Accredited Social Health Activist

The Accredited Social Health Activist (ASHA) is a community-based health worker appointed under the National Rural Health Mission (NRHM), now a component of the National Health Mission (NHM) of India. Introduced in 2005, the ASHA programme is a cornerstone of India’s public health system, designed to provide grassroots healthcare services, particularly in rural and underserved areas.
ASHAs act as a vital link between the community and the health system, promoting health awareness, encouraging healthy practices, and facilitating access to essential healthcare services.

Background and Objective

The ASHA initiative was launched by the Government of India in 2005 under the National Rural Health Mission (NRHM) to improve maternal and child health, disease prevention, and access to healthcare in rural areas.
Its main objectives are to:

• Bring health services closer to rural communities.
• Mobilise communities to adopt healthy behaviours.
• Promote institutional deliveries and immunisation.
• Strengthen the linkage between communities and the Primary Health Centre (PHC) or Sub-Centre (SC).

ASHAs play a crucial role in achieving national health goals such as the National Health Policy (2017), Sustainable Development Goals (SDGs), and programmes like Ayushman Bharat and Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A).

Selection and Training

• Selection Criteria:
  • One ASHA is selected per village or population of about 1,000 people.
  • The selection is made by the Gram Panchayat in consultation with the local community.
  • Preference is given to women aged 25–45 years, preferably married, widowed, or divorced, who are residents of the same village.
  • Minimum education requirement is generally Class 8 (8th standard).
• Training:
  • ASHAs undergo modular training sessions covering topics such as maternal and child health, nutrition, sanitation, disease control, and community mobilisation.
  • Training includes both theoretical knowledge and practical field exposure.

The training equips them to function as health educators, community mobilisers, and service facilitators.

Roles and Responsibilities

ASHAs perform multiple roles within the health delivery system:

1. Health Educator and Promoter:
   • Spreads awareness on hygiene, sanitation, nutrition, family planning, immunisation, and disease prevention.
   • Encourages institutional deliveries and antenatal check-ups.
2. Facilitator:
   • Acts as a bridge between the community and public health institutions.
   • Assists villagers in accessing health services such as immunisation, maternal care, and disease treatment.
   • Helps families avail of government schemes such as Janani Suraksha Yojana (JSY).
3. Service Provider:
   • Provides first-aid for minor ailments.
   • Distributes essential health supplies such as ORS packets, Iron–Folic Acid tablets, contraceptives, and chloroquine.
   • Conducts home visits for newborn and postnatal care.
   • Supports disease control initiatives like malaria testing, tuberculosis awareness, and leprosy detection.
4. Community Mobiliser:
   • Organises Village Health and Nutrition Days (VHNDs).
   • Motivates communities to participate in health and sanitation campaigns.
   • Promotes collective health action and community accountability.

Incentives and Remuneration

ASHAs are not permanent salaried employees but voluntary workers who receive performance-based incentives under various national programmes.
Common incentive activities include:

• Promoting institutional deliveries under Janani Suraksha Yojana (JSY).
• Facilitating immunisation drives.
• Promoting family planning methods.
• Encouraging antenatal and postnatal care.
• Participating in disease control campaigns such as malaria or tuberculosis.

Additionally, some states provide a fixed monthly honorarium in recognition of their essential services.

Supplies and Support

Each ASHA is equipped with a Drug Kit containing basic medicines, first-aid materials, and health supplies, including:

• ORS packets, paracetamol, iron–folic acid tablets, oral contraceptives, condoms, antiseptics, etc.They also receive logbooks and registers for recording household visits, health surveys, and service reports.

ASHAs are supervised by ASHA Facilitators, Auxiliary Nurse Midwives (ANMs), and Accredited Social Health Supervisors to ensure performance monitoring and support.

Achievements and Impact

Since its inception, the ASHA programme has become one of the largest community health worker networks in the world, with over one million ASHAs working across India.
Key achievements include:

• Improved maternal health: Increased institutional deliveries and antenatal check-ups.
• Child immunisation: Higher vaccination rates across rural India.
• Disease control: Significant contribution to the eradication of polio and detection of tuberculosis cases.
• Community empowerment: Enhanced awareness about health, hygiene, and women’s welfare.

ASHAs were recognised for their outstanding contribution during the COVID-19 pandemic, where they conducted door-to-door surveillance, community education, and vaccination mobilisation.
In 2022, India’s ASHA workers were honoured with the World Health Organization’s Global Health Leaders Award for their exceptional contribution to public health.

Challenges

Despite their achievements, ASHAs face numerous difficulties:

• Low remuneration and irregular payment of incentives.
• Work overload with multiple programme responsibilities.
• Lack of safety and job security.
• Inadequate training and logistical support.
• Limited recognition of their professional status.

Addressing these issues is crucial to sustaining their motivation and improving service delivery in rural areas.

Government Support and Reforms

To strengthen the ASHA programme, the government has:

• Introduced regular capacity-building modules and refresher training.
• Enhanced incentive structures and introduced fixed monthly honoraria in some states.
• Improved supply chain management for drug kits and equipment.
• Integrated ASHAs into broader initiatives such as Ayushman Bharat – Health and Wellness Centres (HWCs).