MORE THAN 700 Accredited Social Health Activists (ASHA) would be available in 645 villages of Indore district from January 2007 as part of a Statewide programme to achieve targets of reducing maternal mortality rate (MMR) to 100 and infant mortality rate (IMR) to 60 by 2012 as per National Rural Health Mission (NRHM) goals for Madhya Pradesh.
Faced with numerous problems while dealing with rural healthcare, particularly reproductive and child health (RCH), the NRHM, which was launched in April 2005, set the lofty goal of bridging the gap through ASHA cadres - necessarily a ‘bahu’ (daughter-in-law) of the village. This is because they feel that a daughter-in-law would continue to stay in the village for the rest of her life.
“The most vulnerable population in rural areas is women and children. More than 60 per cent of our health problems and related social problems would be solved if we take care of this group. That is why the NRHM decided to focus on women and children,” according to Dr Utsuk Datta from National Institute of Health and Family Welfare (New Delhi) who was here to participate in a symposium organised by Indian Council of Medical Research.
Trained to be the person to be contacted first in any health-related problem, particularly that of women and children, ASHA would take care of various health activities like assisting expectant mothers to be taken to nearest health facility for institutional delivery, carrying our periodical vaccination and immunisation programmes, conducting health awareness activities in view of special health days and also help aganwadi workers, ANMs and other health officials - who are burdened owing to the large population they cater to - in implementing village health plan.
Other work would be treating common ailments like cough and simple fever with basic allopathic and AYUSH drugs, which would be part of the kit given by the government and last but not the least, monitor health parameters like nutrition levels and incidence of certain diseases in her area.
“We purposely avoided government personnel here as this is not a salaried job but incentive-based work and we feel the villagers would identify more if ASHA is their own person,” Dr Datta said adding, “the woman chosen by the Panchayat itself would be given an initial training for seven days and then four days each every four months.”
Training for ASHA in Madhya Pradesh started some 10 months ago and most of the districts are through with the first phase target of selection and training 40 per cent ASHA cadre. In Indore district, with the first phase almost over, health authorities are looking forward to achieve the target soon for the second phase and are hopeful that by January 2007 all 735 ASHAs would be working in their respective villages.
But if there is a scheme, can problems be far behind? “Our first problem was to find suitable candidates. Thinking it is a government job, a tendency was observed to push the names of near and dear ones instead of the really qualified people,” said District Planning Manager for RCH here Dr Monika Mandloi, who is also the nodal officer for ASHA for the district.
“Another problem was that of dropouts at the very initial level. Almost 80-85 per cent target is achieved smoothly, but the remaining 15-20 per cent brings down success rate,” Dr Mandloi said and added, “in spite of such problems, we are hopeful of achieving the target by December-end.”
Dr Devakinandan, associated with the training programme under NRHM, who was also here in connection with the ICMR symposium, said, “It is necessary to break the vicious inter-generational cycle of malnutrition. We have the biggest challenge to reduce and end malnutrition, morbidity and mortality and we hope ASHA would go a long way in achieving it.”