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Accredited social health activist (ASHA)

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Accredited social health activist (ASHA)

 Accredited social health activist (ASHA) is a key link to public health services in villages in India. We conducted a cross-sectional study to determine the proportion of women utilizing services of the ASHA for pregnancy-related conditions. We assessed the knowledge, attitude, practices, hindrances and motivation factors among ASHAs regarding pregnancy-related conditions. We also sought to determine the factors associated with the utilization of ASHAs for pregnancy-related services. Presently 11086 ASHAs are working in Uttarakhand State.

The following drugs are provided to ASHA's every year under NRHM. The consumption of these items was surveyed by DARC in all the districts of Uttarakhand.

Incentives given in different activities under NRHM

ASHA RESOURCE CENTER 

Terms of Reference

NRHM has put in place several community processes, such as the ASHA programme, establishment of Village Health and Sanitation Committee (VHSC), Village Health Planning, provision and management of untied funds to the sub center and VHSC, increasing public spaces for participation in health, Rogi Kalyan Samitis, and Community Monitoring.  The ASHA is seen as a key figure in enabling these processes.    The past few years has shown that in the absence of support and supervision to ASHA, her role in enabling such community processes remains limited. 

Several reviews of the ASHA programme have demonstrated that for effective facilitation of the ASHA scheme, a supportive structure at all levels of programme implementation (State, District, Block, Village level etc.) is required for monitoring, mentoring, and handholding support to the initiative.   This document lays out the Terms of Reference for establishing an Asha Resource Center at the state level.   

I.          Institutional Arrangements in the ASHA Resource Center (ARC)

 (i)       State Level

At the State level, the ASHA Resource Centre will operate under the strategic direction and leadership of Mission Director, NRHM and in close coordination with the State Programme Management unit (SPMU). It will also work in close coordination with Community Processes division of National Health Systems Resource System (NHSRC) for program development.

 The ARC team at the state level is expected to have the following staff composition:  Team Leader, State ASHA Programme manager, Statistical Assistant, Data assistant, and one office attendant.  In addition, given the need to develop state specific communication material, one communications and documentation officer should be appointed at the state level. Given the scale of the programme in the state and the need to also conduct training of the VHSC members, a District Training and Monitoring Consultant, (one per 10 districts) would be recruited.  They could be located at state level and travel to the districts or be based in the district but would report.  (For description of responsibilities please see Section II)

In each district, the ARC will field a team comprising of one District Mobilizer and one Data Assistant.  The District Community Mobilizer will work in close coordination with the DPMU and report to the Programme Manager, ARC, through the DPMU.  (For description of responsibilities please see Section II)

At the Block level, the ARC will recruit a Block Community Mobilizer, who will be assisted by the ASHA facilitator.  The Block Community Mobilizer will report to the District Community Mobilizer and the Block Medical officer. (For description of responsibilities please see Section II)

1. II.             Roles and Responsibilities of ARC at state, district and block levels.

The role of the State ARC is to provide technical support to the State Programme Management Unit (SPMU) and the State and District Health Societies for strategic planning, implementation, monitoring and coordination of all activities related to the community processes component of NRHM, viz: The ASHA programme, VHSC and Village Health Planning, RKS and community monitoring under NRHM.   The ARC will also be responsible for coordinating with the National Health Systems Resource Centre (NHSRC) for facilitation of technical assistance to strengthen programme effectiveness and capacity building on community process on a regular basis.

The broad responsibilities of the ASHA Resource Center at the state level include:

Planning, Implementation Review and Feedback to State Planning Processes

• To act as the secretariat of ASHA Mentoring Group.
• Develop annual work plans with specific deliverables and measurable outcome s
• Review and assess ongoing community processes and provide feedback to the development of the annual Project Implementation Planning (PIP).

Training and Capacity Building

• Assessment of training needs of VHSC, ASHA, ASHA facilitators, block mobilizers, and district mobilizers.
• Identifying a cadre of trainers at state, district, and block levels with the appropriate skill mix to provide quality training to ASHA
• Ensuring and maintain a stable team of district and block trainers. .
• Designing a training plan for trainers, district and block mobilizers, ASHA facilitators and ASHA.
• Designing state specific training modules and communication material
• Identifying partner NGOs and training sites (for those training components that need competency based training)
• Planning, implementing and monitoring the training programme in consultation with the districts at district, block, and sub block levels.
• Conducting training of trainers in collaboration with NHSRC and the national trainers.

Monitoring and Supervision

• Develop data base to track ASHA and VHSC through the structure at sub block, block, district and state levels to enable tracking of dropouts, payments, and to use as a planning and monitoring tool
• Developing/adapting monitoring formats and registers for ASHA, VHSC, and for the community monitoring process.
• Developing/adapting supervisory protocols and check lists for staff at various levels
• Developing monitoring formats for block, district and state ARC teams
• Develop s schedule of review and monitoring visits at the various levels
• Organizing Monthly review meeting with the Mission Director/SPMU

Coordination and Convergence

• Assist Mission Director for effective coordination among various stakeholders from the government departments and non-government sectors to strengthen community processes.
• Ensure effectiveness in programme monitoring and updating programmatic progress to the Mission Director periodically.
• Identify generic and specific impediments to the programme in districts and enable problem solving at district and state levels.
• Build partnerships with civil society organizations to serve as resources in training and capacity building of ASHA and for other community processes.
• Address issues of convergence with PRI and WCD to strengthen effectiveness of  ASHA and other community processes.

Development of IEC/ BCC material, and Documentation

• Develop IEC/BCC/Advocacy related activities contributing to the community processes at the state level and district level.
• Documentation of successful innovations and model community processes, sharing with key stakeholders and develop scaling up strategies.

Specific Functions related to ASHA

• Review and strengthen existing selection processes, in order to recruit the full complement of ASHA required, and plan for recruitment strategy for drop out.
• Ensure role clarity and advocate for an enabling environment to improve ASHA effectiveness.
• Identify state specific issues for inclusion into future rounds of ASHA training and ensure that the requisite 23 days of training for ASHA are held each year.
• Facilitate ASHA training programmes at sub block levels through the district and block level structures.
• Facilitate timely incentive payments through regular reviews and assessments and spot checks of the situation related to payments
• Ensure distribution and refilling of drug kits to ASHA

Responsibilities of the ARC at the District Level

The major responsibilities of District ARC (especially District Community Mobilizer) are;

• Capacity building of Block facilitator and Block Trainer’s Team in coordination with District Trainer’s Team
• Create and maintain district resource database for the health sector and assist in optimal allocation of resources
• Coordinate with other govt. dept. such as; WCD, Water and Sanitary, Education and PRI, at District level for intersectoral coordination, and support Block facilitator for the same at block level.
• Develop measurable performance indicators for the District and Block level ASHA support system/unit.
• Undertake periodic review meetings for ASHA programme and community processes.
• Undertake frequent field visits for supportive supervision to the activities related to community processes implementation..
• Arrange visits/meetings of ASHA Mentoring Groups at District and Block Level.

Responsibilities of the ARC at the Block Level

• Block level mobilizer will assist Block Medical Officer for the effective implementation of ASHA, VHSC and other related community processes activities in the block

• Capacity building of ASHA facilitators and ASHAs (in coordination with Block level trainer’s team), review, implementation and monitoring of ASHA, VHSC and other related community processes activities. 
• Coordinate for monthly meeting at PHC to discuss and sort out various issues of ASHAs relating to incentive payment, drug kit replenishment etc.
• Coordinate with other govt. department such as Health, WCD (ICDS official), Water and Sanitation, education etc. at block level for inter-sectoral coordination
• Support/guide ASHA facilitator for various coordination at village level
• Submit reports on the above activities to District ASHA Coordinator

 (iv)     Sub Block Level

At the sub block level, level, one ASHA/Block facilitator for every 10-20 ASHAs to assist Block level organizer as well as to provide continuous handholding support to ASHAs will be engaged.   She will be resident in the area.  She will support ASHA for/in coordination with ANM, AWW, PRI, VHSC, SHG etc., and will report to Block level organizer. She will support ASHA in organizing monthly meetings, Village Health and Nutrition Day (VHND), VHSC meetings as well as monitor drug kit replenishment.   It is expected that she will spend 20 days in the field to provide support ASHA in her area of operation.

IV.       Staffing Requirements of the ARC

State Level

1. Team Leader
2. ASHA Programme Manager
3. Consultant- Documentation & Communication
4. District Training and Monitoring Consultant, (one per ten districts)
5. Data Assistant
6. Accounts Assistant
7. Statistics Assistant
8. Office Attendant

District Level

1. District Community Mobilizers
2. Data Assistant

Block and Sub Block Level

1. Block Community Mobilizers
2. ASHA Facilitators

The funding for the basic staff of ARC at state, district, block and sub block levels is built into the programme. Of the Rs. 10,000 allocated per ASHA, Rs. 3500 has been earmarked for the support mechanism. 

Job Descriptions of key positions in ARC.

1.      Team Leader - State ASHA Resource Center:

Eligibility and Qualifications

• Master’s degree. Preferably doctorate in social work or management studies or any of the social sciences in health or medical science
• At least 8 years experience in community mobilization or related field with a minimum of 5 years experience in health sector
• Familiarity with/having worked in community health worker programmes, or on gender empowerment programmes – theory and practical aspects
• Sensitivity to and knowledge and experience of working on issues related to gender empowerment
• Experience of having organized or worked at the field level as Manager/Coordinator/Trainer and as organizer of training programmes/Consultation/Workshops is essential
• Experience of Monitoring and developing monitoring plans is desirable
• Action Research or project publications on community participation in health programmes or in community health
• Computer proficiency with high level of familiarity with data base management programme and commonly used packages like MS Word, Excel, power point etc.
• Excellent communication and presentation skills, analytical and interpersonal abilities, excellent oral and written communication skills in English and Hindi
• Desirable- Experience of working for health rights or in a health rights framework

Roles & Responsibilities

·        Developing capacities and strategies for implementation of ASHA program and for other community processes like the VHSC, Rogi Kalyan Samitis, community monitoring program etc. This would involve developing the implementation plans for training and monitoring of these program

• Developing appropriate training material for ASHA and other community
• Processes and training of civil society institutions.
• Developing mechanisms for community monitoring for health.
• Developing policies and strategies that enhance the role of public in public health planning and management.
• Developing policies and strategies that promote and enable decentralization.
• Provision of overall administrative support for ARC

Reporting: Team Leader will report to the Mission Director - NRHM of the state, who will be responsible for Monitoring and Evaluation of his/her performance, and will work in close coordination with Community Processes division of National Health Systems Resource System (NHSRC) for program development.

Age limit: Below 50 Yrs.

2.      State ASHA Program Manager

Responsible for Training, Review and Supportive Supervision

Eligibility and Qualifications

• Master’s degree in social work or any of the social sciences in health or Rural Development
• At least 5 years experience in management of community health programmes or community mobilization or related field activities with a minimum of 3 years experience in health sector
• Familiarity with/having worked in community health worker programmes, or on empowerment of health volunteers or health projects involving Government & NGO cooperation
• Sensitivity to and knowledge and experience of working on issues related to prevention and promotion of health care services
• Experience of having worked as trainer and as organizer of training programmes is essential
• Publication on community participation in health programmes or in coordination of government-NGO supported community health projects
• Computer proficiency with high level of familiarity with data base management programme and commonly used packages like MS Word, Excel, power point etc.
• Excellent communication and presentation skills, analytical and interpersonal abilities, excellent oral and written communication skills in English and Hindi

Roles & Responsibilities:

• Develop strategic plan & budget at State and District level besides strategic plan, action plan and training calendar.
• Support development of appropriate training modules, HMIS for successful implementation of Community processes.
• Ensure functional coordination with SPMU, NGO Cell, DPMU and other Health officials in the state
• Coordinate with Mentoring Groups and convey the meeting of Mentoring Groups to develop policy and other appropriate support mechanism towards better functioning/performance of ASHA program and other community processes.
• Facilitate documentation of best practices, case studies relating to community processes besides developing IEC/BCC materials.
• Analysis and provide feedback on training conducted on the community processes by District and NGOs.
• Undertake periodic visits to district and selected NGOs to do the supportive supervision of activity implementation.
• Provide support to NRHM for effective functioning of community processes through advocacy & networking.
• Undertake review, assessment & piloting innovative initiative as per the requirement.
• Undertake any such assignments, which may be assigned by the Team Leader, ASHA Resource Center
•  

Reporting   Will report to Team Leader, ASHA Resource Center, who will be responsible for Monitoring and Evaluation of his/her performance

Age limit:     Below 40 Years of Age 

3.      District ASHA Coordinator / District mobilizer (Responsible for Each District Support)

Eligibility and Qualifications

• Master’s degree in social work or any of the social sciences in health or Rural Development

• At least 2 years experience in management/coordination of community health programmes or community mobilization or related field activities with a minimum of 1 years experience in health sector

• Familiarity with/having worked in community health worker programmes, or on empowerment of health volunteers or NGO health projects or on involvement of PRIs in Health projects

• Sensitivity to and knowledge and experience of working on issues related to monitoring of health projects and coordination of Government & NGO cooperation in health programmes at the grassroots set-up

• Experience of having assisted/contributed/coordinated or worked as trainer and as organization support to training programmes at the district level is essential

• Computer proficiency with high level of familiarity with data base management programme and commonly used packages like MS Word, Excel, power point etc.

• Excellent communication and presentation skills, analytical and interpersonal abilities, excellent oral and written communication skills in English and Hindi

Roles & Responsibilities:

• Responsible for training support, review, implementation of ASHA program for the District including other identified community process under NRHM.
• Facilitate district specific strategies for orienting block facilitators, district officials on ASHA , VHSC and community processes.
• Participate in the conflict resolution related to ASHA.
• Ensure smooth working relationship with DPMU and DMHS at district level and health functionaries at block level to strengthen implementation of community processes.
• Establish support system for enhancing coordination between DPMU and ARC.
• Provide field level coordination supports for the members of AMG.
• Develop district specific review mechanism for addressing issues of incentives/compensation for ASHA.
• Responsible for NGO coordination to ensure  district level support for ongoing community processes.
• Responsible for facilitation of intersectoral coordination especially resolving conflict of interests among ASHA, AWW and ANM.
• Documentation of block level innovations for wider dissemination of best practice lessons  and operationalization of community monitoring processes..
• Organization of district level ASHA Sammelan for recognition of their good work and contribution to NRHM
• Establish and operationalize monthly review of ASHA effectiveness by streamlining mechanism for addressing issues of redresses of grievances.

Reporting   Will report to State ASHA Programme Manager, ASHA Resource Center, who will be responsible for Monitoring and Evaluation of his/her performance

Age limit:     Below 30 Years of Age 

4.      State ARC - Data Assistant

Eligibility and Qualifications

• Bachelors degree in Computer Applications/Arts/Science/Commerce with having PG Diploma in Commuter Science/Applications

• At least 3 years of work experience in handling data base support to effective functioning of health or social sector projects or organizational management involving data analysis, data management and maintenance of data resource

• Computer proficiency with high level of familiarity with data base management programme and commonly used packages like MS Word, Excel, power point and spreadsheets for programmatic analysis and projections

• Excellent communication and presentation skills, analytical and interpersonal abilities, excellent oral and written communication skills in English and Hindi

Roles & Responsibilities:

• Maintain district specific database on the community processes.
• Ensure collection and collation of reports from the district level and compile the same for presentation to the ARC team.
• Consolidate the data on the reporting format and submit the collated report.
• Responsible for the documentation of the activities.
• Undertake any such assignments, which may be assigned by the State ASHA Programme Manager, ASHA Resource Center

Reporting   Will report to State ASHA Programme Manager, ASHA Resource Center, who will be responsible for Monitoring and Evaluation of his/her performance

Age limit:     Below 30 Years of Age

5.                                                                                                                              Accounts Assistant

Eligibility and Qualifications

• Bachelors degree in Commerce

• At least 3 years of work experience in handling financial data base support to effective functioning of health or social sector projects or organizational management involving accounts/financial analysis, financial management and assistance in maintenance of accounts

• Computer proficiency with high level of familiarity with data base management programme and commonly used packages like MS Word, Excel, power point and spreadsheets for financial analysis and projections

• Excellent communication and presentation skills, analytical and interpersonal abilities, excellent oral and written communication skills in English and Hindi

Roles & Responsibilities:

• Maintain day-to-day accounts record of ARC.
• Responsible for day-to-day functioning of the ARC
• Ensure placement of funds and receipt of the UC from the districts and other expenditures.      
• Undertake any such assignments, which may be assigned by the State ASHA Manager, ASHA Resource Center

Reporting   Will report to State ASHA Programme Manager, ASHA Resource Center, who will be responsible for Monitoring and Evaluation of his/her performance

Age limit:     Below 30 Years of Age

6.                                                                                                                              Sub Block Facilitators for ASHA

ASHA Team Coordinators will be positioned at cluster or sector level and provided with   performance based incentives. These coordinators will be contributing to support a group of 10-20 ASHAs to handhold and mentor at sector level for effectiveness of ASHA & VHSC scheme. District community mobilizers with the support of ASHA Resource Center will be responsible for their operational effectiveness and capacity building on a regular basis.

1. 7.      Consultant State ARC – Communication & Documentation:

Eligibility and Qualifications

• Master’s degree in social work or any of the social sciences in health or Rural Development
• At least 5 years experience in IEC/BCC Strategic interventions assisting management of community health programmes or community mobilization efforts or related field activities with a minimum of 3 years experience in health sector
• Familiarity with/having worked in community health worker programmes, or on empowerment of health volunteers or health projects involving gender empowerment programme
• Experience of having worked as IEC/BCC trainer and as organizer of training programmes in health field is essential
• Contributions in the publication on IEC/BCC or related community participation in health programmes/health projects
• Computer proficiency with high level of familiarity with data base management programme and commonly used packages like MS Word, Excel, power point etc.
• Excellent communication and presentation skills, analytical and interpersonal abilities, excellent oral and written communication skills in English and Hindi

Roles & Responsibilities

• Develop and initiate strategies for appraisal/assessment and documentation of ASHA initiatives and related community processes like VHSC, Rogi Kalyan Samities, Hospital Development Societies and the community monitoring programmes etc.
• Develop IEC/BCC strategies and training materials for ASHA and related community processes and training of civil society – PRIs and local bodies & council members
• Develop communication support materials and communication strategies for use in community processes targeting effective implementation of ASHA Scheme
• Assist in monitoring and mentoring of community processes
• Office support and organization of documentation of ASHA Resource Center functioning
• Undertake any such assignments, which may be assigned by the Team Leader, ASHA Resource Center

Reporting - Will report to Team Leader, ASHA Resource Center, who will be responsible for Monitoring and Evaluation of his/her performance

Age limit:     Below 40 Years of Age

1. 8.      District Training and Monitoring Coordinator  (Responsible for 10-15 Districts  Training & Monitoring Support)

Eligibility and Qualifications

• Master’s degree in social work or any of the social sciences in health or Rural Development
• At least 3 years experience in management/coordination of community health programmes or community mobilization or related field activities with a minimum of 2 years experience in health sector
• Familiarity with/having worked in community health worker programmes, or on empowerment of health volunteers or NGO health projects
• Sensitivity to and knowledge and experience of working on issues related to prevention and promotion of health care services involving Government & NGO cooperation
• Experience of having worked as trainer and as organizer/coordinator of training programmes at the district/regional level is essential
• Computer proficiency with high level of familiarity with data base management programme and commonly used packages like MS Word, Excel, power point etc.
• Excellent communication and presentation skills, analytical and interpersonal abilities, excellent oral and written communication skills in English and Hindi
• Desirable- Experience of working for health rights or in a health rights framework or in addressing issues of Women’s Health projects

Roles & Responsibilities:

• Develop support system for a region wise district ASHA ASHA program and other community processes budget and work plan.
• Disseminate  the GOs at division wise and insure to available at district level officials
• Ensure periodic training of district level officials
• Ensure smooth working relationship with DPMU and CMHO to district level l to strengthen implementation of Community processes.
• Facilitate documentation of best practices, case studies relating to community processes besides developing IEC/BCC materials.
• Analysis and provide feedback on training conducted on the community processes by District and NGOs.
• Undertake periodic visits to district and selected NGOs to do the supportive supervision of activity implementation.
• Provide support to NRHM for effective functioning of community processes through advocacy & networking.
• Building intervention for review and supportive supervision of community processes.
• Linkage with MNGO at Division level.
• Undertake any such assignments, which may be assigned by the State ASHA Programme Manager, ASHA Resource Center

Reporting   Will report to State ASHA Programme Manager, ASHA Resource Center, who will be responsible for Monitoring and Evaluation of his/her performance

Age limit:     Below 35 Years of Age

Module Training Status Since 2005 in 13 districts of Uttarakhand