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ASHA accredited social health activist India roles functions community health

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ASHA - Accredited Social Health Activist

Introduction

ASHA stands for Accredited Social Health Activist. It is a key component of India's National Rural Health Mission (NRHM), launched in 2005, under the Ministry of Health and Family Welfare. The concept is to have a health activist in every village who creates awareness, facilitates access to health services, and acts as a link between the community and the formal healthcare system.
  • Park's Textbook of Preventive and Social Medicine, p. 997-998

Selection Criteria

  • Must be a resident of the same village she serves
  • Woman - married, widow, or divorced
  • Age group: 25-45 years (preferably)
  • Education: Minimum 8th class (formal education)
  • Should have communication skills and leadership qualities
  • Adequate representation from disadvantaged/marginalized groups is encouraged
  • Norm: 1 ASHA per 1,000 population
  • In tribal, hilly, and desert areas: 1 ASHA per habitation (norm relaxed)

Training

ASHA undergoes phased training (23 days in the first phase, then continuing education) conducted at the sub-centre and PHC level. ANMs and Anganwadi Workers (AWWs) serve as resource persons for her training.

Role and Responsibilities

  1. Health awareness: Creates awareness on determinants of health - nutrition, basic sanitation, hygiene, healthy living/working conditions, and available health services.
  2. Counselling: Counsels women on birth preparedness, safe delivery, breastfeeding, complementary feeding, immunization, contraception, prevention of RTI/STI, and care of the young child.
  3. Facilitator/mobilizer: Mobilizes community to access services at anganwadi/sub-centre/PHC - immunization, ANC, PNC, supplementary nutrition, sanitation.
  4. Village health planning: Works with the Village Health and Sanitation Committee (gram panchayat) to develop a comprehensive village health plan.
  5. Escort/accompany: Accompanies pregnant women and children requiring treatment/admission to nearest PHC/CHC/First Referral Unit (FRU).
  6. Primary care provider: Provides primary medical care for minor ailments (diarrhoea, fevers), first-aid for minor injuries, and acts as a DOTS provider under the Revised National Tuberculosis Control Programme (RNTCP).
  7. Depot holder: Holds essential drugs/supplies - ORS, iron folic acid tablets, chloroquine, disposable delivery kits, oral pills, condoms. A drug kit is provided to each ASHA (contains both AYUSH and allopathic formulations).
  8. Enhanced provider role: States can explore graded training for newborn care and management of common childhood illnesses.
  9. Vital events reporting: Reports births, deaths, and unusual health problems/disease outbreaks to sub-centre/PHC.
  10. Sanitation promotion: Promotes construction of household toilets under the Total Sanitation Campaign.

Integration with Anganwadi Worker (AWW)

  • AWW organizes Health Days (once/twice a month); ASHA mobilizes women, adolescent girls, and children to attend
  • AWW acts as depot holder for ASHA's drug kit
  • ASHA assists AWW in updating eligible couple lists and mobilizing pregnant/lactating women for nutrition supplementation
  • AWW and ANM both serve as resource persons for ASHA training

Integration with ANM (Auxiliary Nurse Midwife)

  • ANM holds weekly/fortnightly meetings with ASHA to discuss activities and resolve problems
  • ANM informs ASHA about outreach session dates/times
  • ANM uses ASHA to motivate pregnant women for ANC visits and family planning
  • ANM guides ASHA on iron-folic acid compliance, tetanus toxoid, oral pill dose/side effects, and danger signs of pregnancy
  • ANM ensures ASHA receives compensation and TA/DA for training attendance

Incentive / Compensation

ASHA is a community-based volunteer, not a salaried worker. She receives performance-based incentives (not a fixed salary) for activities such as:
  • Institutional deliveries (JSY - Janani Suraksha Yojana)
  • Immunization
  • DOTS
  • Referral of TB patients, etc.

Significance

ASHA is the cornerstone of India's community health architecture. As of 2013, India had over 870,000 ASHAs, making it one of the largest community health worker programs in the world. She bridges the gap between the rural/tribal/underserved population and the formal health system, and has played a major role in improving maternal and child health indicators, vaccination coverage, and TB treatment outcomes.
Source: Park's Textbook of Preventive and Social Medicine, pp. 997-998 | Wikipedia - Accredited Social Health Activist
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