ABSTRACT
The Accredited Social Health Activist (ASHA) programme in India is the world's largest all-female Community Health Workers (CHWs) programme. ASHAs are supposed to bridge the gap between community and health services by functioning as healthcare catalysts, service providers, and community-level health activists. This paper discusses the ethical challenges posed by using the same template for capacity building of ASHAs in rural and urban contexts, without accounting for the differences. Urban heterogeneity and rapidly growing urbanisation demand special attention for crucial programme activities like the capacity-building of ASHAs. When the relevant literature like policy and programme documents, training modules, and implementation guidelines were analysed, it was evident that the simple transplantation of rural models to urban contexts would not be a useful strategy. The recommended areas for improvement are the urban-specific customisation of ASHAs’ roles, the consideration of urban heterogeneity in the training content and pedagogy, utilising the advantages of the urban set-up, ensuring supportive supervision mechanisms for ASHAs, strengthening overall inter-sectoral convergence and community processes in urban areas.
ABSTRACT
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.
ABSTRACT
Introduction: All people, everywhere, deserve the right care, right in their community. In any community, maternal mortality ratio strongly reflects the overall effectiveness of health systems. To increase utilization of existing health services, Accredited Social Health Activist (ASHA) is the key component of the National Rural Health Mission. o assess compare the level of knowledgeO : bjective T any of ASHA workers regarding maternal health services in between rural and urban areas of a block of Haryana. Method: The present cross-sectional, community-based study was conducted in block Barwala, district Hisar of Haryana. The assessment of knowledge of ASHA workers was done on the basis of scoring. Appropriate statistical tests like percentages and chi-square (?2) test were applied. RegardingResult :s maternal health services majority of ASHA workers had good knowledge, assessed by score gained by them and none of them was having poor knowledge about maternal health services. However in rural area score, gained was better than urban area & the observed difference was found to be statistically significant. Knowledge of identification & treatment of anaemia and identification of danger signs during pregnancy were inadequate among ASHA workers of both areas. Knowledge of ASHA workers wasConclusion: inadequate as far as anaemia and danger signs during pregnancy were concerned. Frequent and regular refresher training should be organized in their working area.
ABSTRACT
Background: Breast cancer is the most frequent cancer in the world, and it is the main cause of death and morbidity in Indian women. Breast self-examination (BSE) is a routine exam that can detect 40% of breast abnormalities and involves two key components that is looking and feeling. Women should learn what is normal for them, so that they can recognize any changes immediately. Aim & objectives: 1) To assess Knowledge and Practice about Breast Self-Examination. 2) To assess awareness about warning signs of Breast cancer. Methodology: A Descriptive cross-sectional study was conducted among 55 Accredited Social Health Activists (ASHAs) in the month of January 2021 in the Rural field practice area of Rural Health Centre (RHC) attached to the Department of Community Medicine, Government Medical College, Visakhapatnam. A predesigned, semi structured questionnaire was used to assess the knowledge and practice of BSE. Data was entered in MS Excel and analysed using SPSS Version 17. Chi square test was applied to find out the statistical associations if any between categorical variables. Results: In the present study only 1.8% of the ASHA workers were found to have good knowledge. 41.8% and 56.3% had average and poor knowledge respectively about BSE. Out of 55 ASHA workers, 39 (71%) have heard of BSE, 25.4% were practicing regularly and 14.5% of them were practicing correct method. Conclusion: The Knowledge and Practice of BSE among ASHA workers was observed to be inadequate which points out the need for training programs to educate them.
ABSTRACT
Introduction: National Rural Health Mission (NRHM) was launched by Indian Government with key feature of introduction of a new designated health care worker – “Accredited Social Health Activist” (ASHA) who acts as interface between community and public health system. Objectives: To assess knowledge about MCH related functions and to estimate status of support to beneficiaries by “ASHAs”, To Assess Quality of Home Based New Borne Care performed by ASHA and to find out impact of number of modular training rounds on knowledge and practices of ASHAs. Methodology: A cross-sectional study was conducted during February 2019 to December 2020 using a mixed approach, with a combination of quantitative and qualitative research methods after approval of institutional Ethics committee. All Urban Health Centres (UHC) under Municipal Corporation in Ahmedabad were covered. From each UHC, 2 ASHAs were selected by lottery method. So, total 144 ASHAs were selected from 72 UHCs. Performance assessment was done by direct interview with ASHA and their beneficiaries. Results: All 144 ASHAs were aware about responsibilities of Antenatal-women registration and Immunization. Nearly all ASHAs (99.3%) knew about task of PNC registration. Escorting to delivery and tertiary care centre, if complications arise was facilitated by 61.8% and 29.2% ASHAs respectively. Conclusion: All ASHAs were aware of their major responsibilities related to MCH and also providing same in their field area. Statistically significant association was observed between number of rounds for modular training undertaken by ASHAs and knowledge and practice of ASHAs in context to various components of MCH care.
ABSTRACT
Background: Mortality due to Non communicable disease (NCD) has increased from 50% to 60% in India from 2004 to 2014. Increasing mortality due to NCD has compelled Government of India to launch a national program (NPCDCS). This program has involved peripheral health workers hence this study was conducted to assess level of knowledge and attitude of peripheral health workers working in rural area of CHC Naila regarding NCDs. Methods: Present study was conducted at CHC Naila, Rajasthan, during June to Dec 2019. All (38) peripheral health staff working under CHC Naila were assessed and categorised regarding NCD and NPCDCS program. Results: Majority (77%) peripheral health workers had more than ten years of field experience. All have heard about NPCDCS program and type of NCDs covered under it. they were aware of sign & symptoms of common NCDs, however 18.42% of these were not aware of their role of community awareness about risk factors of NCDs and conducting regular screening. Conclusion: Though the level of awareness of health workers regarding type of NCDs, its consequences and risk factors was good however skill development training is needed so that they can screen people effectively and motivate them for healthy life style for optimum result.
ABSTRACT
Background: Safe motherhood is about informing and educating woman about danger signs in pregnancy, how to identify and seek advice from health personnel and prepare for safe confinement. In public health system, in India it is the responsibility of ASHA to motivate the pregnant woman in her area for safe institutional delivery. BPACR is a tool which assesses, how well the pregnant women are prepared for the challenges in pregnancy. Aim& Objective: To ascertain the level of awareness of Birth Preparedness and Complication Readiness (BPACR) among antenatal mothers residing in urban slums . Methodology: A community based cross-sectional study was conducted among pregnant women residing in urban slums of Shivamogga, Karnataka. Data was collected using pre-designed questionnaire, 揗onitoring BP/CR?tools and indicators for maternal and new born health� of the 揓HPIEGO�. Data was analysed and results were tabulated. Results: In this study, only 42% of pregnant women knew about the term 態irth preparedness� while the rest 58% pregnant women did not know it. Education status and complication experienced during present or previous pregnancy were found to have significant association with BPACR. Identification of blood donor and skilled birth provider were less among study group. Conclusions: Awareness of danger signs and complication readiness was found to be good in our study.
ABSTRACT
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.
ABSTRACT
Purpose: Community volunteers like Accredited Social Health Activists (ASHAs) could be utilized for linking community and eye care services. Research is needed to effectively utilize them. This study was to assess whether ASHAs could imbibe new knowledge in eye care and conduct vision screening. Methods: Settings and Design: A pre?post?intervention study in South Delhi Integrated Vision Centres. It was conducted from January 2016 to March 2017. One day of conceptual training followed by hands?on training in vision screening was imparted to ASHAs. The knowledge was assessed thrice: before, immediately after, and following 1 year after training. The vision screening skill was assessed twice. Descriptive analysis using percentages, mean and standard deviations. Paired t?test was used for assessing the change in scores. Results: A total of 102 ASHAs were recruited. A significant increase in the knowledge score of ASHAs before (14.96) and after training (25.38) (P < 0.001) was noted. The knowledge score was sustained at 1 year (21.75). The satisfactory skill of vision screening was seen in 88 (86.3%) ASHAs after training, while 79 (77.5%) ASHAs still retained it after 1 year. Conclusion: The potential to involve ASHAs in community?based frontline eye care activities: awareness generation of eye diseases, identification of referrable conditions, and facilitating individuals to seek eye care facilities. This study informs about the duration, frequency, and content of the training. It also provides evidence on the improvement and sustainability of eye care knowledge and skills by ASHAs after conceptual and hands?on training
ABSTRACT
Background: The Rashtriya Bal Swasthya Karyakram (RBSK) program is technically known as Child Health Screening and Early Intervention Services. The main purpose of the program is to detect and manage 4Ds which are prevalent in children. Objective: The objective of the study was to assess the knowledge of ASHA workers as well as anganwadi workers about the RBSK in rural area of District Kathua using semi-structured questionnaire. Materials and Methods: The present study was a cross-sectional descriptive study conducted in the zone Budhi which is a field practice area of the Department of Community Medicine, GMC Kathua. The zone consists of 24 villages with 18 ASHA workers and 35 anganwadi workers and one mobile RBSK team available at Community Health Center, Parole. After obtaining ethical clearance, all the ASHA workers and anganwadi workers were included in the study as they were willing to participate. Results: The present study revealed that majority of the workers were between the age group of 20–40 years. About 71.42% of the anganwadi workers were 12th pass and majority of the ASHA workers were 8th and 10th pass. Majority of the anganwadi workers received training related to RBSK program and knew about the benefits of the RBSK program. About 82.85% of the workers knew about the equipment used by RBSK team members for screening. Conclusion: Anganwadi workers and ASHAs need to be made aware of their perceptions and role in the program so that their efficiency is increased and the percentage of child morbidity and mortality can further be lowered.
ABSTRACT
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.
ABSTRACT
Purpose: An Accredited Social Health Activist (ASHA) available in community could be a potential primary eye care (PEC) worker. Training programme for ASHAs on PEC was undertaken & evaluated in a district of a capital city. Methods: ASHAs selected randomly from a district were imparted one day training on PEC & expected to refer patients to nearby Vision Centres (VC). Their knowledge was assessed before & after training and re-evaluated 1 year later. ASHAs were asked to conduct vision screening of 40+ population in their areas and ASHA referrals were noted by Optometrist in VC. Focus Group Discussions (FGD) of ASHAs were held to find barriers & facilitating factors in engaging ASHAs in PEC. Training was evaluated using Kirkpatrick's evaluation model for measuring reactions, learning, behaviour and results. Results: Mean knowledge score increased from 14.96 (±4.34) pre-training to 25.38 (±3.48) post- training and sustained at 21.75 (±4.16) at 1year. Monthly average OPD of vision centres increased by 23.6% after ASHA training. FGDs revealed that ASHAs were willing to work in eye care for awareness generation and patient facilitation but were hesitant in conducting vision screening. Conclusion: ASHAs can be trained as PEC workers provided they have adequate support.
ABSTRACT
Background: The post-natal period is the most critical time for the mother and the newborn. Most of the maternal deaths occur in first month of life. Based on these facts Government of India took an initiative, home based postnatal care (HBPNC), to follow up postnatal mothers and newborns for first six weeks. The present study assessed the quality of HBPNC provided by accredited social health activist (ASHA) workers and various factors associated with it.Methods: This cross-sectional study was conducted under Community Health Center, Dubaldhan in block Beri of Haryana. A total of 60 ASHA workers were visited and all the postnatal mothers under the supervision of each ASHA worker were included in the study. In this way 264 postnatal mothers were contacted. A scoring system was used to assess the quality of HBPNC given by ASHA worker.Results: Majority of ASHA workers were not able to record temperature and weight of the baby correctly. Regarding care of cord and danger signs in newborn only half (50%) of the mothers were counselled, whereas, only 48% mothers were counseled regarding care of eyes. Statistically significant association of quality of newborn care with education and training attended by ASHA workers was seen.Conclusions: Our study confirmed that most of the new born babies were not getting good quality of home based newborn care. Recent training attended by ASHA worker is highly associated with providing good quality newborn care to babies by ASHA workers.
ABSTRACT
Background: ASHA is a health activist in the communities who creates awareness on health and its social determinants and mobilizes the community towards local health planning and increased utilization and accountability of the existing health services. This study was conducted with the aim of evaluating the work performance of ASHAs in tribal and remote rural areas in Kurnool division of Kurnool district.Methods: This is a community based observational and cross sectional study carried out from July 2014 to July 2015. Six PHCs of Atmakur CHNC namely Kottalcheruvu, Bairluty, Kothapally, Yerramattam, Gokavaram, Pamulapadu were selected for the study by using multistage random sampling technique. 65 ASHAs from 20 SCs of these six PHCs had participated in the study for evaluation of their performance in the field.Results: Majority of ASHAs had average level of the performance in counselling of antenatal cases, escorting postnatal cases, motivating cases for family planning adoption, escorting family planning cases whereas the performance level was found to be good among majority of ASHAs with regard to escorting antenatal cases, counselling of postnatal cases and getting children immunized. Majority of ASHAs were not performing activities regarding creating awareness on social determinants of health, providing primary medical care for minor ailments, informing births and deaths to SC/PHC, distributing ORS, IFA and chloroquine.Conclusions: Regular on job training as well as review training for ASHAs every 6 months helps them to increase their participation in various activities with a rejuvenated enthusiasm. The incentives for ASHA must be raised and paid promptly to them to improve their performance.
ABSTRACT
Background: Job satisfaction of accredited social health activist (ASHA), a voluntary health worker under national health mission, is not yet documented in many areas of the country. The present study assessed the job satisfaction of ASHA in Bhatar community development block of Purba Bardhaman district, West Bengal.Methods: A cross sectional study was undertaken during September–November 2017 among all the 191 ASHAs in Bhatar block. With prior consent, interviews were conducted using a questionnaire developed based on measures of job satisfaction (MJS) tool. The questionnaire contained total 28 items in six individual facets of satisfaction-personal component, workload, professional support, training, incentive and care providing. Responses for each item were recorded in 3-point Likert’s scale, total score ranging from 28–84. Overall satisfaction was categorised as dissatisfied (score=28), neutral (29-56) and satisfied (57-84) and similar categorisation was done for individual facets. Chi square test was applied to determine associated factors.Results: Overall 93.7% ASHAs were satisfied with their work, 6.3% were neither dissatisfied nor satisfied. Majority were satisfied regarding individual facets except incentive; 73.3% were rather dissatisfied. Overall satisfaction was significantly associated with the service duration of ASHA (p=0.001).Conclusions: Overall satisfaction level among ASHAs in the area though are quite high, some individual aspects like incentives needs to be looked into. Further studies will be helpful to delineate many unexplored reasons or aspects which might be necessary for developing strategies.
ABSTRACT
Background: Cervical cancer is one of the most prevalent cancers among Indian women. Cervical cancer incidence reduces dramatically when effective screening programs linked with access to treatment are in place and are readily accessible. Peripheral health workers (PHWs) being frontline workers have a major influence on raising awareness among community about acceptability of available screening programmes. This study was thus conducted to assess the awareness of PHWs regarding risk factors, signs and symptoms, early detection and prevention for cervical cancer.Methods: A questionnaire-based study was conducted among 450 PHWs (ASHAs and BHWs). Information was collected regarding their bio-social characteristics, awareness about female cancers, risk factors, signs/symptoms, early detection methods and services available for screening and prevention of cervical cancer.Results: Awareness of different aspects of cervical cancer was found to be very low. Only eight per cent of the PHWs had good awareness score. BHWs obtained statistically significant better mean scores as compared to ASHAs. Few (7.6%) PHWs had received training for any type of female cancers. Only 17 per cent of the PHWs were aware of HPV vaccine availability and only 29 per cent from them could name the vaccine.Conclusions: Majority of the PHWs had poor awareness about cervical cancer and available screening facility in our health system. They had almost no idea of availability of free HPV vaccination at the Sampoorna clinics. This low level of awareness calls for regular training of PHWs on cervical cancer which would ultimately trickle down to the community.
ABSTRACT
Background: The National Rural Health Mission (NRHM) aimed to bridge the gap in rural health care with the introduction of the Accredited Social Health Activist (ASHA) in 2005. It is essential to identify the motivators and barriers to work performance by the ASHAs in order to facilitate better health care in the community. Objective: To identify the motivators and barriers to the work performance of ASHAs in the Solur PHC area, Ramanagara district, Karnataka. Material & Methods: A qualitative study was conducted in one PHC area of Ramanagara District, Karnataka. Four KIIs with government health functionaries and one FGD with nine ASHAs were conducted. A thematic frame-work approach was used for data analysis. Results: The main personal motivators were altruism and intrinsic satisfaction, while social support and team-work were important environmental motivators. De-motivating factors were financial problems such as insufficient pay and irregular financial incentives, as well as logistic difficulties, including transportation and safety. Conclusion: Personal, cultural, financial considerations and working conditions affect the performance of an ASHA. It is essential to address relevant issues faced by these health workers in order to improve their work satisfaction and efficiency.
ABSTRACT
Background: Accredited Social Health Activist (ASHA) forms the backbone of NRHM who provides promotive, preventive, and curative health facilities in especially the vulnerable groups. There is a need to comprehensively look into the knowledge and performance of ASHA in terms of her job responsibilities in maternal health, hence this study was conducted to assess knowledge regarding maternal health care among the ASHA workers and to assess the impact achieved after the training programme.Methods: Community based interventional study was conducted among ASHA’s in Jawadhu Hills between April to July 2017, a pretested semi structured questionnaire was administered to elicit the knowledge of ASHA in regard to maternal health care. After the initial assessment, an intervention training programme was conducted based on a module prepared in their native language and post training assessment was done after two months. The statistical tests used were proportions, chi-square test. A p value less than 0.05 was considered to be significant.Results: Based on the initial assessment around 60% of ASHA knew about the core ANC, which statistically (p<0.05) improved after the training programme. Based on danger signs of pregnancy less than 10% knew about vaginal bleeding (3.8%), swelling of legs (4.8%), visual disturbances (6%) which statistically (p<0.05) improved after the training.Conclusions: Knowledge of ASHAs on various aspects of maternal health care was moderately adequate, before the training programme and it was significantly improved after the training programme, which shows that there is a need for regular fixed training programme to maintain the performance of ASHA
ABSTRACT
Background: Our aim was to study the socio demographic determinants of ASHA workers, to study the work profile of the ASHA workers, to assess the knowledge, awareness and practice of their roles and responsibilities in the delivery of health care services and to suggest specific recommendations on the ASHA scheme based on the study findings.Methods: The type of study was a cross sectional study, placed at Khordha district in Odisha. Time Period of this study was March to June 2018. 1218 ASHAs were finally included in the study. On the days of the monthly sector / block level meetings with ASHA workers they were appraised and accordingly a predesigned, pretested questionnaire was implemented to them.Results: Nearly 93% of ASHA workers were trained with module 1 to 5, first AID and DOTs training. Refresher training was given to 34% of ASHA workers, FTD/Malaria training was given to 88.4% of ASHA workers. 1218 (100%) ASHA’s helped in immunization. Majority of them 1199 (98.4%) accompanied delivery cases and 1198 (98.3%) were aware about family planning activities.Conclusions: Activities of ASHA’s should be increased with a corresponding increase in incentives, so that she can get up to Rs. 10000-15000 per month. IEC/BCC skills to ASHA may be built by short course certification. Other services like strengthening the role of ASHA on promotive and preventive health care particularly age at marriage, nutrition, home based care delay in first child birth and spacing between 1st and 2nd birth.
ABSTRACT
Background: Fast food culture is a vigorously uprising trend among the youngster’s engaged in higher education as well. Objectives: To assess fast food consumption among female research scholars of a central university and to identify influencing factors for the prevailing situation. Material and Method: For this cross sectional study 282 female research scholars of Banaras Hindu University were selected through multistage sampling. They were interviewed with pre-designed and pretested proforma about socio– demographic characteristics and consumption of fast foods. Results: Out of 282 subjects, 69.5% subjects consumed fast food daily whereas in case of 12.4% subjects this was 3-4 days per week. Fast food consumption was significantly influenced by area of residence, type of family, religion, caste, family size, source of income and socio-economic status. Consumption of fast food on daily basis was more in subjects from, urban area (77.8%), nuclear family (71.1%), family size 3 (81.9%), source of income other than service and business (73.0%) and SES I (74.9%). As per logistic model higher AORs were for urban area (4.77; 95% CI : 2.28-10.0); OBC caste (3.02; 95%, CI 1.45-6.27), and when total family member were 3 (3.51; 95%; CI 1.34-9.22). Conclusion: Fast food consumption was considerably high by female research scholars and area of residence, caste and family size were its significant predictors.