Asha: Accessibility, Functions, Obligations, Compensation, Benefits And Facilitators of Asha

ASHA stands for Accredited Social Health Activist, a female community health activist with training. The ASHA will be trained to act as an intermediate between the public health system and the community, having been chosen from within and held accountable to it. There were more than 10.52 lakh ASHAs as of June 2022. Except for Goa, all states and union territories currently implement the ASHA program.

ASHA selection standards in remote areas

• ASHA must be primarily a married, widowed, or divorced woman who lives in the community; ideally, she should be between the ages of 25 and 45.
• She should be a well-educated woman who gives precedence to candidates who meet the requirements up to the tenth standard, provided that they are both available and of interest. If no one eligible who meets this need is available, then this may be reduced.

The selection procedure for ASHA would be stringent and involve many community groups, self-help groups, Anganwadi Institutions, Block Nodal officers, District Nodal officers, the local Health Committee, and the Gramme Sabha.

ASHA accessibility In urban areas

To be selected as an ASHA, a woman must:

• Live in one of the designated "slum/vulnerable clusters" and be a member of the specific vulnerable group that the City/District Health Society has recognized.
• She should ideally be between the ages of 25 and 45 and identify as "Married/Widow/Divorced/Separated."
• ASHA should possess strong leadership abilities, be able to engage with the community and be fluent in the language of the region or population she is required to cover.
• She needs to be a woman of literacy with at least a tenth-class formal education. Women in Class XII who are motivated and willing should be given priority since they may eventually be admitted to ANM/GNM institutions as a means of advancing their careers.

If there are no qualified women in the area who belong to that specific vulnerable group, then the age and educational requirements can be relaxed. Maintaining a balance between education and the representation of the marginalized is important. For her to find the time to complete all of her tasks, she should have the support of her family and friends. To better serve these groups, adequate representation from underrepresented population groups must be guaranteed.

current women Community workers under other programs, such as urban ASHAs, link workers under NRHM or RCH II, JnNURM, SJSRY, etc., may be granted precedence if they can devote time for their activities and meet the aforementioned residency, age, and educational requirements.

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ASHA accessibility in rural areas

For every community with a population of 1000 or more, there is one Community Health Volunteer, or ASHA (Accredited Social Health Activist). About her recruitment, the States are permitted to flexibly relax both the educational requirements and the population criteria based on the specific circumstances of each locality.

In cities

• The City/District Health Society must plan out the city and urban regions, analyze the vulnerability of the people living in slums or conditions similar to them, and identify these "slum/vulnerable clusters" before choosing an ASHA.
• In urban areas, it is generally accepted practice to choose one ASHA for every 1000–2500 people. Given that homes in urban settings are typically found in very small geographic areas, an ASHA can, depending on spatial considerations, encompass anywhere from 200 to 500 families.
• Another ASHA may be contacted when the population it covers surpasses 2,500. When socially and economically disadvantaged populations are geographically dispersed or live in scattered settlements, the ASHA "slum/vulnerable clusters" selection process can be used for a smaller population.
• It will be preferable to choose more than one ASHA below the designated population standard when more than one ethnic or vulnerable group is present in a given geographic area. In this situation, one ASHA might be chosen from within a certain vulnerable group to better meet their unique requirements through an appropriate comprehension of the sociocultural customs of that community.
• To provide services at the doorstep, the chosen ASHAs will ideally be co-located at the Anganwadi Centre, which operates at the slum level.
• ASHAs will be chosen in metropolitan regions with 50,000 people or fewer, just like in rural ones.
• You can also use the other community volunteers that were established under other government programs for this reason.

Functions and Obligations of ASHA 

An ASHA is a community-level care provider in their position. To improve health outcomes, a variety of tasks are involved, such as facilitating access to health care services, raising awareness of health care entitlements, particularly among the impoverished and marginalized, encouraging healthy behaviors and organizing for collective action, and providing curative care when necessary and in line with her training and skill set.

ASHA's compensation

An ASHA employee is essentially an "honorary volunteer," but in some circumstances (such as training attendance, monthly reviews, and other meetings), she may get payment for her time. She also qualifies for rewards provided by several federal health initiatives. 

Additionally, she would get money from social marketing of specific medical supplies like sanitary napkins, condoms, and tablets for contraception. Her employment should be planned so that it doesn't interfere with her primary source of income, and she should be paid fairly through performance-based benefits for the time she devotes to these responsibilities.

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Benefit Package for ASHA

Pradhan Mantri Suraksha Bima Yojana would provide coverage for ASHAs and ASHA Facilitators (Life Insurance). The age range for eligibility is 18–70 years. Coverage runs for a full year, from June 1 to May 31. The benefits are as follows:

Pradhan Mantri Jeevan Jyoti Beema Yojana (PMJJBY): an annual premium paid by the Government of India, with a benefit of Rs. 2.00 Lakh in the event of the insured's death.

The Pradhan Mantri Suraksha Bima Yojana (PMSBY) provides benefits of Rs. 2 lakh in case of accidental death or permanent disability, and Rs. 1 lakh in case of partial disability, with the Government of India contributing an annual premium.

ASHA workers can also apply for Pradhan Mantri Shram Yogi Maan Dhan (PM-SYM), which offers a pension benefit of Rs. 3000 pm after the age of 60 (beneficiaries contribute 50% of the premium and the government of India contributes 50%).

Incentives for regular activities would increase for ASHAs from the present Rs 1000 to a minimum of Rs 2000 per month. This will take effect in October 2018. Above and beyond the task-based rewards authorized at the Central and State levels is this.

At its seventh meeting, which took place on September 7, 2022, the Mission Steering Group of NHM authorized the following extra incentives for ASHAs:

• Offering a cash prize of Rs. 5,000 for each certification to recognize The accomplishment of ASHAs and ASHA Facilitators who have obtained two separate certificates of certification with success (i) RMNCHA+N (ii) expanded list of additional services, including palliative care, from non-communicable-diseases
• Offering ASHAs a reward of Rs. 10 for each ABHA account they create and seed on one of the MoHFW's several IT portals, such as the RCH Portal or the CPHC NCD Portal.
• Offering a reward of Rs. 50/-to ASHAs or community volunteers who help update the bank account details of TB patients who have been notified in the Nikshay portal within 15 days of the start of treatment to enable DBT payments under the National Tuberculosis Elimination Programme.
• ASHA and community health volunteers would receive a monetary incentive of Rs. 250 for each person who completes the TB preventive treatment.
• The following are ways to improve ASHA's incentives for referring SAM kids to NRCs for admission and for following up with kids who are released from NRCs: The ASHA incentive for sending SAM children with medical complications to NRCs was increased from Rs. 50 to Rs. 100 per child. 
• The ASHA incentive for follow-up visits with SAM children who are released from the NRC has been increased from Rs. 100 to Rs. 150 per child. (Rs 50 for the first and fourth visits, and Rs 25 for the second and third visits).
• After all follow-ups are completed, the child in the ASHA case is proclaimed free of SAM status, with an additional incentive of Rs. 50/-per SAM child. 
• Offering incentives to ASHA workers in all four Kala-azar endemic states for the detection of PKOL cases and their full treatment at a rate of Rs. 500 per case (Rs. 200 at the time of diagnosis and Rs. 300 once treatment is finished).
• Increasing the ASHA incentive for each confirmed case of malaria from Rs. 75 to Rs. 200 to guarantee full treatment. 

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Facilitators of ASHA

An ASHA facilitator is in place for between 10 and 25 ASHAs as part of a support mechanism, to oversee performance and offer handholding and mentoring support. She is an essential component of the network of support structures. Over the past three years, states have made significant strides toward establishing support structures as they have come to understand the connection between robust support systems and an efficient ASHA program. 

The ASHAs themselves often choose the facilitators for the ASHAs. For ASHAs who meet the requirements in terms of ability, experience, and qualifications, this role also offers a career path. As of March 2022, there are 80,000 ASHA facilitators.

All states have chosen ASHA Facilitators, except Andhra Pradesh, Himachal Pradesh, Jammu & Kashmir, Kerala, Nagaland, Tamil Nadu, Telangana, West Bengal, Rajasthan, and UTs. In these states, ANMs or, in the case of West Bengal, the Supervisor designated by the Gramme Panchayat or PHC supervisors at the PHC level, as in the case of Rajasthan, offer ASHAs on-the-job mentoring support. 

If they meet all the requirements, more than half of the states (11 out of 19) with ASHA facilitators have chosen them from a group of ASHAs. The states of Madhya Pradesh, Odisha, Uttar Pradesh, Uttarakhand, Haryana, Karnataka, Punjab, Sikkim, and Bihar are among them.

ASHAs are given precedence when choosing ASHA facilitators in other states. Gujarat, Maharashtra, Mizoram, Tripura, Meghalaya, Assam, and Arunachal Pradesh. There are no ASHAs in Goa.

Approximately twenty supervision visits are made by ASHA Facilitators each month.  The supervisory visit fees for ASHA facilitators have been raised from Rs. 250 to Rs. 300 per visit, effective October 2018, to encourage them to perform better (to be paid in November 2018). ASHA Facilitators would therefore be paid roughly Rs 6000 a month.

ASHA Facilitators who have completed two independent certification exams will get a cash prize of Rs. 5,000 for each certification. (i) RMNCHA+N (ii) An expanded package of additional services that include palliative care in addition to non-communicable diseases (approved in the NHM Mission Steering Group at its 7th Meeting on September 7, 2022)

The following is a general summary of the role of ASHA facilitators:

• Visit villages (including going with ASHA on home visits, presiding over community/VHSNC meetings, and participating in Village Health and Nutrition Days).
• Organize monthly cluster meetings involving all ASHAs in the region.
• Allow ASHAs to connect with the households who are most disadvantaged.
• Encourage block-level ASHA training.
• Assist in choosing new ASHAs.
• Make it easier to resolve grievances.

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