An accredited social health activist (ASHA) is a community health worker instituted by the Ministry of Health and Family Welfare (MoHFW) as a part of India's National Rural Health Mission (NRHM).^[1] The mission began in 2005; full implementation was targeted for 2012. Once fully implemented, there is to be "an ASHA in every village" in India.^[2] In July 2013, the total number of ASHAs in India was reported to be 870,089.^[3] In 2018 the number of ASHAs were 939,978. The ideal number of ASHAs is 1,022,265.^[4]

Roles and responsibilities

ASHAs are local women trained to act as health educators and promoters in their communities. The Indian MoHFW describes them as:^[5]

...health activist(s) in the community who will create awareness on health and its social determinants and mobilize the community towards local health planning and increased utilization and accountability of the existing health services.

Their tasks include motivating women to give birth in hospitals, bringing children to immunization clinics, encouraging family planning (e.g., surgical sterilization), treating basic illness and injury with first aid, keeping demographic records, and improving village sanitation.^[6] ASHAs are also meant to serve as a key communication mechanism between the healthcare system and rural populations.^[7]

She will act as a depot holder 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.^[8]

The tableau of Ministry of Health and Family Welfare highlighting - 'Aasha' during the Republic Day Parade, 2006

Selection

ASHAs must primarily be female residents of the village that they have been selected to serve, who are likely to remain in that village for the foreseeable future. Married, widowed or divorced women are preferred over women who have yet to marry since Indian cultural norms dictate that upon marriage a woman leaves her village and migrates to that of her husband. ASHAs preference for selection is they must have qualified up to the tenth grade, preferably be between the ages of 25 and 45, and are selected by and accountable to the gram panchayat (local government). If there is no suitable literate candidate, these criteria may be relaxed.^[9]

Remuneration

Although ASHAs are considered volunteers, they receive outcome-based remuneration and financial compensation for training days. For example, if an ASHA facilitates an institutional delivery she receives ₹600 (US$8.40) and the mother receives ₹1,400 (US$20). ASHAs also receive ₹150 (US$2.10) for each child completing an immunization session and ₹150 (US$2.10) for each individual who undergoes family planning.^[10] ASHAs are expected to attend a Wednesday meeting at the local primary health centre (PHC); beyond this requirement, the time ASHAs spend on their CHW tasks is relatively flexible.

Monitoring and Evaluation under National Rural Health Mission

A baseline survey is to be taken at the district level. It is for fixing decentralized monitoring goals and indicators. The community monitoring would be at the village level. The planning commission would be the eventual monitor of outcomes. External evaluation will be taken up at frequent intervals.