ASHA Program in India

Lessons learned

Dr Rajesh Jha
Joint Director,
Dept of Health & Family Welfare,
Govt. of Uttar Pradesh,
India
Background

India launched the ASHA program in 2005-06 as

part of the National Rural Health Mission (NHM)
Biggest inspiration for designing the ASHA
programme came from the Mitanin initiative of
Chhattisgarh (Mitanin meaning ‘a female friend’ in
Chhattisgarhi) which had started in May 2002.
The Mitanin were the all-female volunteers
available for every 50 households and 250 people.
With the launch of the National Urban Health
Mission in 2013, the program was also extended to
urban settings.
Now we have more than 1 million ASHAs working
in India.
Who is an ASHA
(Accredited Social Health Activist)

ASHA must be primarily a woman resident of the village;

◦ ‘Married/Widow/Divorced’ and preferably in the age

group of 25 to 45 yrs.

◦ Effective communication skills, leadership qualities

◦ literate woman with formal education up to Eighth Class

◦ ‘One ASHA per 1000 population’

◦ In tribal, hilly, desert areas -1 ASHA per habitation

Selection, governance and capacity building

• 1 ASHA for 1000 population in rural area and

200 to 500 household in urban areas
• The selection of ASHA is made by the local
self-governance (elected representatives).
• Structured Induction training followed by
module related to various program
• Grievance redressal mechanism to bring
the safe working environment
• Mentoring structure to provide mentoring
and handholding to ASHA.
• Certification of ASHA to promote peer
progression.
 Community based platforms to strengthen the ASHA Programmes

Convergence Planning and
Service delivery
platforms
Strengthening Village Health and
Nutrition Days
Microplanning, Logistics availability,
Mobilization Onsite mentoring and
supportive supervision
2 3
Coordination Platforms
Strengthening ASHA AWW^
ANM^^ meetings
Improved and coordinated due-list
Problem solving and planning
Sankul meetings for coordination
between ASHA and ASHA Sangini
4
Capacity Building
Tools and Job-aids
Transformation of cluster Village Health Index Report /
meetings as capacity building ASHA Diary
platforms for ASHAs
ASHA Sangini Diary
Onsite mentoring of ASHA
High-Risk Pregnancy and Low
Sanginis and ASHAs
Birth Weight newborns tracking
Tools

^AWW: Anganwadi Workers: Digital application to create health

records
^^ ANM: Auxiliary Nurse and Midwife
 Roles and responsibilities

Provide information to the Facilitate the community in accessing

community on determinants of Mobilize the health-related services
health Nutrition Awareness
community Immunization, Ante Natal Check-up (ANC),
Post Natal Check-up (PNC), ICDS, sanitation
Basic sanitation & hygienic and other services being provided by the
practices government.
Roles and
responsibilities

Counsel women on birth Work with the Village Health &

preparedness and institutional Comprehensive Sanitation Committee of the Gram
delivery Mother & Child Village Health Panchayat to develop a comprehensive
Plan village health plan.
Infection (RTIs/STIs) and care of
the young child Accompany pregnant women & children
requiring treatment/ admission
 ASHAs and COVID-19

• Migration tracking: more than Three Million

migrants tracked and entered on the portal.
• Health Education related to COVID: Mask, Hand
washing, and social distance
• Provision of Personal Protective Equipment (PPE)
to FLWs
• Support in rollout of Aarogya Setu App (GoI)

Asha workers win Global Health Leaders

Award – WHO
https://www.who.int/india/india-asha-
workers
Lesson learnt

Community Engagement: Community involvement in

the program boosts trust, healthcare awareness, and
resource usage.

Incentives and Recognition: ASHAs need incentives

and recognition to stay motivated. Financial rewards and
acknowledgments can improve their performance.

Capacity Building: In healthcare, ASHA workers require

ongoing training to enhance their skills, knowledge, and
confidence. This training takes place during ASHA
Cluster Meetings as health is a constantly evolving area.
Lesson learnt

Integration with Health Systems: The collaboration

among ASHAs, primary healthcare centers, and other
healthcare providers resulted in a more efficient service
delivery, and consistent care, and prevented redundant
efforts.
Leveraging Technology: Mobile applications,
telemedicine, and digital health records have the potential
to enhance communication, data management, and
decision-making processes, resulting in improved
accessibility and streamlining of healthcare services.

Sustainable Financing: Governments and policymakers

need to allocate enough resources and find new financing
approaches to sustain the ASHA program.
Thank you