Asha Sharma’s scientific contributions

Maternal and child health (MCH) services have seen many changes, the recent one being introduction of a trained female community health activist under NRHM - 'ASHA' (i.e. Accredited Social Health Activist) to actas a link worker in MCH programmes. But any programme, no matter how relevant its components are, is likely to fail unless it succeeds in improving the coverage, knowledge and imparting satisfaction to its clients. Literature and anecdotes reported a mismatch between the people's need and the services delivered. People have a right to be involved in the decision making. Clients' (beneficiaries') perception and satisfaction will help to understand the gaps and adopting a bottom-up approach i.e. the understanding of the ground realities from the mothers so as to throw light on quality, need and sustainability of the MCH-related programmes. In this descriptive study conducted in Delhi from September to December 2012 to analyse MCH services in Delhi in terms of beneficiaries' awareness, coverage and satisfaction, a multi stage sampling technique was used and a sample size of 1000 beneficiaries was selected randomly from the list of mothers obtained from the conveniently selected Primary Health Centre. Data were analysed by descriptive and inferential statistics in SPSS. The study findings showed that 92.65 percent mothers received their first ante-natal check-up in the first trimester but 48.3 percent of mothers only received three ante natal check-ups. Home visits were found to be performed by health worker both in ante natal and post natal period during 3rd month of pregnancy and within 6 week after delivery. Among the health workers who visited beneficiaries, ASHA visited mothers the most during ante natal and post-natal period and ANM visited less during ante-natal period and somewhat nil (0.1%) within first 6 weeks after delivery (post-natal). Also, 99.6percent of mothers received IFA tablets and there was 100 percent coverage of TT immunisation. Most deliveries (96%) were indicated to be institutional and 40 mothers (4%) delivered at home. The reason for home delivery was that they did not feel institutional delivery as necessary; 92.2 percent mothers were given breastfeeding within first two hours of delivery; 99.6 percent of mothers were aware about various components of MCH services and the major source of information regarding MCH services was found to be ASHA followed by ANM. Majority of beneficiaries (86%) were found to be fully satisfied with the MCH services and there was no rating below average satisfaction. No significant difference in satisfaction based on their age & educational qualification was observed; however significant difference was observed in the satisfaction based on the number of children as the mothers with more than one child were more satisfied than mothers with one child which may be due to high expectations level of mothers during first child birth than the second.

The impact of NRHM and the ASHA would be meaningful when the individual ASHAs who are chosen and trained perform as an effective link worker for better use of health facilities, and basic health services. The key selection criteria such as education level, representativeness of the local community, adequate knowledge and preparedness to perform effectively are also found (1) to be extremely critical for sustainability and retention. Large number of urban areas have been completely left out or poorly targeted due to lack of sensitization among service providers and a sense of apathy towards urban poor by considering them as an "unnecessary intrusion" into the city. ASHA being a local women selected by the community is considered suitable for serving the urban population also. However not much studies were done to explore the performance, and knowledge of ASHA workers in an urban setting. Therefore the present study aimed to assess awareness of ASHAs on MCH care & Services in Delhi state and to find the association of knowledge with specific demographic variables.