ASHAS' AWARENESS & PERCEPTIONS ABOUT THEIR ROLES & RESPONSIBILITIES : A STUDY FROM RURAL WARDHA

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Origindl Arti'\z
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ASHAS'AWARENESS & PERCEPTIONS ABOUT THEIR ROLES
& RESPONSIBILITIES : A STUDY FROM RURAL WARDHA
sv cosAyl*, AV RAUT'**, PR.DESHMSK11**+, AM MEHENDALEa+'*, BS GARGT+*+i
ABSTR.ACT
Iattoiluction I The National Rural Hcalth Mission (NRHM) was launched on l2th April 2005; one
of the key componerrts of the NRHM is to prwide cvery village in thc country with a trained female
community health activist - Accredited Social Health Activist (ASHA). ASHA is a health activist in
the community, who will create awarcness on health and its dctcrminants and mobilize the
community torards local hcalth planning and incrcased utilization and accountability of the o<ist-
ing hcalth services.
objectig. : to study tlrc a$areness and perceptions of ASHA regrrding their rolc in health care
provisiou & to study thc problcms faccd by ASHA'
studl Ar?d lt Methodolog ., The study was undertaken in selected villages of Primary Health
Certlc, Anji, district Wardha in Maharashtra. P"tpotio sampling mahod was adopted' 7 indepth
intcrvis$,s carried out before saturatiou of rcspoDs€s ohE6eed. sa'q4 prA : I Nov 2009 to 3r Dec 2009.
ASHA were aware about their responsibility rcgarding ANC, immuDlzatlon
malaria, high risk pregnancy but nonc of thc ASHA r+ere having specific
ulc of immuoization, hov, to dctect TB & leprosy cases. Aloost all were aware
l
Introduction
the NRHM focuscs on reducing the maternal & chitd mortality & morbidity,
infrastructures & up gradation of services. We found out that the public
not successful in generating awarcness and creating a cadre of functional
foro of ASHA. ANC services at t}le village leral nrerc affected becausc of
ASHA in village hcalth & nutrition day (VHND) & because of lack of
fiealth care prwision
Since thb the community health variations anddefinitions of this term. Globally,
they are.called by a variety of names including
Health Auxiliaries, Barefoot Doctors, Health
Agents, Health Promoters, Family Welfare
Educators, Health Volunteers, VillaS€ H€alth
Workers, Community Health Aides, Community
Health Volunteers and Community Health
work€r
co
+- Post
the Alma Ata
been several
!t prcf, *++ prcf.,
. Dr. Sushila
Dept. of
Crmm. DisL Wadha (MS).
33
J MCIM$ Mareh 2O11, Vol 16, No@' )i ' 38
:
1,,',
:ti_1 ,
i:.
itha! r1,cy iolllit :bc gAting performance based iacentive but none of them were aware about how
, muchdacentiv& they will o<actly ga while doing that panicular rvork. Challenges faced by most of
, mg49H4lygS{ask of supPort from PHC staff, the lack of good training, unclcar reimbursement
, P9try.*eP.Lftarity in ho$' to collaborate work with thc ANM and Anganwadi worker'

ASHAS' Auarcacss tl P.tccp,io,Lt db 'hch mbs tl Rcspodsibilitits : A Studl lton rurd Wardha
Workers. With the varying demands and
differing levels of health within countries,
regions, districts, and villages, each community
has its own vLrsion of the community health
worker.
According to WHO, 'CHWs are men and
wom'en chosen by ihe community, and trained to
deal with the health problems of individuals and
the community, and to r,vork in close relationshiP
with the health services. They should have had a
level of primary education that enables to read,
write and do simple mathematical calculations'
(wHo 1990).'
Witmer et al (1995) define community
health workers as "Community members who
work almost exclusively in community settings
aod who serve as connectors between health care
consumers and providers to promote health
among groups that have traditionally lacked
acress to adequate care. By identifying community
pmblems, developing innovative solutions, and
translating them into practice, community health
workers can respond creatively to local needs".z
The National Rural Health Mission
(NRHM) was launched on l2'h April 2005 with
an objective to provide effective health care to the
rural population with emphasis on Poor women
& children. One of the key components of the
NRHM is to provide every village in the country
with a trained female community health activist
i.e. Accredited Social Health Activist (ASHA)'
ASHA is a health activist in the community, who
will create auarentiss on.health and is determinans
and mobilize the community tcnrards local health
planning and increased utilization and account-
ability of the existing health services. The ASHA
is o<peced to be an interhce betnren the commrnity
and the public health system. NRHM is envisaged
as a horizontal program with emphasis on
initiatives and planning at local level.sr ASHA
being the grass root level worker the success of
NRHM depends on how efficiently is ASHA
able to perform but the efficiency of ASHA or
efficiency of performance of ASHA depends on
their awareness & perception about their roles
& responsibilities in health care prwision. Hence,
this study was conduaed with follor,rdng objective.
Objective :
l. To study the awareness and perceptions of
ASHA regarding their role in health care
provision
2. To study the pmblems faced by ASHA
Methodology r
Stuitl orri: The study was undertaken in
selected villages of Primary Health Centre, Anji
of district Wardha in Maharashtra. There are 28
villages undgr the Primary Health Centre, Anji'
Based on the population of the respective
villages and the norm of selecting an ASHA for
appro:<imately 1000 population, 67 ASHA have
been selected in these 28 villages. Some of these
ASHA had undergone the initial induction
training of ? days while the others were due for
the training from the District health system'
Information on this was sought from thq Primary
health centre Anji and only those villages'
Wherein the ASHA had undergone the induction
training was purposioely selected f6r the study
purPose.
Methodology and samPle,size :
Purposive samplini method was adopted'
We carried out indePth interviews among such
puposfuely sebcteit ASHA till redundancy in
respons€s started creeping up. In all, 7 indepth
34
J MCIMS, Manh 2011, Vot 16, No (i), 33 ' )8

I. AWARENESS:
Tdbtc 1. AWARENESS OFdSIT{ ABOUT THEIR ROLE {, RESPO'IVS/SILITIES
interviews were carried out before saturation of
resPonses was observed'
Data collection :
A written informed consent was taken
from the ASHA; average time required for each
indepth interview was approximately I hour &
45 min, data collection was done by investigator
himself. A semi-structured schedule with oPen
Most of the ASHA's were not aware
about Village Health Nutrition and Sanitation
Committee ryHNSC), some had heard about
it but they also did not know regarding the
compositi'on, functions of VHNSC and what
exact role the VHNSC was orpected to play in
making the Village health plan, also all the
ASHA were not able to explain their role in
making such a Village health plan which is
amongst one ,of the key furrctions of ASHA.
Almost all wer€ aware that they would
be getting gefformance based incentive but none
of them vere aware about how much incentives
ended questions was used for data collection
Process.
Stuily perioil : I Nor, 2009 to 3l Dec 2009
Results :
I. AWARENESS
2. PERCEIVED ROLLS OR RESPONSIBILITIES
3. CHALLENGES FACED BY ASHA:
they will eractly get while doing that Particular
work. After probing on this most of ASHA told
that-
"qr€ iFi{ qd qrlq<r r<<a fa-qrre .riHiTI trIElcII
{iq'qrd qra rrr* orq fir Iffin i-sr i-sr ror or"
Most of the ASHA said that they repeatedly
asked about their incentives in their training but
trainer told that, first you do your work & don't
focus on only money.
Sonc ASHA told tha,
"rff Hro-d dft-rt al qrlfiI T(F qq qr ffi
cur dt'ff q<r rdr qqfurd {R6 Rd nrfi"
ASHA 7
ASHA6
ASHA 3ASHA4
ASHA 2
ASHA 1
AWARENESS
MEANINGOFASHA
NRHM
VILLAGEHEALTH PLAN
INCENTIVES
IMMUNIZAT1ON
H!3H RISKPREGNAT.ICY
IMIEGRATEDCOUNSELII.IG
&rESil'rGCENTRE(|CTC)
35
J MCIMS, Morch 2011, Vol 16' No G)' 11 ' 18
SV Gosa.i A ct al
ASHA 5.
TUBERCULOSIS, LEPROSY
& MAL€RIA
HIV / AIDS

ASHAS' Atnrcncss ti Peftcptiont aboltt ,h.ir mhs A ResPctrsibililits : A Stu"dl from ruml Wardho
clarity in how to collaborate work with thr
ANM and Anganwadi worker. Medical
officer, ANM considered ASHA as their
subordinate and did not understand the
problems faced by ASHA, they also failed to
give them proper guidance and mutual
respect and love. The ASHA complained
regarding the lack of recognition and prioriry
treatment of cases referred by them to MO/
ANM.
Discussion :
WHAT DO WE ALREADY KNOW
ABOUT VILLAGE HEALTH WORKER IN
INDIA?
Follo,r,ing repora of, srcessfr:l oeeriments
in the nongoremrrrental sector with the community
health workers (CHWsI the Indian government
introduced a CHW Scheme across the country
in 1977 envisaging "provisioq of health services
at the doorsteps of villager'l (Chatterjee 1993,
Maru t983).5
2. PERqEWED ROLES OR RESPONSIBILI.
TIES :
Most of. the A,SIIA's petceipe their duties to
inclu.ilc:
) Assisting wombn for Immunization &
supplementary nutrition,
I Counseling her on eating nutritious
food, maintaining clean.liness
> Some gave information on provide escort
to pregnant uomen for delivery in hocpital
> Referred TB, Leprosy, malaria to PHC
But the primary role of registration &
encouraging the women for availing institu-
tional delivery. was largely missed by the
ASHA.
3. CTIALLENGES FACED EV ASIIA:
Challenges faced by most of the ASHA
were lack of support from PHC staff, no
comperuationforservicesAherthaninstitutbnal
delivery unclear reimbursement policydela,red
payments, poor confidence in their own
ability to carry out the desired work which
reflected on the lack of good training & poor
J MCIMS, March 2oll, Vol 16, No (i), B . 38
Some ASIIA told that, they had asked to
Medical Officer repeatedly about their incentives
but Medical Officer did not give detailed and
)
proper information regarding incentives.
Most of the ASHA were aware about their
.responsibility regarding immunization but none
of them explain what are the signs of high risk
pregnancy & none of the ASHA were-o<plained
how to detect case of tuberculosis, leprosy, malaria.
Most of the ASHA were aware about the
HIV,/AIDS & how it is transmitted but pone of
&e ASHA knew about the integrated counselihg
& testing centre (ICTC).
However, the names of the worker and the
scheme changed over time - from CHW in l9?7
to Community Hedlth Volunteer in 1980 and
Village Health Guides in 1981.
The Village Health Guide (VHG) Scheme
was made I00% centrally sponsord under the
Family Welfare Program till April 2002
The Village Health Guide (VHG) Scheme
was made 100% centrally sponsored under the
Family Welfare Program until April 2002. In
2000-2001, a very high ler"el reviewcommittee was
established to study in delails the entire scheme.
The review committee looked at the r,or*' done
by CHWs, their abilities and honorarium and
sustainability issues. Bard on this study recom-
mendation, the goremment of India comrnunirated
36