- BCMO/ CDPO
¾At PHC level- MO/LHV/LS/ANM
11
g
Monitoring
¾ PHC level monthly meetings

• Review of ASHAs work
• Collection and compilation of reports
• Incentive payments to ASHAs
¾ MCHN monitoring by external agency
¾ Monthly
M thl reports
t from
f districts
di t i t
SIHFW: an ISO 9001:2008 certified Institution 12

SIHFW: an ISO 900: 20081 certified Institution 12
Monitoring Indicators for ASHAs
Institutional 5 Deliveries per year (80% of

deliveries total deliveries should be
escorted byy ASHAs))
Social 80% beneficiaries ((ANC &

Mobilization children) of the due list
should be mobilized for
MCHN d day.
Sterilization 1 case p
per month.
13
Reporting System for ASHA
¾ Form no
no. 6-9:- Deliveries escorted by ASHAs
¾ NRHM formats:- No. of ASHAs, training,
monthly meetings
meetings,
performance, integrated
package
p g etc.
¾ CHC monitoring:- Deliveries escorted by ASHAs
Sterilization motivated by
ASHAs
14
Integrated Compensation
One time honorarium Amount
(Rs.)
Monthly meeting 100
Social mobilization for MCHN day 150
Organizing monthly VHSC meeting 100
Bi-monthly conduction of meeting for 100
adolescent girls
Total to be paid by NRHM 450
Amount to be paid by WCD after 1000
attending monthly meeting at PHC
Total 1450
Performance Based Compensation
Activity Amount
(R )
(Rs.)
JSY 400+100+100 600
Male Sterilization 200
Female Sterilization 150
DOTS 250
Cataract 175
Toilet construction 60
RT to Malaria cases 50
16
Work load: ASHA (1000 Pop.)
Beneficiary category Expected number in an Year
Pregnant women 30-31
• Out of which 4-5 may have
complications
• 50% shall
h ll have
h anemia
i
New Born 27-28
Children in 0-1 Year 30 (3% of the population)
Children 1-5 years 130, (13 % of Population)
Eligible
g couples
p 16-17% ((15-45 yyears))
Eligible for Vasectomy/ 5-7% of Eligible couples
Tubectomy
Eligible for spacing Methods 11-12% of Eligible couples
Linkages of ASHA Sahyogini
MSS,SHG
Gram
ANM MO PHC
ANM,MO,PHC sabha,Gram
sabha Gram
panchayat
ASHA Sahyogini
S h i i
AWW Education, PHED,
NGO
18
Palpable Impact
¾ ANC registration in first trimester: 46.96%
¾ Institutional Deliveries – 77.34%
¾ Immunization – full immunization
immunization- 85.09%
85 09%
• OPV3 : 90.23%
• DPT3 : 90.54%
• BCG : 90.35%
• Measles : 86.85%
¾ No.
o of
o Ste
Sterilization
at o – 63
63.91%
9 %
¾ Practices
• Breast feeding practices
• Health seeking behavior
¾ Referral
¾ Community involvement –VHSC/MCHN
(Source :www.rajswasthya.nic.in)
19
Factors critical to success of ASHA
¾ Selection of ASHA by prescribed process as

per the ASHA guidelines.
¾ Linkage with nearest functional health facility

for referral services
services.
¾ Identified transport for referral of cases from

village to facility.
20
¾ Successful organization of monthly Health and
Nutrition Day (in every village with the ANM / AWW)
¾ Monthly meeting of ASHA at PHC.
¾ Timely payment of incentives to ASHA.
¾ Timely replenishment of ASHA kit
¾ Priority and recognition of cases referred by ASHA

to MO / ANM
21
Status of ASHAs in Rajasthan
j
54915
60000
43428
50000
n Thousand
40000
Targeted
30000
Workingg
In
20000
10000
0
Targeted Working
ASHA
Source Pragati Prativedan 2011-12
DM&HS 22
No. of ASHAs - Received Training
Year Rajasthan
1st & 2ndModule
M d l 40361
3rd Module 33811
4th Module
M d l 32652
5th Module 30797
15 days
d comprehensive
h i 10851
module
6th Module
M d l 138 (till January 2012)
Source:- Pragati Prativedan, 2010-2011 & ARC
23
Supporting Mechanism for ASHA Sahyogini
ASHA
mentoring
t i
Monthly Review
State
group SPMU
Assessment of
DPMU,ICDS
(D Di
(Dy.Direc.)
) District progress
Bi Monthly
Block
BCMO,CDPO Meetings
PHC
•Periodic Trainings/
PHC,MO,AF.L Monthly Meetings
PHC •Replenishment of ASHA Kit
HV •Incentive Payment
Sub- Meetings, Reffral

ANM Records, Incentives
Center Payments
SHA,AWW,
SHA AWW Village Health
Village Survey,VHSC
VHSC
Mamber,MCHN Days 24
y of Contraceptives
Home Delivery p
¾ The GOI supplies contraceptives such as

Condom, Oral Pill and Emergency pills to states
as part of the free supply and social marketing
scheme.
scheme
Object:-
¾ To improve access to contraceptives
¾ Reduce unmet need

25
¾ The scheme implemented on a pilot basis in 233
districts in 17 states.
states (Including 19 districts of
Rajasthan).
¾ ASHA is being involved for the free supply of

contraceptives at the door step of beneficiaries.
¾ ASHA get incentives for her efforts
26
Role of ASHA
¾ Counsel all the eligible couples for contraceptive
choices
¾ Client screened by the MO/ANM before selling

OCPs
¾ Prepare a list of eligible couples of her village
¾ Mention the preferred type of contraceptive
27
¾ Regular collect stock of contraceptives
¾ Deliver contraceptives at door step of the

beneficiaries
¾ Charge the beneficiary at the approved rates as

an incentive for her efforts
28
/ /
Role of MO I/C/ANM
¾ Certify the list of eligible couples
¾ Ensure all ASHAs collect supply
¾ Verify
V if ASHAs’
ASHA ’ performance
f on a monthly
thl basis
b i
¾ Screen
S th couple
the l for
f eligibility
li ibilit for
f OCPs
OCP
29
oeo
Role of State
¾ Designate a person for manage and monitor the

scheme
¾ Orient the CMOs, ASHA & ANMs of the districts

where
h th scheme
the h i being
is b i launched
l h d
¾ IEC material displayed

p y at all PHC and sub-
centers
30
oeo
Role C Health
of PHC ea t Supe so s
Supervisors
¾ Prepare list of ASHAs
¾ Collect, Compile and prepare report
¾ Regularize the payment or incentives
¾ Facilitate with BCMO,BPM,BHS
¾ Monitoring
¾ Meeting & Training

31
/
Role of DACs/BHSs
¾ Create database of ASHAASHA.

¾ Liaise with district level stakeholders for mobilizing
support
¾ Supervision and monitoring of the ASHAs, NGOs
and Block ASHA facilitators and PHC ASHA
Supervisors.
¾ Attend ASHA meetings g at block and PHC.
¾ Prepare annual training plan of ASHA for different
rounds.
32
¾ Compilation of monthly report with the help of Data
Assistant of DPMU.
¾ Dissemination of guidelines related to ASHA to all
functionaries at different levels.
¾ Follow up with Block ASHA facilitators/ BPMs on
the progress of assigned job.
¾ Monitor timely payments of ASHAs
¾ Monitor pphysical
y and financial pprogress
g of the
component.
¾ Field visits
33
Role of DPM/BPM
¾ Develop annual plan for selection and

training for ASHA
¾ Drafting of annual targets for ASHA, CHC-

PHC (sterilization, ID & immunization)
34
¾ Support
pp District ASHA Coordinator in
developing localised implementation plans.
¾ Monitor physical and financial progress of

the component.
p
¾ Ensure adoption and implementation of

plan and fund flow at local level.
35
Collective
Collecti e Role of DAC/DPM/BHS/BPM
¾ Reporting
R ti – timely
ti l and
d properly
l
¾ Hand holding support to ASHAs
¾ Timely payments to ASHA

ASHA-Sahyogini
Sahyogini
¾ Regular monthly meetings at PHC/CHC
¾ Identification of non-performing
non performing ASHAs
36
Programmatic
g Check List
¾ Whether ASHA monthly meetings at PHC/CHC are

being organized or not
¾ Does every institution organizes it
¾ No.
N off ASHAs
ASHA are regularly
l l attending
tt di ththe meeting
ti
¾ Are ASHAs g
getting
g their incentives as p
per activities
37
Measures of Effectiveness
¾ % of newborns visited thrice in first week

including once on first day
¾ % of pregnant women who received more than

20 visits for common illnesses per month
¾ % of ASHAs who referred all ( or at least half )

their pregnant women for institutional delivery
38
Case Study
Santosh Malav, an ASHA, Namana
PHC, Bundi, registered a tribal pregnant woman
named Vimla.
Vimla Santosh knew that Vimla was
anemic and any complication may occur at the
time of delivery. At the time of delivery, Vimla
needed blood,
blood but as Namana PHC was not
having any facility of blood transfusion, doctor
referred the patient to district hospital Bundi.
39
When
Wh the
th doctors
d t asked
k d about
b t arranging
i blood,
bl d
none of the family members agreed to donate.
All were afraid to the after effects of the blood
d
donation.
ti
At that time Santosh donated blood and saved

life of Vimla.
40
SIHFW: an ISO 9001:2008 certified Institution
40
Thank You
For more details log on to

www sihfwrajasthan com
www.sihfwrajasthan.com
or
contact : Director-SIHFW on
sihfwraj@yahoo co in
sihfwraj@yahoo.co.in

ASHA Scheme

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ASHA Scheme

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Accredited Social Health Activist

State Institute of Health & Family Welfare, Jaipur

ASHA is the first port of call for any health

population especially women & children,

find it difficult to access health services.

¾ Convergence of ICDS and Health Dept.

¾ Listing of interested and eligible women by

¾ Panel of three names

¾ Approval through Gram Sabah- Community

GOI norms- 23 days and 5 phases

¾ DTT for 15 days

ASHAs started from Oct. 2009

State Training Team NIHFW

District Trainer Team (DTT) SIHFW

Block Trainers Team (BTT) DTT

ASHA-Sahyoginis BTT & NGOS

¾ ASHA mentoring group State Level

¾ PHC level monthly meetings

SIHFW: an ISO 9001:2008 certified Institution 12

Institutional 5 Deliveries per year (80% of

Social 80% beneficiaries ((ANC &

AWW Education, PHED,

¾ Selection of ASHA by prescribed process as

¾ Linkage with nearest functional health facility

¾ Identified transport for referral of cases from

¾ Monthly meeting of ASHA at PHC.

¾ Timely payment of incentives to ASHA.

¾ Timely replenishment of ASHA kit

¾ Priority and recognition of cases referred by ASHA

Source:- Pragati Prativedan, 2010-2011 & ARC

Sub- Meetings, Reffral

¾ The GOI supplies contraceptives such as

¾ To improve access to contraceptives

¾ Reduce unmet need

¾ ASHA is being involved for the free supply of

¾ ASHA get incentives for her efforts

¾ Client screened by the MO/ANM before selling

¾ Prepare a list of eligible couples of her village

¾ Mention the preferred type of contraceptive

¾ Deliver contraceptives at door step of the

¾ Charge the beneficiary at the approved rates as

¾ Certify the list of eligible couples

¾ Ensure all ASHAs collect supply

¾ Designate a person for manage and monitor the

¾ Orient the CMOs, ASHA & ANMs of the districts

¾ IEC material displayed

¾ Collect, Compile and prepare report

¾ Regularize the payment or incentives

¾ Facilitate with BCMO,BPM,BHS

¾ Meeting & Training

¾ Create database of ASHAASHA.

¾ Develop annual plan for selection and

¾ Drafting of annual targets for ASHA, CHC-

¾ Monitor physical and financial progress of

¾ Ensure adoption and implementation of

¾ Hand holding support to ASHAs

¾ Timely payments to ASHA

¾ Regular monthly meetings at PHC/CHC

¾ Whether ASHA monthly meetings at PHC/CHC are

¾ Does every institution organizes it

¾ % of newborns visited thrice in first week

¾ % of pregnant women who received more than

¾ % of ASHAs who referred all ( or at least half )