Supporting ASHAs for better primary healthcare
World Health Organization’s Global Health Leaders Award 2022 for Accredited Social Health Activists (ASHAs) for COVID-19 work is the most significant international recognition ever and a proud moment for ASHAs. Given that ASHAs are a strong link between communities and the primary health system, I wish that such recognition will also result in an increased focus on enhancing their capacity building, and incentives to further health outcomes.
ASHA is a community health worker instituted by the Ministry of Health and Family Welfare as part of India’s National Rural Health Mission in 2005. The idea behind having ‘one ASHA per 1000 population’ is to better connect low-income communities to the comprehensive primary healthcare system. ASHA must be a female and a resident of the village they have been selected to serve. She must have completed at least 8th standard schooling and is preferably in the age group of 25-45 with basic leadership & communication skills. They are selected by and are accountable to the gram panchayat.
Role of ASHA in Providing Comprehensive Primary Healthcare Services
An ASHA worker’s key role is to provide outreach, mobilization & counselling services, along with escorting pregnant women, children & elderly persons to the nearest health facility and helping the community in accessing health and health-related services at Aganwadi Centres, Sub-Centres, and Primary Healthcare Centres. Their role also includes follow-up visits to expecting mothers or patients’ homes to ensure the continuity and quality of care.
All of these activities are aimed at enabling the communities to access the 12 comprehensive primary healthcare services listed in the national health mission.
Learnings from working with ASHAs during the pandemic
In line with our COVID-19 response, after the initial support in providing medical infrastructure, including the necessary equipment for the primary healthcare system, to combat the pandemic, we partnered with District Medical & Health Office (Srikakulam, Andhra Pradesh) to provide technical support in the management of COVID-19 between June 2021 till March 2022.
We launched the initiative in 841 villages in the district and based on its positive impact on the community and encouraging receptivity, the initiative was further scaled to 4245 villages of the erstwhile Srikakulam district, covering 28,80,000 people. As part of the initiative, we have undertaken:
[a] Co-designing a checklist with clear guidelines on how to test, track, provide treatment guidance, and plan for post-treatment follow-ups, for ASHAs & other frontline health workers, in partnership with DM&HO Srikakulam
[b] Capacity building on effective utilization of the checklist
[c] Providing kits to screen for COVID-19, monitoring mild and moderate cases, and facilitating referral services
[d] Organising supportive supervision sessions by ASHA facilitators & district medical officers to help them achieve the district health outcomes in terms of COVID-19 care
Image from our training program for ASHA workers on combating COVID-19
By the end of FY-22, a total of 4,392 frontline healthcare workers including 2,581 were ASHAs, were trained in partnership with DM&HO on the checklist guidelines so that they can closely work with the community and support them in accessing COVID care services. ASHAs also supported in mobilizing people for the government vaccination programs, including a one-of-its-kind vaccination drive organized by Dr. Reddy’s Foundation for 6,000 people. Close interaction with ASHA volunteers while implementing our initiative, made me realize some pertinent challenges faced by this community. I believe that addressing these concerns will pave the way for better performance and better community healthcare outcomes.
Challenges faced by ASHAs
- Among Anganwadi Workers (AWW), Auxiliary Nurse Midwives (ANM), and ASHAs, only ASHAs do not have any fixed salary. This can be demotivating.
- Effective capacity-building interventions for ASHA workers are low. We have found them very keen to learn new things during the capacity-building programs we organized. One key insight was that a paper-based learning system works better for them than an e-learning intervention due to the non-availability of supporting IT infrastructure in remote areas. Better capacity-building interventions will lead to better decision-making.
- They lack enough supportive supervision, which is usually provided by ASHA facilitators and also by other medical officers. Supportive supervision enables ASHAs in achieving their outcomes quickly by guiding them on following apt processes, protocols, and interventions.
- Many of the ASHAs come from vulnerable backgrounds, due to the preference given to single mothers, widows, in selection. But to make them more engaged states need to focus on their career progression where experienced and capable ASHAs can move up and take the role of ANM or ASHA facilitator.
The WHO’s recognition of ASHAs certainly shows the impact they can have on improving healthcare outcomes. To further strengthen the AHSA community there is a need to re-look at their remuneration/incentives, capacity building, supportive supervision facility, and career progression and address the concerns. Further investments by governments and CSR initiatives in them can surely pave the way to making them an effective link between the community and the primary healthcare system.
Pranav Kumar Choudhary | COO
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