The contribution of Accredited Social Health Activist under NRHM in the implementation of comprehensive health care in East Champaran district,Bihar(ASHA) Anil cherian
This document summarizes a study on the role of Accredited Social Health Activists (ASHAs) in implementing comprehensive primary healthcare in Bihar, India. Key findings include:
1) ASHAs had limited understanding of their stated roles beyond maternal and child health.
2) Their recruitment and training did not follow NRHM guidelines and most received inadequate initial training.
3) ASHAs received little support from the community and healthcare workers.
4) The study recommends strengthening community involvement in selecting and training ASHAs, and establishing ongoing mentorship programs to better support their roles.
tHESE SLIDES ARE PREPAREED TO UNDERSTAND about ASHA AND ANGANWADI IN EASY WAY Important links- NOTES- https://mynursingstudents.blogspot.com/ youtube channel https://www.youtube.com/c/MYSTUDENTSU... CHANEL PLAYLIST- ANATOMY AND PHYSIOLOGY-https://www.youtube.com/playlist?list=PL93S13oM2gAPM3VTGVUXIeswKJ3XGaD2p COMMUNITY HEALTH NURSING- https://www.youtube.com/playlist?list=PL93S13oM2gAPyslPNdIJoVjiXEDTVEDzs CHILD HEALTH NURSING- https://www.youtube.com/playlist?list=PL93S13oM2gANcslmv0DXg6BWmWN359Gvg FIRST AID- https://www.youtube.com/playlist?list=PL93S13oM2gAMvGqeqH2ZTklzFAZhOrvgP HCM- https://www.youtube.com/playlist?list=PL93S13oM2gAM7mZ1vZhQBHWbdLnLb-cH9 FUNDAMENTALS OF NURSING- https://www.youtube.com/playlist?list=PL93S13oM2gAPFxu78NDLpGPaxEmK1fTao COMMUNICABLE DISEASES- https://www.youtube.com/playlist?list=PL93S13oM2gAOWo4IwNjLU_LCuhRN0ZLeb ENVIRONMENTAL HEALTH- https://www.youtube.com/playlist?list=PL93S13oM2gAPkI6LvfS8Zu1nm6mZi9FK6 MSN- https://www.youtube.com/playlist?list=PL93S13oM2gAOdyoHnDLAoR_o8M6ccqYBm HINDI ONLY- https://www.youtube.com/playlist?list=PL93S13oM2gAN4L-FJ3s_IEXgZCijGUA1A ENGLISH ONLY- https://www.youtube.com/playlist?list=PL93S13oM2gAMYv2a1hFcq4W1nBjTnRkHP facebook profile- https://www.facebook.com/suresh.kr.lrhs/ FACEBOOK PAGE- https://www.facebook.com/My-Student-S... facebook group NURSING NOTES- https://www.facebook.com/groups/24139... FOR MAKING EASY NOTES YOU CAN ALSO VISIT MY BLOG â BLOGGER- https://mynursingstudents.blogspot.com/ Instagram- https://www.instagram.com/mystudentsu... Twitter- https://twitter.com/student_system?s=08 #PEM, #ASHA,#ANGANWADI#ICDS,#nurses,#ASSESSMENT, #APPEARENCE,#PULSE,#GRIMACE,#REFLEX,#RESPIRATION,#RESUSCITATION,#NEWBORN,#BABY,#VIRGINIA, #CHILD, #OXYGEN,#CYANOSIS,#OPTICNERVE, #SARACHNA,#MYSTUDENTSUPPORTSYSTEM, #rashes,#nursingclasses, #communityhealthnursing,#ANM, #GNM, #BSCNURING,#NURSINGSTUDENTS, #WHO,#NURSINGINSTITUTION,#COLLEGEOFNURSING,#nursingofficer,#COMMUNITYHEALTHOFFICE
Primary health centers are the corner stone of rural health services .
It act as a referral unit for 6 sub centers and refer out cases to CHCs.
It covers a population of 30,000 in plain area and 20,000 in hilly and tribal area.
There are 4-6 beds for patients and some diagnostic facilities are also available.
The work an anganwadi worker does goes largely unknown, unnoticed and unrecognized. She packs an extraordinary sweep of activities into a day â from preschool education to community service, from mentoring parents to census operations.
Aksharaâs preschool team spends a day with one such anganwadi worker, Ganga Bhyramma, who has been at the Byadarahalli anganwadi in Bangalore for the last eighteen years. She is a storehouse of information on anganwadis in general, on how they function. She provides context to anganwadis and explains their relevance in the community. She herself is a pillar in her community, a rallying figure for people. Her work is multi-dimensional. Her main focus is preschool education. But Ganga Bhyramma handles myriad responsibilities and her day quickly gets fragmented and she sometimes has no time to devote to the children in her anganwadi. She would like to put them in the forefront of her activities and that is not always possible. But the Akshara team never once heard her complain.
tHESE SLIDES ARE PREPAREED TO UNDERSTAND about ASHA AND ANGANWADI IN EASY WAY Important links- NOTES- https://mynursingstudents.blogspot.com/ youtube channel https://www.youtube.com/c/MYSTUDENTSU... CHANEL PLAYLIST- ANATOMY AND PHYSIOLOGY-https://www.youtube.com/playlist?list=PL93S13oM2gAPM3VTGVUXIeswKJ3XGaD2p COMMUNITY HEALTH NURSING- https://www.youtube.com/playlist?list=PL93S13oM2gAPyslPNdIJoVjiXEDTVEDzs CHILD HEALTH NURSING- https://www.youtube.com/playlist?list=PL93S13oM2gANcslmv0DXg6BWmWN359Gvg FIRST AID- https://www.youtube.com/playlist?list=PL93S13oM2gAMvGqeqH2ZTklzFAZhOrvgP HCM- https://www.youtube.com/playlist?list=PL93S13oM2gAM7mZ1vZhQBHWbdLnLb-cH9 FUNDAMENTALS OF NURSING- https://www.youtube.com/playlist?list=PL93S13oM2gAPFxu78NDLpGPaxEmK1fTao COMMUNICABLE DISEASES- https://www.youtube.com/playlist?list=PL93S13oM2gAOWo4IwNjLU_LCuhRN0ZLeb ENVIRONMENTAL HEALTH- https://www.youtube.com/playlist?list=PL93S13oM2gAPkI6LvfS8Zu1nm6mZi9FK6 MSN- https://www.youtube.com/playlist?list=PL93S13oM2gAOdyoHnDLAoR_o8M6ccqYBm HINDI ONLY- https://www.youtube.com/playlist?list=PL93S13oM2gAN4L-FJ3s_IEXgZCijGUA1A ENGLISH ONLY- https://www.youtube.com/playlist?list=PL93S13oM2gAMYv2a1hFcq4W1nBjTnRkHP facebook profile- https://www.facebook.com/suresh.kr.lrhs/ FACEBOOK PAGE- https://www.facebook.com/My-Student-S... facebook group NURSING NOTES- https://www.facebook.com/groups/24139... FOR MAKING EASY NOTES YOU CAN ALSO VISIT MY BLOG â BLOGGER- https://mynursingstudents.blogspot.com/ Instagram- https://www.instagram.com/mystudentsu... Twitter- https://twitter.com/student_system?s=08 #PEM, #ASHA,#ANGANWADI#ICDS,#nurses,#ASSESSMENT, #APPEARENCE,#PULSE,#GRIMACE,#REFLEX,#RESPIRATION,#RESUSCITATION,#NEWBORN,#BABY,#VIRGINIA, #CHILD, #OXYGEN,#CYANOSIS,#OPTICNERVE, #SARACHNA,#MYSTUDENTSUPPORTSYSTEM, #rashes,#nursingclasses, #communityhealthnursing,#ANM, #GNM, #BSCNURING,#NURSINGSTUDENTS, #WHO,#NURSINGINSTITUTION,#COLLEGEOFNURSING,#nursingofficer,#COMMUNITYHEALTHOFFICE
Primary health centers are the corner stone of rural health services .
It act as a referral unit for 6 sub centers and refer out cases to CHCs.
It covers a population of 30,000 in plain area and 20,000 in hilly and tribal area.
There are 4-6 beds for patients and some diagnostic facilities are also available.
The work an anganwadi worker does goes largely unknown, unnoticed and unrecognized. She packs an extraordinary sweep of activities into a day â from preschool education to community service, from mentoring parents to census operations.
Aksharaâs preschool team spends a day with one such anganwadi worker, Ganga Bhyramma, who has been at the Byadarahalli anganwadi in Bangalore for the last eighteen years. She is a storehouse of information on anganwadis in general, on how they function. She provides context to anganwadis and explains their relevance in the community. She herself is a pillar in her community, a rallying figure for people. Her work is multi-dimensional. Her main focus is preschool education. But Ganga Bhyramma handles myriad responsibilities and her day quickly gets fragmented and she sometimes has no time to devote to the children in her anganwadi. She would like to put them in the forefront of her activities and that is not always possible. But the Akshara team never once heard her complain.
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Mata Yasoda - Mobile Application for Anganwadi Centers (ICDS)Nagarajan M
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Mata Yashoda project aims to decrease malnutrition among 6 months to 6 years children of Sabarkantha district. Per 1000 population one Anganwadi Cenre (AWC) is established to nutrition and pre-school education to children. Study says in 50% of infant deaths malnutrition is indirect cause of death. One Anganwadi Worker (AWW) and one Tedaghar (cook) are posted to deliver services. In AWC apart from nutrition services and pre-school services AWW has to participate in various other activities like Meeting, Sabha, Krishi Rath and has to report all the services given by her.
Also monthly weight monitoring is done for each child and plotted on graph to track childâs nutritional status. She has to fill 11 (eleven) registers for services given by her. So AWW has to give most of time in reporting and other activates. So quality of service given by AWW has suffered. Mata Yashoda project has converged all these register in single mobile application. So AWW has to fill data once and reports are automatically generated by this software. So less time is consumed and AWW gets extra time for children.
Monitoring from taluka and district level has become very easy with single online real time Dashboard. Time spent on actual delivery of services is reduced due to cumbersome register maintenance. More than 11 registers are to be maintained by the AWW. This task is automated leading to increased time and energy to carry out ICDS services. The administration is able to get real time information for monitoring.
this is a report of my summer internship that i had done in Ruby hall clinic(550 beds) Pune.Title of my project is "Feasiablity study of implementation of personal health records in Ruby hall clinic".
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The contribution of Accredited Social Health Activist under NRHM in the implementation of comprehensive health care in East Champaran district,Bihar(ASHA) Anil cherian
1. The contribution of Accredited Social Health Activist (ASHA) under National Rural Health Mission (NRHM) in the implementation of Comprehensive Primary Health Care in East Champaran district, Bihar (State) India Dr. VandanaKanth, Dr. Anil Cherian, Dr. Jameela George â Emmanuel Hospital Association, New Delhi. Teasdale Corti Research Project on CPHC
2. ASHA & NRHM The NRHM 2005-2012 launched to revitalize the public health system. Key health reform initiative : Accredited Social Health Activist (ASHA) ASHA represents the latest in a long series of attempts to introduce a lay village level health worker. ASHA scheme has been undertaken by 10 states and 1.2 lakhs
3. Comprehensive Primary Health Care Global initiative to revitalize âhealth for allâ which is also resonant in the call for Universal Health Care. Comprehensive Primary Health Care Increased equity in access to health care. Reduced vulnerabilities through community empowerment. Reduced exposure to risk by addressing the social determinants of health.
4. NRHM in Bihar Launched in July 2006 Village Health & Sanitation Committeeâs have not been constituted. 92% of targeted number of ASHAâs have been selected. 79% have received Module 1 training according to the RET Report for East Champaran. ASHA training was assigned to the PHE department.
5. Overarching Research Question How can the contributions of the ASHA to Comprehensive Primary Healthcare be strengthened?
6. Research Objectives To study the apparent contradictions in the stated roles of the ASHAâsand their current practice. To study the recruitment & training process of ASHAâs, the nature and levels of community support and their effect on her ability to contributing to CPHC in communities. To study the contextual factors (enabling and barriers) affecting the ASHAâs functioning, specifically in bring about improvements in health seeking behaviours, increasing utilisation of primary care services, timely referrals to appropriate secondary levels of care, building community capacities to assess, analyze and act on social determinants of health
7. Methodology Study location: 2 blocks of Purbi (East) Champaran District in Bihar. Study period: June 2009-October 2010 Mixed methods Focus Group Discussions (FGDs) with CBOâs & ASHAâs Key informant interviews ASHAâs , ANMâs , AWW, Panchayat members and Mukhiyaâs (Villages chiefs). Participatory methods such as a Venn Diagram(chappati), Quantitative Methods: Household KABP survey ( Sample size= 300 households)
9. Findings ASHAâs understanding of their roles as given in the NRHM ASHA Guidelines 22% had a reasonable understanding 53% had some understanding 25% had very poor understanding of their roles. Universal perception: Welfare of pregnant mothers and immunization of children. Registration of pregnant women ( JSY Scheme) Immunization of mothers and children Facilitation of Institutional Delivery.
10. Perception of ASHA (self-perception), Auxiliary Nurse Midwives (ANM) and Anganwadi Workers (AWW) on the roles and responsibilities of ASHAâs
11. Other roles of ASHA None of the ASHAâs were involved in village level health planning. Concept of community monitoring was not understood. They were not involved in the facilitating the construction of toilets or in the promotion of sanitary and hygienic practices. Concept of âsocial health activist was not well understood. Most ASHAâs assumed that the term was related to volunteerism and the fact that she was not paid a salary
12. Factors contributing to the ASHAâs understanding about their roles Bi-variate analysis, N = 199 ASHAâs, Dependent variables = poor knowledge/ good and adequate knowledge)
13. Recruitment of ASHAâs The recruitment of ASHAâs in East Champaran Bihar has not been according to NRHM norms. Most of the ASHAâs were recruited by the Village headman (Mukhiya) and in one of the two blocks studied; the medical officer of the PHC selected 33.9% of the ASHAâs. The Gram Panchayat was involved in the selection of less than 10% of ASHAâs.
14. Training of ASHAâs The training received by the ASHAâs in East Champaran was very varied. 33% (1 out of 3) the ASHAâs in Adapur block were not even trained at induction. The remaining 67% ASHAâs only received 7 days of initial training The PHC medical officer conducted training. The main training method used was reading from the manual.
15. ASHA support and linkages The ASHAâs were hardly supported by the Panchayat. The Village headmen (Mukhiya) were only involved with her recruitment. Even the assistance that they received from Auxiliary Nurse Midwives or the Anganwadi worker was limited. Only 40% of ASHAâs said they received assistance from ANMâs and 60% from Anganwadi workers. Assistance to ANM,s was in immunization of children and pregnant mothers Anganwadi (Child Development)worker it was in identifying pregnant women.
16. Discussion Major gaps in the roll out of ASHA scheme in Bihar. The community involvement or the involvement of civil society in the whole process ârecruitment / training has been limited. ( Compare Mitanin Programme Chhatisgarh). Activist role of ASHAâs in mobilizing the community, addressing the social determinants and equity issues not happening.
17. Discussion Training of ASHAâs â 67% vs 79% ( RET) of Module 1. Method of training inadequate. The only factor that was mildly significant was the length of the training day. Training may be an important aspect in the capacity building. The financial incentives appears to determine the role that the ASHA playâs.
18. Recommendation Greater involvement of civil society and community based institutions in the roll out of the ASHA schemes. Training of ASHAâs on their role is important. Sporadic training however may not be adequate and needs to be replaced by a ongoing mentorship programme. ASHA mentorship programme should be taken up through a SHRC. Attention needs to be given to the training methodology. VHSC are important to support the ASHAâs and need to develop.
Editor's Notes
This project was undertaken as part of a Global Initiative called the TeasdalleCorti Partnership Research Project
Selected from the village itself and accountable to it, the ASHA will be trained to work as an interface between the community and the public health system. ASHA must primarily be a woman resident of the village â married/ widowed/ divorced, preferably in the age group of 25 to 45 years.She should be a literate woman with formal education up to class eight. This may be relaxed only if no suitable person with this qualification is available.
We are not asking the question can ASHAâs be effective? There is enough evidence to show from projects around the world to show that lay workers can play a critical role in the developmenr of health.
FGD â 59 CBOâs, 10 ASHA Groups199 ASHAs, 17 ANM, 255 AWW, Mukhiya 21, PRI members - 21
A majority of them â 78% of them did not understand their roles.Registration of pregnant women, immunization of mothers and children and facilitation of institutional delivery
The role that the ASHA plays is determined to a large extent by the financial incentives that she receives.
ASHA will be chosen through a rigorous process of selection involving various community groups, self-help groups, Anganwadi Institutions, the Block Nodal officer, District Nodal officer, the village Health Committee and the Gram Sabha.
. Capacity building of ASHA is being seen as a continuous process. ASHA will have t undergo series of training episodes to acquire the necessary knowledge, skills and confidence for performing her spelled out roles.