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A study on assessment of ASHA’s work profile in the context of Udupi Taluk, Karnataka, India
Abstract
Accredited social health activist (ASHA) workers and their activity are considered as the one of the key component of National Health Mission (NHM). ASHA workers serves as an important link between community and the health facilities.
Objective
To assess the knowledge and practice of ASHA workers regarding their roles and responsibilities and to study the challenges faced by them.
Method
A cross sectional study was conducted in health care centers of Udupi Taluka, Karnataka with 100 ASHA workers for Quantitative and 10 for Qualitative.
Result
The study revealed that the knowledge of the ASHA workers on ANC and PNC (82%) is considerably higher than the knowledge on Family planning (71%), Child health (65%) and General health (67%). 80% had expressed their dissatisfaction towards incentives and other working conditions
Conclusion
The overall knowledge of ASHA workers was sufficient in the field of MCH but there is a need for mitigation of few key challenges, which would significantly contribute to improvement of ASHA’s work profile.
... The findings of the present study are also supported by another study conducted by Swathi S, Sumit K, Sameer P (2018) 12 on, "A study on assessment of ASHA's work profile in context of Uduppi Taluk, Karnataka, India among 100 ASHA workers". The study revealed that 97% of the ASHA workers reported that they were informing the concerned about births and deaths in their respective villages. ...
Introduction: The study was conducted to assess the knowledge and practice levels of ASHAworkers regarding services provided under the National Health Mission (NHM). These levels were further correlated to know whether they are related or not. It aimed at providing deficient information to ASHA workers, and at motivating them to sustain their efforts for adequate practice. Methods: A non-experimental descriptive (correlative) research design was used. 60 ASHA workers were selected from the accessible population using convenient sampling technique. The prepared tools (self-structured knowledge questionnaire and practice checklist) and Information Booklet were validated by a panel of experts, and were pre-tested for clarity and feasibility. A pilot study was conducted on 10% of ASHA workers. The main study was conducted from 9th September 2020 to 20th September 2020. The data collected was analysed by using descriptive and inferential statistics. Result: The study revealed that majority of the ASHA workers had average knowledge and adequate practice regarding services provided under NHM. There was a significant association of their knowledge scores regarding services provided under NHM with their educational status. No significant association was found between their practice scores and their demographic variables. A moderately strong positive correlation was found between their knowledge and practice regarding services provided under NHM. Conclusion: The findings of the study concluded that ASHA workers working in Primary Health Centres of Tangmarg, Baramulla had average knowledge and adequate practice regarding services provided under NHM. However, some components need to be focused on.
The National Health Mission (NHM) was launched in India in 2005 to improve population health by restructuring the health system and enhancing primary care. After nearly 20 years, it is essential to review its impact on the health system. This scoping review is the first of its kind which aimed to review and synthesize research on the effects of the NHM on human resources for health and governance, and its overall impact on the health system. We identified 46 research articles, 19 (41%) on human resources for health, 17 (37%) on governance, and 14 (30%) studying the overall impact. Most of the research on human resources was focused on the ASHA program and RKS and VHSNC dominated governance research. Maternal and child health studies dominated the health system impact literature. Outcomes show a partial achievement of the NHM's goals. Health workforce supplementation has improved access to healthcare in rural areas but remains inadequate to rising demand. Similarly, decentralization mechanisms have improved accountability, however, more community empowerment is needed. Healthcare demand has staggered to primary care facilities and improvements in some population health indicators have been observed, but social inequities and poor care quality remain. Further research and policy initiatives are needed to address several issues such as rational resource deployment, career progression for contractually hired care providers and ASHA, building health awareness at the grassroots for better community representation, and increased attention to non‐communicable diseases, mental health, and the impacts of aging and climate change.
Aim
To explore the Quality of life among the community health workers and its association with the socio-demographic variables.
Subject and methods
A cross-sectional study was conducted among 739 Community Health Workers (CHWs), where a multistage random sampling technique was used and three districts were selected based on the proportion of Accredited Social Health Activist (ASHA) in the districts of Karnataka. “WHOQOL-BREF” was used along with a Sociodemographic profile to determine the Quality of Life (QoL) among the CHWs. Multivariate regression models, T-test and ANOVA tests were used for the analysis.
Results
The overall Quality of life mean ± SD was 3.4 ± 0.95. Domain-wise social relationship was found to be highest with a mean ± SD of 66.5 ± 21.7 and Environmental domain was found to be the least with a mean ± SD of 48.6 ± 16.6. The Multivariate regression models reveal that education up to primary level, an individual income of INR 5000 and more, and family income of INR 15000 to 40000 contribute to the higher score, whereas total family members of 5–8, age 25 to 44, and education of secondary schooling, PUC/diploma contribute to the lower scores of QoL.
Conclusion
The results of the study showed that CHWs had neither good nor bad quality of life. And there is a need to improve physical and environmental factors such as job satisfaction, population coverage, better income, physical safety, good working environment, better transportation facilities which can improve the QoL among CHWs.
Introduction
Accredited Social Health Activist (ASHA) workers and their activities are regarded as a critical component linking the community and health-care facilities. They are the cornerstone of the Indian public health-care system responsible for spreading awareness and recommending preventive measures in the community. This study aims to assess the awareness, writing skills, and practical-based performance of the ASHA workers in urban and rural Karnataka.
Materials and Methods
A cross-sectional study was conducted among ASHA workers in rural and urban Mysore district. A multistage sampling technique was adopted for selecting the participants. The ASHA workers were asked to fill out a pretested semi-structured questionnaire. An unpaired t -test was used for inferential statistics. P < 0.05 was considered statistically significant.
Results
The mean age of the workers in urban areas was 36.38 ± 5.877 years, while in rural, it was 41.53 ± 6.755 years. The overall average score for rural ASHA workers was more (70.49 ± 14.018) when compared to the urban ASHAs (65 ± 13.400). The average years of experience were 6.14 ± 1.44 years in urban and 10.5 ± 2.66 years in rural areas. The daily working hours ranged from 3 to 10 h in urban and 2 to 10 h among rural ASHA workers.
Conclusion
The overall score of rural ASHA workers was higher when compared to urban ASHAs. Even though the grading and performance of the ASHA workers were good, their expertise in identifying and tackling life-threatening conditions remains inadequate. This can be improved with more vigilant and periodic training and monitoring along with periodic recruitment at regular intervals.
Objectives
To explore perceptions of healthcare providers and mothers of children with severe wasting on the perceived reasons for severe wasting, constraints on the management and barriers to caregiving and care-seeking practices.
Design
In-depth qualitative interviews conducted with healthcare providers and mothers of children with severe wasting.
Setting
Urban and rural locations in Karnataka state, India.
Participants
Healthcare providers (anganwadi workers, accredited social health activists, auxiliary nurse midwives, junior health assistant, medical officers, nutrition counsellors) from public healthcare centres and mothers of children with severe wasting.
Results
Forty-seven participants (27 healthcare providers, 20 mothers) were interviewed. Poverty of households emerged as the underlying systemic factor across all themes that interfered with sustained uptake of any intervention to address severe wasting. Confusion of ‘thinness’ and shortness of stature as hereditary factors appeared to normalise the condition of wasting. Management of this severe condition emerged as an interdependent phenomenon starting at the home level coupled with sociocultural factors to community intervention services with its supplemental nutrition programme and clinical monitoring with therapeutic interventions through an institutional stay at specialist referral centres. A single-pronged malnutrition alleviation strategy fails due to the complexity of the ground-level problems, as made apparent through respondents’ lived experiences. Social stigma, trust issues between caregivers and care-seekers and varying needs and priorities as well as overburdened frontline workers create challenges in communication and effectiveness of services resulting in perpetuation of severe wasting.
Conclusions
To ensure a continuum of care in children with severe wasting, economic and household constraints, coordinated policies across the multidimensional determinants of severe wasting need to be addressed. Context-specific interventions are necessary to bridge communication gaps between healthcare providers and caregivers.
Background:
Accredited social health activist (ASHA) workers act as a "bridge" between rural people and health service outlets and play a central role in achieving national health and population policy goals. According to the National Family Health Survey (NFHS) V (2019-2021) data, infant mortality rate (IMR) is still high in rural areas (32.4 per 1000 live births) in Punjab, compared to urban areas (20.1). Maternal mortality ratio (MMR) is also high (129 per lakh), according to sample registration system (SRS) 2016-2018 data.
Materials and methods:
In this descriptive, cross-sectional study conducted at RHTC, Bhadson, we assessed the knowledge of ASHA workers regarding maternal and child health (MCH) services and their provision by them to their beneficiaries (mothers with children aged 0-6 months). Out of the total 196 ASHA workers, 72 were selected randomly to assess their knowledge, while 100 beneficiary mothers were interviewed face to face to assess the services provided by the ASHA workers.
Results:
Almost 65.2% of ASHA workers were above 35 years of age. Majority of the ASHA workers (40/72) replied that average weight gain in pregnancy is 10 kg. Very few, that is, 17 (23.6%), ASHA workers knew that breastfeeding should be started within the first hour after delivery of the baby. Counseling regarding nutrition, birth preparedness, institutional delivery, and birth registration was given by ASHA workers to 75%-85% of mothers. There was statistically significant improvement in the practices by mothers with the counseling given by ASHA workers regarding pre-lacteal feed, utilization of family planning methods, and delaying early bathing.
Conclusions:
The study concludes that ASHA workers have good knowledge regarding various aspects of antenatal period, but when it comes to postnatal period and care of the newborn, there are some lacunae. These aspects of newborn care need to be reinforced into the refresher trainings of the ASHA workers.
Background:
Community health workers (CHW) contribute to achieving health targets of the Sustainable Development Goals (SDG) and Universal Health Care (UHC) in low- and middle-income countries (LMICs). In India, accredited social health activists (ASHAs) function as health facilitators, service providers, and programme supporters for rural and tribal communities and are at the frontline during the COVID-19 pandemic. We aimed to describe the ASHAs' work roles both before and during the COVID-19 pandemic, explore the tasks ASHAs performed throughout the pandemic, and understand its effects on the evolving role of ASHAs.
Methods:
We used qualitative data from a pre-COVID-19 study conducted in 2018-2019 including face-to-face interviews with purposively sampled ASHAs and their health care supervisors (n = 18) from rural Maharashtra state (India), and a follow-up study during the COVID-19 pandemic using telephonic interviews with a subset of participants from the pre-COVID-study (n = 8). Data were analysed thematically using MAXQDA v11.00.
Results:
The primary theme in the pre-COVID-19 study was ASHAs' role as described above, except as social health activists, linking beneficiaries to the local maternal and child health care services, distributing medicines for common illnesses, access to government schemes, and engaging in multiple health surveys. During the pandemic, raising awareness, screening of at-risk populations, arranging referrals, providing treatment and follow-up to COVID-19 patients, and supporting their family members. These activities increased the workload and health risks to ASHAs and their family, causing stress and tension among them. However, they had effectively carried out the new duties. ASHAs have improved their status, earning praise from families, society, and the government. They were honoured with the Global Health Leaders Award at the 75th World Health Assembly.
Conclusion:
ASHAs' contribution to the health system improved the indicators related to maternal and child health during the pre-COVID-19 pandemic. Additionally, they maintained frontline health care during the COVID-19 pandemic, demonstrating resilience despite the challenges of increased workload and stress. However, the COVID-19 pandemic highlights the need to respond to and understand the implications of ASHAs' evolving roles.
Objective:
Due to constraints in the dedicated health work force, outbreaks in peri-urban slums are often reported late. This study explores the feasibility of deploying Accredited Social Health Activists (ASHAs) in outbreak investigation and understand the extent to which this activity gives a balanced platform to fulfil their roles during public health emergencies to reduce its impact and improve mitigation measures.
Methods:
Activities of ASHAs involved in the hepatitis E outbreak were reviewed from various registers maintained at the subcenter. Also, various challenges perceived by ASHAs were explored through focus group discussion (FGD). During March to May 2019, 13 ASHAs involved in the hepatitis outbreak investigation and control efforts in a peri-urban slum of Nagpur with population of around 9000. In total, 192 suspected hepatitis E cases reported.
Results:
During the outbreak, ASHAs performed multiple roles comprising house-to-house search of suspected cases, escorting suspects to confirm diagnosis and referral, community mobilization for out-reach investigation camps, risk communication to vulnerable, etc. During the activity, ASHAs faced challenges such as constraints in the logistics, compromise in other health-related activities, and challenges in sustaining behavior of the community.
Conclusions:
It is feasible to implement the investigation of outbreaks through ASHAs. Despite challenges, they are willing to participate in these activities as it gave them an opportunity to fulfil the role as an activist, link worker, as well as a community interface.
The Accredited Social Health Activist (ASHA) programme has proven to be cost-effective and successful in addressing the growing shortage of health workers and reaching the vulnerable. ASHA’s contribution towards the improvement in maternal and child health and other health programmes at the community level is reported and acknowledged widely in literature. However, nearly 16 years into the introduction of ASHA, challenges in terms of workload, fatigue, poor work–life balance and low levels of compensation have emerged.
Aim
To assess the workload on ASHAs, impact of their responsibilities on their quality of life and the potential for structured task sharing/shifting among other healthcare workers.
Methodology
The study used a mixed-method approach with data and source triangulation. A multi-stage random sampling method was used to collect the data. Qualitative research was carried out to explore ASHAs’ and stakeholders’ perspectives, and a thematic analysis was undertaken using NVivo-12. ASHAs’ quality of life was also measured using the World Health Organization Quality of Life (WHO QOL)-BREF. The study was carried out in three districts of Karnataka: Mysuru, Raichur and Koppala.
Results
The majority of ASHAs reported that they experience work burden in terms of population coverage, extended hours of work and additional tasks. Lack of access to transportation, inadequate support from other healthcare personnel and delayed payment of incentives add to them often feeling overworked and underpaid. The research also elicited perspectives on ASHAs’ work from different stakeholders. Findings from the study emphasise the necessity for sharing/shifting of selected tasks among other frontline health workers based on complexity and capabilities.
Aim and objectives:
To assess the factors and perception of various stakeholders on the integration of oral health into the national health schemes using a mixed-method research design.
Materials and method:
A mixed-method study was carried out in 2018 in two phases. In the first phase of the study, a pretested and prevalidated self-designed close-ended questionnaire was used to assess the knowledge, attitude, perception, barriers, myths, and feasibility of the integration of oral health in national health schemes. This questionnaire was administered to 96 stakeholders consisting of a medical officer (MO), accredited social health activists (ASHA), auxiliary nurse midwifery (ANM), and dental surgeon in nine Delhi Government dispensaries. The questionnaire consisted of 42 close-ended questions and four open-ended questions. The domains and themes were identified along with the challenges and opportunities of integration for focus group discussion (FGD) after analyzing the results of the first phase. The FGD consisted of seven members representing each of the above stakeholders along with one moderator and one recorder.
Results:
88.3% of the ASHA workers and 85.7% of the ANM accepted that oral screening should be incorporated in their routine practice. The major barrier to the incorporation of oral health in general health was the lack of training and insufficient provision of monetary incentives. Job burnout, work situation, inadequate pay, opportunities, workload, and limited carrier development were the demotivators, whereas respect, goodwill, and recognition from the general public were the inducers.
Conclusion:
There was a strong agreement for National Oral Health schemes to be given space and priority in India. The majority agreed that they can be used as a medium for imparting oral health education. The majority of the stakeholders believed that oral health should be a part of general health and they are open to any scheme or program which would add an oral health component.
Introduction-Currently Government of India is providing comprehensive integrated health care to the rural people under the umbrella of National Rural Health Mission (NRHM). A village level community health worker " Accredited Social Health Activist " (ASHA)' acts as an interface between the community and the public health system. Therefore present study was conducted to access the socio-demographic profile of ASHA workers and to assess the knowledge, awareness and practice of their responsibilities.
Introduction: The role of Accredited Social Health Activist (ASHA) workers is vital in public health delivery system in India. The study was planned with objective to assess the socio-demographic profile of ASHA workers, awareness and practices of their roles and responsibilities and difficulties faced while working in north-east district of Delhi, India. Materials and methods: A descriptive cross sectional study was conducted in north east district of Delhi among 55 ASHA workers after taking written informed consent. Data was collected using a pre tested semi-structured questionnaire consisted of items on socio-demographic profile of ASHA workers, knowledge and practices about their roles and responsibilities and difficulties faced in community. The data was analyzed by using SPSS software version 17. Qualitative data was expressed in percentages and quantitative data was expressed in mean + SD. Results: Mean age (+SD) of ASHAs was 31.84 + 7.2 years. Most of them were married (96.4%), Hindu (85.5%) and were catering to a population of 1000-2000 (87.3%). Most of the ASHA workers were aware of their work of maternal and child health services. However lesser numbers were aware of their role in registration of births and deaths and to treat minor ailments. 96.4% reported that they maintain family planning register, only 51 (92.7%) reported that they maintain antenatal register. 10 (18.2%) ASHAs reported that they face problems in coordination with Auxiliary Nurse Midwife (ANMs). Conclusion: ASHAs performance is impacted by their limited orientation towards their roles and responsibilities. Training should provide complete knowledge about the same.
Background
Community health workers (CHWs) form a vital link between the community and the health department in several countries. In India, since 2005 this role is largely being played by Accredited Social Health Activists (ASHAs), who are village-level female workers. Though ASHAs primarily work for the health department, in a model being tested in Rajasthan they support two government departments. Focusing on the ASHA in this new role as a link worker between two departments, this paper examines factors associated with her work performance from a multi-stakeholder perspective.
Design
The study was done in 16 villages from two administrative blocks of Udaipur district in Rajasthan. The findings are based on 63 in-depth interviews with ASHAs, their co-workers and representatives from the two departments. The interviews were conducted using interview guides. An inductive approach with open coding was used for manual data analysis.
Results
This study shows that an ASHA's motivation and performance are affected by a variety of factors that emerge from the complex context in which she works. These include various personal (e.g. education), professional (e.g. training, job security), and organisational (e.g. infrastructure) factors along with others that emerge from external work environment. The participants suggested various ways to address these challenges.
Conclusion
In order to improve the performance of ASHAs, apart from taking corrective actions at the professional and organisational front on a priority basis, it is equally essential to promote cordial work relationships amongst ASHAs and other community-level workers from the two departments. This will also have a positive impact on community health.
Background: National Rural Health Mission started in the state of Uttarakhand with the objective to address the health needs of rural population, especially the vulnerable section of the society. Under this scheme, ASHA has been identified as one of the key strategy for wider coverage of services, considering her the first port of call for any health related demands, especially women and children. Objective: To find out the biosocial profile of ASHA and services provided by them. Material & Methods: A descriptive study was conducted in Imlikhera Block of Haridwar district in 2008 participated by all (150) ASHA. Data was collected by trained investigators of Rural Development Institute which is also a State ASHA resource Centre. Results: Maximum (42%) ASHA were in 26-30 Years of age group. However, 23% ASHA were in less than 25 years of age which is below than the stipulated selection criteria. About 6.3% ASHAs were not fulfilling the educational criteria of selection (education upto 8th class). Study reported that majority of ASHA consider care of pregnant women, vaccination and family planning as their prime services. 42% ASHA reported that they think this work can pave their ways for future employment. Conclusion: Supervisory body should see that selection of ASHA should be as per stipulated criteria and they should be sensitized about their major role of motivator & activist, for creating awareness and demand generation in the society.
Background: The Government of India launched the National Rural Health Mission on 5th April 2005. A new band of community based functionaries, named as Accredited Social Health Activist (ASHA) was proposed to escort and transport the client to reach the hospital and provide referral services in case of complications. A time to time assessment of the knowledge of ASHAs is essential as the success of government's health programmes in rural areas depends on them and hence the present study was undertaken. Material and Methods: This cross sectional study was conducted in the Barai block rural area of Gwalior district and 88 ASHAs were included in the study as per the eligibility criteria. Results: 88.6% & 85.2% of ASHAs responded for abdominal pain & bleeding respectively as complications during pregnancy and 88.6% and 85.20% ASHAs responded for obstructed labor and excessive bleeding as complications during delivery.73.8% ASHAs responded for antenatal care counseling followed by family planning (70.4%). Conclusion: There is a need to revise and update the knowledge of ASHA workers from time to time. On the job trainings of the ASHAs should be in process to develop necessary knowledge and skills with recent updates. The block level meetings should be utilized for the feedback, enhancing knowledge & solving the problem faced by the ASHAs.
Background: The discourse on the ASHA’s role centres around three typologies - ASHA as an activist, ASHA as a link worker or facilitator, and ASHA as a community level health care provider. She will counsel women on birth preparedness, importance of safe delivery, breastfeeding and complementary feeding, immunization, contraception and prevention of common infections including reproductive tract infection/sexually transmitted infection (RTIs/STIs) and care of the young child. Hence this study was conducted to evaluate the knowledge of antenatal and postnatal care of ASHA workers. Methods: A cross sectional study was done on 132 ASHA workers selected from 5 random PHCs in Bijapur taluk. Data was collected in a prestructured proforma using interview technique from June to October, 2012. Results: Most of the ASHA (68.1%) considered minimum of 3 postnatal visits after the normal vaginal delivery. Around 73.4% were aware that the new born child is to be wrapped up in the cloth soon after birth to prevent hypothermia. Majority (735.%) were aware about the duration of exclusive breastfeeding to be practiced by the lactating mother. 69.7% of the respondents said the duration of breastfeeding should be between 18-24 months. Conclusions: Self-explanatory, specific financial guidelines should be made available within time to the programme managers. Under the cascade model of training to the ASHA, trainings should provide complete knowledge and skills to the trainees within the stipulated time. Quality of training should be enhanced and refresher trainings should be planned regularly.
Full Length Research Article Assessment of Knowledge of Accredited Social Health Activists (ASHA)
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