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Background: Early detection and proper intervention in psychiatric diseases would be morelikely if community health workers had sufficient mental health literacy, which involvesadequate understanding and a positive attitude toward psychiatric illnesses. Our goal was toanalyses community health professionals' knowledge and attitudes toward the mentally ill andtheir socio-demographic correlates, particularly Accredited Social Health Activists (ASHA).Methodology: Using a National Health Service (NHS) survey form, researchers were able todetermine the attitudes of Accredited Social Health Activist (ASHA) workers towardpsychiatric disease. We looked at a total of 50 completed responses. Chi square test andStudent's t test were employed as statistical analysis approaches.Results: We discovered a lack of mental health understanding and a negative attitude amongASHA employees.Conclusions: The causes of attitude deficits in ASHA workers should be targeted foradditional educational interventions and training, so that positive attitudes can be instilled inthem and other health workers, benefiting our society in the long run.
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Background: Accredited Social Health Activist (ASHA) is the grass root level worker and hence plays a prime role in making primary healthcare accessible to rural areas. She creates awareness on health and persuading the community toward local health planning and hence plays major role in increasing utilization of health services. The knowledge of the people about the availability of ASHA in their area and about the activities performed by her also play important role in utilization of services given by ASHA. Hence, keeping this in view the present study was conducted. Aim and Objectives: (1) The aim of the study was to assess the knowledge of the rural women about the availability of ASHA in their area and (2) to assess the knowledge of the rural women about the activities performed by ASHA. Materials and Methods: The study was conducted in rural field practice area of Government Medical College, Amritsar, Punjab. The study was a cross-sectional type and the adult decision maker female of the family was interviewed using a pre-designed and semi-structured pro forma after approval from Institutional Ethics committee. A total of 1521 females were interviewed. Results: The present study revealed that majority (52.3%) of the respondents were in the age group of 24–45 years, 41.7% illiterate and 54.6% in the upper lower class. It was found that 45.8% respondents were visited by ASHA and out of these, majority of the respondents (78.2%) were visited for Maternal and child health services followed by health awareness (20.7%) and minor illnesses (9.9%). Conclusion: The visits by ASHA were irregular and majority of the respondents were visited by ASHA for maternal and child health services in all the three villages and hence knowledge regarding these activities was seen to be more among the respondents. However, overall less knowledge was seen among the villagers about other activities being performed by ASHA worker.
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Objective: We aimed to identify key barriers to Water Sanitation and Hygiene (WASH) promotion and infant diarrhea prevention services delivered by Accredited Social Health Activists (ASHAs) in rural India. Methods: A case-study was conducted across nine tribal villages in Banswara district (Rajasthan), where in-depth observational and qualitative data was collected from frontline health workers and infant caregivers. Results: ASHAs’ prioritization of their incentive-based link-worker tasks over their health activist roles, limited community mobilization, and lack of monitoring of such activities hindered the delivery of WASH promotion and infant diarrhea prevention services. Caregivers’ lack of trust in ASHA’s health knowledge and preference for private providers and traditional healers also hindered the uptake of ASHA’s health promotion services. Conclusions: Strengthening ASHAs’ health activism roles and building trust on frontline health workers’ knowledge among tribal communities will be the key to address the determinants of child malnutrition and stunting and accelerate progress towards the national development agenda.
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Context: Early childhood caries is one of the most widespread diseases affecting children in urban and rural India. Community health workers can bring about a quantum of change in improving the oral health in children. Aims: The aim of the study was to assess the impact of oral health training imparted to Anganwadi and accredited social health activist (ASHA) workers on improving the oral hygiene of 148 children aged 1–6 years. Settings and Design: The preintervention followed by oral health training and postintervention assessment were done at three Anganwadi and ASHA centers of Rajasthan. Methodology: The preintervention data included Decayed, Missing, and Filled Teeth/decayed, extracted, and filled teeth, oral hygiene indices (Oral Hygiene Index-Simplified [OHI-S] and Oral Hygiene Index Simplified-Modified [OHIS-M]), plaque index, and caries activity using Oratest. The oral health training consisted of PowerPoint presentations, video presentations, live demonstrations on brushing technique, rinsing, plaque disclosure, and flossing technique. They were enlightened on deleterious oral habits, emergency protocol on trauma, etc. The postintervention data included outcome measures consisting of oral hygiene indices (OHI-S and OHIS-M), plaque index, and Oratest after 2 months to evaluate the impact of training. Statistical Analysis used: The data were analyzed using Chi-square test, Fisher's exact test, independent t-test, paired t-test, and one-way analysis of variance test. Results: There was a significant improvement in toothbrushing practices and rinsing (P < 0.05). There was a significant difference in debris index, calculus index, OHI-S/OHIS-M, plaque index, and Oratest after intervention (P < 0.05). Conclusion: Empowering Anganwadi and ASHA workers can be a feasible approach in India, where oral health is not a priority in primary health care as yet.
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Background: One of the key components of national rural health mission was to create a band of female health volunteers, appropriately named “accredited social health activist” (ASHA) in each village within the identified States to act as a bridge between the rural people and health services outlets. They act as health activists in community who will create awareness on health and its determinants, counsel mothers on key healthy behaviors and mobilize the community towards local health planning and increased utilization and accountability of the existing health services. Objectives of the study was to describe the socio-demographic profile of ASHAs working in Vijayapur district and to evaluate the knowledge, attitude, practice of ASHAs towards the maternal care.Methods: A cross-sectional study on 617 ASHAs of Vijayapur district. A pre-designed, semi- structured questionnaire was prepared in English and the interview was conducted in Kannada by explaining them questions one by one.Results: Out of 617 ASHAs interviewed, 427 (69.2%) of them told a pregnant woman should have antenatal care (ANC) visits and 413 (65.3%) ASHAs opined that a minimum of four ANC visits are required. While 542 (87.2%) ASHAs told that they should accompany pregnant woman transport to health centre during labour pains and 570 (92.8%) told that they should stay with the pregnant lady until her delivery is over. Also, it was found that knowledge of ASHAs regarding maternal care was significantly associated with age and duration of service of ASHAs.Conclusions: On the whole, knowledge of ASHAs about care during pregnancy and care of new-born was cons
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Purpose: The effectiveness of Accredited Social Health Activists (ASHAs) with and without monetary incentive in uptake of diabetic retinopathy (DR) screening at community health center (CHC) was compared in South Gujarat, India. Methods: In this non-randomized controlled trial, ASHAs were incentivized to refer people with diabetes mellitus (PwDM) from their respective villages for DR screening after people were sensitized to DM and DR. The minimum sample size was 63 people in each arm. Results: Of 162, 50.6% were females, 80.2% were literate, 56.2% were >50 years, 54.3% had increased random blood sugar (RBS), and 59.9% had diabetes for 5 years. The percentage of screening was significantly higher [relative risk (RR) = 4.37, 95% confidence interval (CI) 2.79, 6.84] in ASHA incentive group and health education (HE) group (RR = 3.67, 95% CI 2.35, 5.75) compared with baseline. Providing incentive to ASHAs was not found to be of extra advantage (RR = 1.19, 95% CI 0.89, 1.57). The likelihood of uptake of screening was higher among uncontrolled PwDM, poor literacy, and higher duration of diabetes in incentive phase (P < 0.001) compared with HE. The results show that age (P = 0.017), education (P = 0.015) and level of RBS (P = 0.001) of those referred were significantly associated with incentives to ASHAs. Conclusion: ASHAs can be used effectively to refer known PwDM for DR screening especially when DR screening program is introduced in population with low awareness and poor accessibility. When incentives are planned, additional burden on resources should be kept in mind before adapting this model of care.
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Background: The accredited social health activist (ASHA) is a link between community and health systems, so her services are very crucial for attainting universal health coverage. Comprehensive understanding of the demotivating factors, affecting the work efficacy of ASHA workers in the tribal areas, will not only help us in framing new ideas for providing them a positive work environment but also in retaining these health providers in their current job and increase their productivity and efficiency. Objectives: The study aims to find out the challenges and demotivating factors that ASHA workers face while implementing their responsibilities in tribal areas and frame recommendations based on study findings. Materials and Methods: An observational cross-sectional study conducted in a tribal area falling within the scope of a primary health care (PHC) center affiliated to a medical college. A semi-structured interview schedule was utilized to interview trained ASHA workers to understand the practical in-field challenges while implementing duties. Results: About 63% of ASHA workers were satisfied working in the tribal area. However, the major causes of de-motivation were community resistance (71.7%), less/irregular incentives (69.5%), transportation problems (52.2%), workload and stress (56.5%), and lack of training (23.9%). Family support and cooperation by auxiliary nurse midwife/multipurpose worker and other health-care staff in referral units were satisfactory for ASHAs in tribal areas. Conclusion: Most of the ASHA workers of the tribal area were satisfied with their job responsibilities, but timely activity-based incentives for the ASHA workers and regularity in their monthly salary and more community awareness about ASHA can motivate ASHA workers and increase their efficiency in providing PHC.
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Background: Accredited Social Health Activist (ASHA) workers and their activity are considered as one of the key components of National Health Mission (NHM). ASHA workers serve as an important link between community and health facilities. Objectives: The objectives of the study were to assess the work profile of ASHA workers in Kathua district of Jammu and Kashmir. Materials and Methods: The present prospective cross-sectional study was conducted in Parole Block of district Kathua in Jammu and Kashmir from February 2019 to May 2019. A total of 176 rural ASHA workers were interviewed using a predesigned, pretested questionnaire after seeking informed consent. Results: About 52.2% catered to a population of 500–1000. About 34% of the workers were educated up to 10th standard and 10.7% up to 12th standard. About 64.2% of the ASHA workers are active in supporting institutional deliveries and 88% of the ASHAs made household visits for nutrition counseling. Conclusions: ASHA acts as a first link between the community and health-care services. Thus, it is necessary to strengthen the role of ASHA on promotive and preventive health care services through regular joint training of ASHAs.
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Background: ASHA acts as a ‘bridge’ between the rural people and health service outlets and plays a central role in achieving national health and population policy goal. ASHAs form the backbone of the NRHM. They need to provide preventive, promotive and curative health facilities in the rural community. Maternal and child health is an important public health issue which indicates level of socio-economic development in each and every country. ASHA workers are the main front-line workers in primary health care delivery system who are expected to work in this domain to bring out betterment in RCH indicators.Method: It was a mixed method study. Quantitative portion was descriptive, cross-sectional and qualitative part was focus group discussion (FGD). The study had been conducted in one block (Deganga block) of North 24 parganas district of West Bengal which was previous to selected purposively for the study. All ASHAs of Deganga block and one beneficiary mother (mother who had a baby of less than 1 year) for each ASHA from her area of work had been included as study population. ASHA- Beneficiary dyad had been interviewed with a predesigned pretested questionnaire after taking informed consent.Result: More than half of the study population (64.7% and 50.5 %) had overall good knowledge and practice score related to maternal-child health and family planning respectively, though they had poor knowledge in updated dosage schedule of iron folic acid tablets, proper attachment techniques for successful breast feeding, missed doses of OCP, ECP, IUCD and safe period. They performed less efficiently in areas like counselling about harmful effects of addiction during pregnancy, birth preparedness and complication readiness, colostrum feeding, weaning, ECP and MTP. Mainly inadequate remuneration and lack of job satisfaction were the factors hindering their performance.Conclusion: Frequent refresher courses, regular monitoring and supportive supervisions by respective higher authority, administrative steps for combating their dissatisfaction are of utmost importance to improve their performance.
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Background: Non-communicable diseases are the leading causes of death globally, of which cardiovascular diseases are the most common. Cost-effective strategies, such as task shifting, are needed to mitigate the rising epidemic by controlling hypertension and diabetes in our country.Methods: This was a non-randomized interventional study undertaken in six (3 intervention and 3 control) villages of Lakkur primary health centre (PHC) area under Malur taluk, Kolar district, Karnataka, from November 2013 to April 2015. After obtaining written informed consent, baseline survey was done among 180 diabetics and hypertensives (adults>30 years). In the intervention villages, ASHAs who were trained did the intervention for 6 months. In non-intervention villages, standard usual care was given and repeat survey was done after 6 months to re-measure.Results: This study demonstrated that there was an increase of 44.8% in the proportion of hypertensives whose blood pressure was under control and increase of 26.5% in the proportion of diabetics whose blood sugar was under control in villages that received household visits by trained ASHAs (intervention villages). There was an increase in the medication adherence levels (29.6%) and reduction in tobacco usage (median difference of 4 times per day) among hypertensives and diabetics who are on medication in intervention villages.Conclusions: Findings from this study will provide policy makers and other stakeholders needed information to recommend scalable and cost-effective policy in respect to cardiovascular risk reduction, hypertension and diabetes control in resource-poor settings.
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Background: Several programmatic and logistic issues affect the overall performance of Accredited Social Health Activists (ASHAs). Bihar Government provided bicycles to ASHAs in West Champaran district for increasing coverage of services by improving their mobility. Objective: To assess the use of bicycles by ASHAs and it’s effect on service delivery. It also captures the perspectives of ASHAs in terms of its utilization for performing tasks. Methods: A community-based quasi-experimental study was undertaken during March-May 2016. Proportion of newborn babies visited within 24 h of birth was the primary outcome. Data were collected from two intervention blocks (West Champaran district) and a control block from the neighboring East Champaran district. A total of 323 (177 from intervention blocks and 146 from control block) mothers having children <3 years of age and who had delivered at home were interviewed. Besides, 88 ASHAs working in intervention blocks were also interviewed. Results: Significantly higher proportion of mothers and newborn babies (44%) received postnatal care within 24 h of delivery in intervention blocks as compared to the control block (16%, P < 0.001). Nearly 73.1% of ASHAs were using the bicycle themselves. ASHAs were twice more likely to visit a newborn on the day of delivery if she was provided with mobility support. However, the likelihood of continuing visits after the 1st day was not statistically significant. Conclusion: The intervention demonstrated the potential of ASHAs to improve their functioning at the grass-root level. The scale-up of bicycle intervention should be supplemented with reforms in financial incentives disbursement and better system support.
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Background: Accredited social health activist (ASHA) is a voluntary community health worker and an important human resource for public health system of India. Their motivation to become a community health worker and continued efforts is a mix of monetary and non-monetary factors. Their motivation to work comes partly from desire to work for the community and prestige, but is furthered by the monetary compensation. Objectives: To study the economic status of ASHAs in Uttarakhand, and their contribution to household income and the role the monetary incentives play in their work. Methods: This cross sectional study was conducted in Haridwar and Dehradun districts of Uttarakhand. Eighty one ASHAs were interviewed using pre-piloted semi-structured questionnaire. Their economic status was assessed using Modified BG Prasad Classification. Results: Majority of the ASHAs belonged to class 4 according to modified B G Prasad Classification. Mean monthly earning as ASHA was 1335 rupees (SD: 748) and the mean contribution to the total household income was 28%. Financial incentive was an important motivating factor with associated concerns about delay in payments. About 75% felt that the amount was inadequate considering the time and effort involved. Conclusions: There is need to review the financial and non-financial incentives with due consideration to inflation and consumer price index.
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Objective: To assess Accredited social health activists’ (ASHAs) ability to recognize illness in infants aged less than 2 months. Methods: Investigators observed 25 ASHAs conducting 47 visits. Results: ASHA-investigator agreement on the need to further assess infants was intermediate (kappa 0.48, P<0.001). Using IMNCI’s color codes, ASHAs misclassified 80% of infants. ASHAs did not follow home-based newborn care formats and skipped critical signs. Overall ASHA-investigator agreement on diagnosis was poor (kappa=0.23, P=0.01). Conclusion: There is a need for improved training, tools, and supportive supervision.
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Objective: To assess Accredited social health activists’ (ASHAs) ability to recognize illness in infants aged less than 2 months. Methods: Investigators observed 25 ASHAs conducting 47 visits. Results: ASHA-investigator agreement on the need to further assess infants was intermediate (kappa 0.48, P<0.001). Using IMNCI’s color codes, ASHAs misclassified 80% of infants. ASHAs did not follow home-based newborn care formats and skipped critical signs. Overall ASHA-investigator agreement on diagnosis was poor (kappa=0.23, P=0.01). Conclusion: There is a need for improved training, tools, and supportive supervision.
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Background: Government of India, under National Rural Health Mission has established Village Health Sanitation Nutrition Committees (VHSNCs) and appointed Accredited Social Health Activists (ASHAs) in all the villages. Government of India also started Community Based Monitoring (CBM) project through Non-Governmental Organizations (NGOs). State of Maharashtra was one of the nine states selected for implementation of the pilot project. Objectives: To assess the effect of training and implementation of CBM on Knowledge, Attitude and Practices of VHSNC members including ASHAs. Design: It is a descriptive study using comparison group. Settings: The study was carried out in 90 villages, 45 each from study and comparison group, in the State of Maharashtra, India. Interventions: The study was conducted with the help of the Community Medicine Departments from nearby Medical Colleges. From each village one ASHA and three members of VHSNC were interviewed. An assessment instrument was developed having some parameters. Based upon responses to each parameter, a scoring system was also developed. Then comprehensive score was calculated for each respondent. Main Variable: Comprehensive score obtained by the interviewed individual was studied. Results: Only 41% ASHAs and 28% VHSNC members were trained in CBM by the concerned NGOs. The Mean score of ASHAs’ was 7.52. The mean score was 6.55 for trained members of VHSNC and 5.00 for un-trained members. Discussion: The interviewed members were lacking in core areas. The members are not ready to take ownership and to monitor services. Conclusions: The training and implementation of CBM did not have any difference in awareness and active participation of ASHAs. This may be due to improper coverage of training. The training helped VHSNC members in improving score but actual implementation of project did not improve the score.
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We assessed the feasibility of involvement of Accredited Social Health Activist (ASHA) in newborn care. All the ASHAs (n = 33) of PHC Dayalpur, Faridabad district of Haryana were trained for one day which was followed by two refresher trainings. The mean (SD) knowledge score (out of 11) of ASHAs were 6.45 (2.44), 6.50 (2.01), 7.45 (1.36) and 7.15 (1.27) at pre-training, immediately after training, and after three and six months, respectively. Four fifth (83%) of the newborns born at home were weighed within 3 days of birth. About half (44%) of ASHAs weighed the neonates within ±250 grams of the weight recorded by the author. We conclude that ASHAs could be involved in providing care for newborn. However, such efforts should ensure a stronger focus on skill development and practical experience.