The World Health Organisation (WHO) has recognized the contribution of India’s 1 million Accredited Social Health Activists (ASHAs) during the Covid-19 pandemic. It is acknowledged that ASHAs facilitate linking households to health facilities, and play pivotal roles in house-to-house surveys, vaccination, public health and Reproductive and Child Health measures.

How ASHA workers compliment public health care

• One of the key components of the National Rural Health Mission is to provide every village in the country with a trained female community health activist ASHA or Accredited Social Health Activist. 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.
• The role of an ASHA is that of a community level care provider. This includes a mix of tasks: facilitating access to health care services, building awareness about health care entitlements especially amongst the poor and marginalized, promoting healthy behaviours and mobilizing for collective action for better health outcomes and meeting curative care needs as appropriate to the organization of service delivery in that area and compatible with her training and skills.
• Empowered with knowledge and a drug-kit to deliver first-contact healthcare, every ASHA is expected to be a fountainhead of community participation in public health programmes in her village.
• ASHA will be the first port of call for any health related demands of deprived sections of the population, especially women and children, who find it difficult to access health services.
• ASHA will be a health activist in the community who will create awareness on health and its social determinants and mobilise the community towards local health planning and increased utilisation and accountability of the existing health services.
• She would be a promoter of good health practices and will also provide a minimum package of curative care as appropriate and feasible for that level and make timely referrals.
• ASHA will provide information to the community on determinants of health such as nutrition, basic sanitation & hygienic practices, healthy living and working conditions, information on existing health services and the need for timely utilisation of health & family welfare services.
• She will counsel women on birth preparedness, importance of safe delivery, breast-feeding and complementary feeding, immunization, contraception and prevention of common infections including Reproductive Tract Infection/Sexually Transmitted Infections (RTIs/STIs) and care of the young child.
• ASHA will mobilise the community and facilitate them in accessing health and health related services available at the Anganwadi/sub-centre/primary health centers, such as immunisation, Ante Natal Check-up (ANC), Post Natal Check-up supplementary nutrition, sanitation and other services being provided by the government.
• She will act as a depot older for essential provisions being made available to all habitations like Oral Rehydration Therapy (ORS), Iron Folic Acid Tablet(IFA), chloroquine, Disposable Delivery Kits (DDK), Oral Pills & Condoms, etc.

Challenges

• Low salary
• Safety issues
• No dedicated fund
• Abysmal training
• Weak incentivization scheme

Way forward

• As a sustaining motive, there is a compelling case for granting some of these roles permanent status with acceptable salary.
• Human resource participation in community-related sectors is influenced by the gradual growth of a local resident woman. This should also apply to other field workers including ANMs, GNMs, and Public Health Nurses.
• It is also critical to ensure that performance remuneration is timely and appropriate.
• Upgrading skill sets and making credit and finance more accessible will provide a long-term chance to make a decent life while helping the community.
• Access to affordable health insurance, financing for consumption and livelihood requirements, and coverage under pro-poor public welfare programmes would all help ASHAs become even more powerful change agents.
• An ASHA should be able to earn more than a government employee, with possibilities to advance up the skill ladder as an ANM/ GNM or a Public Health Nurse in the official primary health care system.

https://indianexpress.com/article/explained/asha-public-health-experiment-village-community-7932457/

How to structure

1. Give a brief intro about ASHA workers
2. Explain the importance of them in public health care
3. Mention challenges faced
4. Suggest measures
5. Conclude