ASHA

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Accredited Social Health Activist (ASHA):

Accredited Social Health Activist (ASHA) State Institute of Health & Family Welfare, Jaipur 1 SIHFW: an ISO 900: 20081 certified Institution

ASHA:

ASHA ASHA is the first port of call for any health related demands of deprived sections of the population, especially women & children, who find it difficult to access health services. SIHFW: an ISO 9001:2008 certified Institution 2

ASHA:

ASHA Accredited Recognized by the community Social From the community, By the community and For the community. Health Activist Spreading awareness for health concerns Promoting change in health related practices 3 SIHFW: an ISO 900: 20081 certified Institution

ASHA-Sahyogini: Convergence brought in:

ASHA-Sahyogini: Convergence brought in Convergence of ICDS and Health Dept. Sahyogini as 3 rd worker at AWC already existed before NRHM To avoid Duplication- Sahyogini taken as ASHA (in Rajasthan) Nomenclature devised as ASHA-Sahyogini 4 SIHFW: an ISO 900: 20081 certified Institution

ASHA-Sahyogini: Selection :

ASHA-Sahyogini: Selection Listing of interested and eligible women by ANM and LS Panel of three names Approval through Gram Sabah- Community empowerment 5 SIHFW: an ISO 900: 20081 certified Institution

ASHA-Sahyogini: selection Eligibility :

ASHA-Sahyogini: selection Eligibility Intensive mobilization to get active ASHA- Sahyogini. Any woman can not be the ASHA-Sahyogini. Age - 21years to 45 years Qualification - 8 th 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 SIHFW: an ISO 900: 20081 certified Institution

Roles & Responsibilities:

Roles & Responsibilities Total information of the community Village Health Plan Create Awareness Coordination with AWW/TBA/ANM/MPW Counseling/Mobilization Escorts/Accompany Provision of Primary Medical Health Care Maintain Drug Kit Record and Registration 7 SIHFW: an ISO 900: 20081 certified Institution

ASHA-Sahyogini: Trainings:

ASHA-Sahyogini: Trainings Phase Days 1st 6 days 2nd 4 days 3rd 4 days 4th 5 days 5th 4 days GOI norms- 23 days and 5 phases 8 SIHFW: an ISO 900: 20081 certified Institution

PowerPoint Presentation:

4 rounds of 23 days (10+ 4+5+4 days) Presently 3 rd phase rolled out DTT for 15 days integrated training for fresh ASHAs started from Oct. 2009 9 SIHFW: an ISO 900: 20081 certified Institution

ASHA-Sahyogini : Trainings:

ASHA-Sahyogini : Trainings State Training Team District Trainer Team ( DTT) Block Trainers Team (BTT ) NIHFW SIHFW DTT ASHA- Sahyoginis BTT & NGOS 10 SIHFW: an ISO 900: 20081 certified Institution

Support structure:

Support structure ASHA mentoring group State Level ASHA Resource centre Earlier at SIHFW, now at SPMU Joint Strengthening Committee At State level- ACS/PHS/Secretaries At District level- CMHO/DD-ICDS At Block level- BCMO/ CDPO At PHC level- MO/LHV/LS/ANM 11 SIHFW: an ISO 900: 20081 certified Institution

Monitoring :

Monitoring PHC level monthly meetings Review of ASHAs work Collection and compilation of reports Incentive payments to ASHAs MCHN monitoring by external agency Monthly reports from districts SIHFW: a n ISO 9001:2008 certified Institution 12 12 SIHFW: an ISO 900: 20081 certified Institution

Monitoring indicators for ASHAs:

Monitoring indicators for ASHAs Institutional deliveries 5 Deliveries per year (80% of total deliveries should be escorted by ASHAs) Social Mobilization 80% beneficiaries (ANC & children) of the due list should be mobilized for MCHN day. Sterilization 1 case per month. SIHFW: an ISO 900: 20081 certified Institution 13

Reporting system for ASHA:

Reporting system for ASHA Form no. 6-9 :- Deliveries escorted by ASHAs NRHM formats :- No. of ASHAs, training, monthly meetings, performance, integrated package etc. CHC monitoring:- Deliveries escorted by ASHAs Sterilization motivated by ASHAs 14 SIHFW: an ISO 900: 20081 certified Institution

Integrated compensation:

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 adolescent girls 100 Total to be paid by NRHM 450 Amount to be paid by WCD after attending monthly meeting at PHC 1000 Total 1450 15 SIHFW: an ISO 900: 20081 certified Institution

Performance based compensation:

Performance based compensation Activity Amount (Rs.) JSY 400+100+100 600 Male Sterilization 200 Female Sterlization 150 DOTS 250 Cataract 175 Toilet construction 60 RT to Malaria cases 50 16 SIHFW: an ISO 900: 20081 certified Institution

Work load: ASHA (1000 Pop.):

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 have anemia New Born 27-28 Children in 0-1 Year 30 (3% of the population) Children 1-5 years 130, (13 % of Population) Eligible couples 16-17% (15-45 years) Eligible for Vasectomy/ Tubectomy 5-7% of Eligible couples Eligible for spacing Methods 11-12% of Eligible couples 17 SIHFW: an ISO 900: 20081 certified Institution

Linkages of ASHA Sahyogini:

Linkages of ASHA Sahyogini 18 SIHFW: an ISO 900: 20081 certified Institution

Palpable Impact: Increase in :

Palpable Impact: Increase in ANC registration in first trimester Institutional Deliveries – 69.4%(1207065) till March 2010-11 Immunization – full immunization- 83.2%(1368591) OPV3 : 1059759 DPT3 : 1063675 BCG : 1250107 Measles : 1048061 No. of Sterilization - 70.3% (338574) Practices Breast feeding practices Health seeking behavior Referral Community involvement –VHSC/MCHN 19 SIHFW: an ISO 900: 20081 certified Institution (Source : Pragati Prativedan , 2010-2011 & DMHS )

Factors critical to success of ASHA:

Factors critical to success of ASHA Selection of ASHA by prescribed process as per the ASHA guidelines. Linkage with nearest functional health facility for referral services. Identified transport for referral of cases from village to facility. 20 SIHFW: an ISO 900: 20081 certified Institution

PowerPoint Presentation:

Successful organization of monthly Health and Nutrition Day (in every village with the ANM / AWW) Monthly meeting of ASHA at PHC. Timely payment of incentives to ASHA. Timely replenishment of ASHA kit Priority and recognition of cases referred by ASHA to MO / ANM 21 SIHFW: an ISO 900: 20081 certified Institution

Status of ASHAs in Rajasthan on January 2012 :

Status of ASHAs in Rajasthan on January 2012 Source : SARC-Rajasthan ASHA In Thousand 22 SIHFW: an ISO 900: 20081 certified Institution

No. of ASHAs -received training :

No. of ASHAs -received training Year Rajasthan 1 st & 2 nd Module 40361 3 rd Module 33811 4 th Module 32652 5 th Module 30797 15 days comprehensive module 10851 6 th Module 138 ( till January 2012 ) Source:- Pragati Prativedan , 2010-2011 & ARC 23 SIHFW: an ISO 900: 20081 certified Institution

Supporting Mechanism for ASHA Sahyogini:

Supporting Mechanism for ASHA Sahyogini State ASHA mentoring group SPMU SHA,AWW, VHSC ANM PHC,MO,AF.LHV BCMO,CDPO DPMU,ICDS ( Dy.Direc .) Meetings, Reffral Records, Incentives Payments Periodic Trainings/ Monthly Meetings Replenishment of ASHA Kit Incentive Payment Bi Monthly Meetings Assessment of progress Monthly Review Block PHC Village Health Survey,VHSC Mamber,MCHN Days PHC Sub-Center Village District 24 SIHFW: an ISO 900: 20081 certified Institution

Home Delivery of Contraceptives:

Home Delivery of Contraceptives The GOI supplies contraceptives such as Condom, Oral Pill and Emergency pills to states as part of the free supply and social marketing scheme. Object:- To improve access to contraceptives Reduce unmet need 25 SIHFW: an ISO 900: 20081 certified Institution

PowerPoint Presentation:

The scheme implemented on a pilot basis in 233 districts in 17 states. (Including 19 districts of Rajasthan). ASHA is being involved for the free supply of contraceptives at the door step of beneficiaries. ASHA get incentives for her efforts 26 SIHFW: an ISO 900: 20081 certified Institution

Role of ASHA:

Role of ASHA Counsel all the eligible couples for contraceptive choices Client screened by the MO/ANM before selling OCPs Prepare a list of eligible couples of her village Mention the preferred type of contraceptive 27 SIHFW: an ISO 900: 20081 certified Institution

PowerPoint Presentation:

Regular collect stock of contraceptives Deliver contraceptives at door step of the beneficiaries Charge the beneficiary at the approved rates as an incentive for her efforts 28 SIHFW: an ISO 900: 20081 certified Institution

Role of MO I/C/ANM:

Role of MO I/C/ANM Certify the list of eligible couples Ensure all ASHAs collect supply Verify ASHAs’ performance on a monthly basis Screen the couple for eligibility for OCPs 29 SIHFW: an ISO 900: 20081 certified Institution

Role of State:

Role of State Designate a person for manage and monitor the scheme Orient the CMOs, ASHA & ANMs of the districts where the scheme is being launched IEC material displayed at all PHC and sub-centers 30 SIHFW: an ISO 900: 20081 certified Institution

Role of PHC Health Supervisors:

Role of PHC Health Supervisors Prepare list of ASHAs Collect, Compile and prepare report Regularize the payment or incentives Facilitate with BCMO,BPM,BHS Monitoring Meeting & Training 31 31 SIHFW: an ISO 900: 20081 certified Institution

Role of DACs/BHSs:

Role of DACs/BHSs Create database of ASHA. Liaise with district level stakeholders for mobilizing support Supervision and monitoring of the ASHAs, NGOs and Block ASHA facilitators and PHC ASHA Supervisors. Attend ASHA meetings at block and PHC. Prepare annual training plan of ASHA for different rounds. 32 SIHFW: an ISO 900: 20081 certified Institution

PowerPoint Presentation:

Compilation of monthly report with the help of Data Assistant of DPMU. Dissemination of guidelines related to ASHA to all functionaries at different levels. Follow up with Block ASHA facilitators/ BPMs on the progress of assigned job. Monitor timely payments of ASHAs Monitor physical and financial progress of the component. Field visits 33 SIHFW: an ISO 900: 20081 certified Institution

Role of DPM/BPM :

Role of DPM/BPM Develop annual plan for selection and training for ASHA Drafting of annual targets for ASHA, CHC-PHC (sterilization, ID & immunization) 34 SIHFW: an ISO 900: 20081 certified Institution

PowerPoint Presentation:

Support District ASHA Coordinator in developing localised implementation plans. Monitor physical and financial progress of the component. Ensure adoption and implementation of plan and fund flow at local level. 35 SIHFW: an ISO 900: 20081 certified Institution

Collective Role of DAC/DPM/BHS/BPM:

Collective Role of DAC/DPM/BHS/BPM Reporting – timely and properly Hand holding support to ASHAs Timely payments to ASHA-Sahyogini Regular monthly meetings at PHC/CHC Identification of non-performing ASHAs 36 SIHFW: an ISO 900: 20081 certified Institution

Programmatic Check List :

Programmatic Check List Whether ASHA monthly meetings at PHC/CHC are being organized or not Does every institution organizes it No. of ASHAs are regularly attending the meeting Are ASHAs getting their incentives as per activities 37 SIHFW: an ISO 900: 20081 certified Institution

Measures of effectiveness:

Measures of effectiveness % of newborns visited thrice in first week including once on first day % of pregnant women who received more than 20 visits for common illnesses per month % of ASHAs who referred all ( or at least half ) their pregnant women for institutional delivery 38 SIHFW: an ISO 900: 20081 certified Institution

Case Study:

Case Study Santosh Malav , an ASHA, Namana PHC, Bundi , registered a tribal pregnant woman named 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, but as Namana PHC was not having any facility of blood transfusion, doctor referred the patient to district hospital Bundi . SIHFW: an ISO 9001:2008 certified Institution 39 SIHFW: an ISO 900: 20081 certified Institution 39

PowerPoint Presentation:

When the doctors asked about arranging blood, none of the family members agreed to donate. All were afraid to the after effects of the blood donation. At that time Santosh donated blood and saved life of Vimla . SIHFW: an ISO 9001:2008 certified Institution 40 40

Thank You :

Thank You For more details log on to www. Sihfwrajasthan.com or contact : Director-SIHFW on sihfwraj@yahoo.co.in 41 SIHFW: an ISO 900: 20081 certified Institution