|LETTER TO THE EDITOR
|Year : 2016 | Volume
| Issue : 3 | Page : 275-276
Accredited social health activists epitomize rural social change and Women's empowerment in India
Department of Community Medicine, Yenepoya Medical College, Yenepoya University, Mangalore, Karnataka, India
|Date of Web Publication||11-Apr-2017|
Department of Community Medicine, Yenepoya Medical College, Yenepoya University, Mangalore - 575 018, Karnataka
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Bhargava M. Accredited social health activists epitomize rural social change and Women's empowerment in India. Educ Health 2016;29:275-6
The World Health Organization defines community health worker as those workers who live in the community, are accountable to the community they work within, receive a short, defined training, and are not necessarily attached to any formal institution. India launched a flagship program, the National Rural Health Mission in 2005 to provide accessible, affordable, and quality healthcare to the rural population keeping in view the underlying shortage of health-care personnel. The main thrust was on having a functional, community owned, decentralized health delivery system which comprehensively covers the primary care principles and ethos. An important highlight of this initiative was Accredited Social Health Activist (ASHA) who is a local woman volunteer to be trained to serve as a link between public health system and community.
There are more than 900,000 ASHAs under the renamed program, the National Health Mission, and they are now a vital and integral part of public health system of India. They contribute significantly in mother and child health-care services with special foci on promoting institutional delivery and immunizations. Moreover, their work has expanded to include health promotion and disease prevention and activities related to communicable diseases and sanitation. Most of these women come from poor socioeconomic background, and monetary incentives are important motivators for them.
A survey of 81 ASHAs was conducted in May–July 2015 in the Dehradun district, North India. The detailed methodology and findings are described elsewhere. The study was preceded by several informal meetings with the ASHAs, ASHA facilitators, and village women. The present letter highlights reflections from this interaction with them and the beneficiary village women.
| Accredited Social Health Activist as a Health Worker|| |
With more than decade-long association of ASHAs with public health system, ASHAs and rural health are now inseparable. From the perspectives of the ASHA and village women, the strong position of ASHA's in the village community cuts across gender and social status. They play an important role in increasing access to health-care services and possess a key to understanding the sociocultural determinants of health of local communities. With their thorough knowledge of the health events and milestones of the residents in their work areas, they are recognized as repositories of valuable knowledge pertaining to important drivers of health behaviors in the community. Unfortunately, the present hierarchical system allows only for transactions such as distribution of work and incentives. Although their importance in the village is well-recognized, they do not receive the same recognition from the regular government health staff. Unfortunately, AHSAs are sometimes not given adequate respect or their contributions are not recognized by the professional staff with whom they interact within the government health system.
| Accredited Social Health Activist: Is She Really a Voluntary Health Worker?|| |
The author attended one of the regular monthly meetings of more than 50 ASHA workers and their facilitators. At the meeting's tea-break looked like any school lunch break: the ASHA's looked like excited school girls, enjoying the chance to meet their colleagues, and discuss shared issues. However, the regimentation that has evolved was painfully visible. The ASHAs had to don pink-colored aprons over their saris or dresses (with ambient temperature of more than 35 Celsius). Moreover, many were busy trying to complete their record books that their facilitator was to check at the end of the meeting While the record books are important for programmatic monitoring and evaluation, they take away some of the feeling and joy of voluntariness.
| Accredited Social Health Activist as a Symbol of Women Empowerment|| |
Women's empowerment encompasses five major components. These are the sense of self-worth, the right to have and determine choices, the right to have access to opportunities and resources, the right to have power to control their own lives, both within and outside the home, and the ability to influence the direction of social change. In this context, ASHAs can be seen as agents of women's empowerment. Their understanding of financial issues, banking, travel, etc., instills a sense of independence and empowerment which is unprecedented for women in their communities. This, along with their new financial contribution within the family, gives them better decision-making ability and right to exercise choices. Her self-reliance and confidence influence other women of the community, and they are looked on to negotiate for public transport, public health system, banks, and postoffice.
| Accredited Social Health Activist as a Working Mother|| |
Like any Indian woman, urban or rural, ASHAs are involved in family care, cooking and domestic work, agricultural work, and managing household food security. They also have responsibilities to their wider family. The expanding number of responsibilities added element of accountability through their log-books, the frequent need to travel to escort women to health institutions for services creates daily stress for these women. An ASHA follows a pregnant woman for 9 months, escorts her during her delivery, and receives an incentive of about 4 or 5 US dollars in the end from the government. She risks losing this incentive if she is not able to escort this woman for her delivery due to family circumstance or should the mother choose to deliver in private hospital. There is always this financial unknown and worry.
| Accredited Social Health Activist as a Link among Other Governmental and Nongovernmental Health Agencies|| |
There is a large-scale partnership of many voluntary organizations with the state government in the field of National Health Mission in the training of ASHAs ASHA's and developing the resource materials they use. This connection with many organizations and agencies provides a special opportunity for ASHAs to develop their own Network in the health field. They essentially function as central players for the many health initiatives undertaken by these agencies. Moreover, departments of community medicine in government and private medical colleges contact them for field work of undergraduate and postgraduate students. While this provides further opportunities for these aspiring women, they are also inadequately compensated by these institutions.
To conclude, there is a clear need to continue training and supporting these women who are more rooted in their communities than any trained family care practitioner. The legacy of change produced among rural women by ASHAs will remain even should they someday no longer be working in the health sector.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Swider SM. Outcome effectiveness of community health workers: An integrative literature review. Public Health Nurs 2002;19:11-20.
Lavanya A, Bhargava M. Keeping up the morale of the foot soldiers of Indian public health: An appraisal of the economic aspects of ASHAs in Uttarakhand, India. Int J Community Med Public Health 2015;2:494-500.