RSC on Functioning of ASHAs COMMUNITY MEDICINE.pptx

RSC ON FUNCTIONING OF ASHA

1. Functioning of ASHAs Presenters: Dr. Ravi Sankar S Dr. Sahil Trilok Dr. Khan Amir Maroof Moderator:

2. Introduction The National Rural Health Mission (NRHM) was launched on 12 th April 2005 to meet the healthcare needs of the rural population. Under the public health infrastructure, sub- centres served as the last point of contact with the community. In EAG states, these sub- centres catered to a significantly larger population than originally intended. The heavy workload of ANMs affected outreach activities in the EAG states. 2

3. AWWs, under the ICDS program, focus primarily on supplementary feeding and preschool education. Their job responsibilities limit their ability to engage in extensive health outreach activities. The gap between the community and the public health infrastructure created a need for new grassroots- level functionaries. As part of NRHM, ASHAs were introduced to bridge this gap. They serve as a vital link between vulnerable communities and the public health system. After eight years of progress under the NRHM, the National Urban Health Mission (NUHM) was launched in May 2013 to focus on the urban poor and provide essential healthcare services. The initiative primarily relies on ASHA workers to strengthen community health efforts. 3

4. ASHA Trained female community health activists. ASHA: Accredited Social Health Activist, is the first point of contact for any health- related demands Accredited (Recognized by the community) Social (From the community, by the community, and for the community) Health Activist (Spreading awareness of health concerns and promoting change in health- related practices). Motivates people to use existing health care services and act as a link between the community and the health care system Works in coordination with Anganwadi Workers (AWWs), Self- Help Groups (SHGs), and other local health teams 4

5. ASHAs play a key role in community mobilization for healthcare, focusing on maternal care, immunization, and disease prevention. Also acts as a depot holder for essential provisions They work in collaboration with Anganwadi Workers (AWWs), Self- Help Groups (SHGs), and other local health teams. According to NHM quarterly report on 30 th September 2024, 10,30,992 ASHAs are actively working under the scheme. The scheme is implemented across all states and Union Territories, except Goa and Chandigarh. 5

6. Eligibility Criteria 6 Rural: One ASHA is selected per 1,000 population in each village The ASHA must be a resident of the village. She should have formal education up to at least Class 10th. Preferably in the age group of 25 to 45 years In tribal, hilly, and desert areas, the norm may be relaxed to ensure at least one ASHA per habitation

7. Urban: One ASHA is selected per 1,000 to 2,500 population in slum or urban poor settlement ASHA must be a woman resident of the slum or urban poor settlement She should have formal education up to at least Class 10th. Preferably in the age group of 25 to 45 years Geographically dispersed or ethnically diverse areas, more than one ASHA may be selected even below the population norm 7

8. Selection Process of ASHAs 8 ASHAs are selected through a community-driven process involving: Urban Local Body (ULB) councellors Community groups Self- Help Groups (SHGs) Anganwadi workers (AWWs) Auxiliary Nurse Midwives (ANMs) Gram Panchayats

9. RURAL Oversight by the District Health Society, with a District Nodal Officer (a senior health official) managing the process. The Block Nodal Officer identifies 10+ facilitators per block, with each facilitator covering about 10 villages. Facilitators should be from NGOs, community groups, Anganwadi centers, or local teachers. Facilitators conduct community discussions (Focus Group Discussions - FGDs) and mobilization events to explain ASHA’s role. At least three candidates are shortlisted per village. Final selection is done by the Gram Sabha, and the Gram Panchayat forwards the approved candidate’s name to the District Nodal Officer 9

10. URBAN The Nodal Officer oversees the process and forms the Urban ASHA Selection Committee (CMHO/CDMO, DPO- ICDS, Urban Local Body representative, etc.). This committee sets up Unit- PHC level ASHA Selection Committees. Community consultations, awareness campaigns, and mobilization events are conducted in slum clusters. Five facilitators per U-PHC catchment area, selected from NGOs, community groups, or local departments, guide the selection. The community shortlists at least three ASHA candidates per slum/vulnerable cluster. The Unit- PHC committee submits these to the City Level ASHA Selection Committee for final approval. 10

11. ASHA Training Induction Training ASHAs are trained under 7 modules after the selection A Total of 25 days of induction training is given The first training period is for 7 days followed by 4 days of 4 training sessions Periodic Training Held for two days, once in every alternate month Interactive sessions for: solving any field- related problem encouragement & motivation upgradation of knowledge and skills work monitoring Performance linked incentives replenishment of supplies. 11

12. ASHA Facilitator First level of support for ASHAs One ASHA facilitator for 10 to 20 ASHAs Tasks of ASHA facilitators: Behavior Change Support: Assists ASHAs in promoting healthy behaviors and improving service access through household visits. On- the- Job Training: Guides ASHAs by observing and assisting during counseling and care. Work Planning: Helps ASHAs organize and manage their tasks effectively. 12

13. Team Support & Motivation: Fosters solidarity and motivation among ASHAs in a cluster. Health Data Collection: Gathers and monitors information on ASHA’s activities. Issue Resolution: Troubleshoots problems, including payment issues and grievances. Drug Kit Management: Ensures timely refilling of ASHA’s drug kit. 13

14. Activities of ASHA 14

15. Home visit: Two to three hours every day for at least four or five days Mainly for health promotion and preventive care In case of a child below two years of age, any malnourished child, or a pregnant woman For a newborn in the house, a series of seven visits or more becomes essential. Attending the Village Health and Nutrition Day (VHND): On one day every month, when the Auxiliary Nurse Midwife (ANM) comes to provide antenatal care, immunization, and other services ASHA will help in mobilization those in need of services 15

16. Visits to the health facility: Usually accompanying a pregnant woman or some other neighbour who requests her services for escort. To attend a training programme or review meeting Holding VHSNC meeting: For increasing health awareness and supporting village health planning. Maintain records: To help organize the work and know what to do on daily basis. 16

17. Attending Urban Health and Nutrition Day (UHND) On one day every month, when the Auxiliary Nurse Midwife (ANM) comes to provide antenatal care, immunization, and other services ASHA will help in mobilizing those in need of services Holding Area Level Meeting: ASHA will hold area- level meetings and Mahila Arogya Samiti (MAS) Each ASHA will supervise the formation of 2 to 5 MAS She will be the Member secretary of MAS Special activities of ASHAs in Urban areas 17

18. ASHA – Roles & Responsibilities Create Awareness Social determinants of health Vulnerable groups on nutrition, basic sanitation, hygienic practices, etc. Existing health services and the need for their timely utilization Counsel Women, Families, and Adolescents Birth preparedness, importance of safe delivery, breast feeding and complementary feeding, Immunization, etc Contraception and prevention of RTI/STDs. Substance abuse, Prevention of domestic violence and Sexual violence 18

19. Community level curative care For common ailments such as fever, diarrhoea, etc. Provider of DOTS under National Tuberculosis Elimination Programme (NTEP) Depot holder for essential health products Screening of NCDs, childhood disability, mental health, geriatric care, and others. Mobilize and facilitate access To outreach sessions/AWC/U- PHC/secondary & tertiary care centres for Institutional delivery, Immunization, ANC, PNC, ICDS, Sanitation, etc ASHA – Roles & Responsibilities (contd.) 19

20. Health planning of the community With the Village Health and Sanitation Committee of Gram Panchayat To take action to increase access to health services for vulnerable groups. With MAS, assist for action on gender based violence, mental health issues, alcohol/drug abuse Escort/Accompany Arrange escort for pregnant women and children requiring treatment/admission to nearest pre-identified PHC/CHC/FRU By ASHA for marginalized community to healthcare facility 20 ASHA – Roles & Responsibilities (contd.)

21. Births, deaths, and any unusual health problems/disease outbreaks in her village/slum to U- PHC Reporting of important events With MAS work on water and sanitation Enabling the construction of household/community toilets Promotion of Sanitation and Hygiene 21 ASHA – Roles & Responsibilities (contd.)

22. ASHA Drug Kit - Guidelines Antipyretics (Pain & Fever Relief) Tab. Paracetamol Paracetamol syrup Hematinics (For Anemia & Iron Deficiency) Tab. Iron Folic Acid (L) Tab. Punarvadu Mandur (ISM Preparation of Iron) Anti- Spasmodics Tab. Dicyclomine Antibiotics & Antimicrobials Tetracycline ointment Cotrimoxazole syrup Paediatric Cotrimoxazole tablets Antiseptics Povidone ointment tube G.V. Paint (Gentian Violet for infections & ulcers) Contraceptives Condoms Oral pills (in cycles) Emergency contraceptive pill 22

23. ASHA Drug Kit – Guidelines (cont.) 23 Oral Rehydration & Nutritional Support ORS packet Zinc tablets Hygiene & Disinfection Spirit Soap Sterilized cotton Sanitary napkins (for menstrual hygiene) Diagnostic Kits Nischay Kit (Pregnancy test kit) Rapid Diagnostic Kit Slides for Malaria & Lancets Maternal & Neonatal Health 1. DDK (Disposable Delivery Kit) for clean deliveries at home First Aid & Wound Care 1. Bandages (4cm X 4 meters)

24. Non-monetary Incentives 26 ASHA uniform, Cycle, Mobile, CUG sim, ASHA diary, ASHA drug kit, etc. Social Security Packages: Pradhan Mantri Jeevan Jyoti Beema Yojana (PMJJBY) Pradhan Mantri Suraksha Beema Yojana (PMSBY) Pradhan Mantri Shram Yogi Maan Dhan (PM- SYM) Ayushman Bharat PM Jan Arogya Yojana (AB-PMJAY) Rs.20,000/- Cash award and Citation to ASHA, if leave after working for minimum of 10 years

25. Key Insights & Observations 27

26. ASHA – Dilshad Garden A total of 7 ASHAs in Dilshad Garden. 4 in Tahirpur Village 1 in Tahirpur Sarai There is currently no ASHA worker in the DDA Flats area of Dilshad Garden. Selection Process: Identification of Vulnerable areas Find people interested in that vulnerable area for health activities Applications received for interviews Interview conducted by MOIC, ANM, and ASHA facilitator in A-Block dispensary. 1 in Kheda Village 1 in Kheda Jhuggi 28

27. Attended 14 days of induction training 7 days in Babarpur dispensary 7 days in Seemapuri dispensary Incentive of Rs. 100 -150/- per day for attending training . ASHAs of A-block dispensary Poonam Bhawna Kiran Babita Jyoti Yashpali Nagma Tahirpur Village 29 Tahirpur Sarai Kehra Village Khera Juggi

28. ASHA – Roles & Responsibilities at Ground Level 30 Household survey where they collect information about no of children, ANC cases, elderly people, eligible couple etc. Listing malnourished children (co-ordinate with AWW and mobilise them to dispensary) Creation of ABHA id TB, leprosy survey under NTEP, NLEP respectively

29. For maternal health Confirmation of pregnancy by UPT kit either at dispensary / home and list out ANC females. Registration of pregnancy and allotment of RCH number at A- block dispensary, Dilshad garden. Folic acid and iron, calcium supplementation throughout pregnancy (100 days). Domestic violence: counsel females and link them to Mahila Arogya Samiti Mandal which is further linked to ASHA co- ordinator. (Ms. Anuradha) 31

30. Headcount of 0-5 year children (0- 1,1- 2,2- 5 separately) HBNC - ASHA visits the house Home delivery: 7 visits (0,3,7, 14,21,28,42 days) NVD: 6 visits (3,7,14,21,28,42 days) LSCS: 5 visits (7,14,21,28,42 days) Checks for the weight of the child and any birth defects. She also counsels about breastfeeding and complementary feeding, along with PNC counseling. She also ensures the immunization of under- 5 children. 32

31. HBYC: at 3,6,9,12, & 15 months. Arranges outreach sessions for immunization. Screening for senior citizens (>60 YEARS: B.P., RBS, HB ) and ensure compliance to treatment for diabetic, hypertensive patients. CBAC: It is done online once a year for individuals > 30 years of age. Done through NCD app by the ASHA; previously it was done by the ANM Organizes UHND for the field area, conducted a minimum of once a year 33

32. MAS: Only one ASHA (Ms. Nagma- Khera Juggi) had formed an MAS in the field area Formed 2 years back At present 15 are there in MAS Till now, not received any MAS untied fund 34

33. ASHA Kits 35 ASHA basic kits: Coat, ASHA diary, Identity card HBNC Kit: Jola(Bag), Weighing machine, Thermometer, Blanket, Watch, Torch, Umbrella. HBYC Kit: Toys, Shakir tape Family Planning Kit: Condom, Mala N, E- Pill, Chaya, PTK kit. ASHA drug Kit

34. ASHA Drug Kit – Our observations 36 IFA tablets Albendazole tablets & Syrup ORS powder Patients will be referred to DGD for Zinc Paracetamol Amoxycillin Free sanitary napkins under the “UDAAN Scheme” by the Delhi government

35. Registers 37 Village Health Register Pregnant women U- 5 year children Eligible couple ASHA diary ORS register Survey registers ANC line register Children head count register

36. Unimmunized/Partially immunized child Anaemia/Malnourished child 38 Immunization for Home Deliveries

37. 1st ANC visit 39 2nd, 3rd & subsequent ANC visit PW and high risk individuals referred to ICTC Follow- up of high- risk pregnancy

38. Facilitating Delivery 40 PNC/HBNC/PMSMA RTI/STI treatment Maternal/Infant/U- 5 child Mortality

39. Family Planning Activities 41 IEC activities & Activities for TB patients

40. Water and Sanitation Activities 42 ORS distribution

41. Birth & Death registration Facilitated 43 Mother’s Absolute Affection Medical check- up of Senior citizens

42. Core Activities 44

43. Performance based incentives 45

44. Performance based incentives 46

45. Software Applications/Web portal managed by ASHAs 47 FP- LMIS NCD ABHA (Web portal)

46. NCD App FP- LMIS App 48

47. ASHA Incentives Fixed honorarium: For core activities, Rs. 3000/- if 6 out of 12 activities are done every month JSY- Rs. 400/- (does not get because very few enrol to it) 1st ANC check- up if done by 3 rd month POG- Rs. 100/- Completion of 4 ANC visits- Rs. 200/- Institutional delivery- 400/- Birth to 9 th month vaccination- Rs. 150/- Delivery with sterilisation- Rs. 1400/- Delivery with CuT- 1050/- High- risk pregnancy institutional delivery- 800/- F/u of CuT insertion: 300/- HIV test of pregnant female- Rs. 20/- Senior citizen with card attending dispensary- Rs. 60/- ABHA Id creation- Rs. 10/- For filling CBAC form- 20/- 49

48. 50

49. ASHA Fund Flow 25th of every month ASHA collect the data submit it to the ANM. Verified by MOIC 30th of every month data sent for incentive to ASHA co- Ordinator Verified at CD M O Direct Bank Transfer of the honorarium to ASHA’s account 51

50. Non-monetary Incentives 52 ASHA uniform, Mobile, CUG sim, ASHA diary, ASHA drug kit. Social Security Packages: Pradhan Mantri Suraksha Beema Yojana (PMSBY) Ayushman Bharat PM Jan Arogya Yojana (AB-PMJAY)

51. Guidelines Vs Observation 53 Guidelines Our Observation Two to three hours every day for at least four or five days Visits only when there is particular work to done, mostly will be present in DGD Once a month UHND In a rotational basis for all ASHAs of the centre in a year Conducting VHSNC meeting No information was received from ASHA regarding VHNSC 24 items should be available in ASHA drug kit Only IFA, ORS, Albendazole, Zinc, Paracetamol, Amoxicillin (optional) Sanitary napkins are available MAS receives untied fund of Rs.5000/- per year Not received any fund from the time of formation

52. Acknowledgement 54 ASHAs: Ms. Poonam, Ms. Nagma, Ms. Bhawna, Ms. Kamlesh ANM: Ms. Surekha

53. Thank You!