Accredited Social Health Activist (ASHA)

Accredited Social Health Activist (ASHA) is a trained female community health activist. Selected from the community itself and accountable to it, the ASHA will be trained to work as an interface between the community and the public health system. As of June 2022, there are over 10.52 Lakh ASHAs. The ASHA scheme is presently in place in all states/UTs (except Goa).

Selection criteria for ASHAs

In rural areas

• ASHA must primarily be a woman resident of the village married/ widowed/ divorced, preferably in the age group of 25 to 45 years.
• She should be a literate woman with due preference in selection to those who are qualified up to 10 standard wherever they are interested and available in good numbers. This may be relaxed only if no suitable person with this qualification is available.
• ASHA will be chosen through a rigorous process of selection involving various community groups, self-help groups, Anganwadi Institutions, the Block Nodal officer, District Nodal officer, the village Health Committee and the Gram Sabha.

In urban areas

• ASHA must be a woman resident of the – “slum/vulnerable clusters” and belong to that particular vulnerable group which have been identified by City/District Health Society for selection of ASHA.
• She should be preferably ‘Married/Widow/Divorced/Separated’ and preferably in the age group of 25 to 45 years.
• ASHA should have effective communication skills with language fluency of the area/population she is expected to cover,leadership qualities and be able to reach out to the community.
• She should be a literate woman with formal education of at least Tenth Class. If there are women with Class XII who are interested and willing they should be given preference since they could later gain admission to ANM/GNM schools as a career progression path.
• The educational and age criteria can be relaxed if no suitable woman with this qualification is available in the area and among that particular vulnerable group.
• A balance between representation of marginalized and education should be maintained.
• She should have family and social support to enable her to find the time to carry out her tasks.
• Adequate representation from disadvantaged population groups should be ensured to serve such groups better.
• Existing women Community workers under other schemes like-urban ASHAs or link workers under NRHM or RCH II, JnNURM, SJSRY etc. may be given preference provided they meet the residency, age and educational criteria mentioned above and are able to provide time for their activities.

Availability of ASHAs

In rural areas

There is one Community Health Volunteer i.e. ASHA (Accredited Social Health Activist) for every village with a population of 1000. The States have been given the flexibility to relax the population norms as well as the educational qualifications on a case to case basis, depending on the local conditions as far as her recruitment is concerned.

In urban areas

• Prior to the selection of ASHA it is important that City/ District health Society undertakes mapping of the city/urban areas with vulnerability assessment of the people living in slums or slum like situations and identifies these “slum/vulnerable clusters” for selection of ASHA.
• The general norm for selecting ASHA in urban area will be ‘‘One ASHA for every 1000-2500 population”. Since houses in urban context are generally located within a very small geographic area an ASHA can cover about 200-500 households depending upon the spatial consideration.
• When the population covered increases to more than 2500 another ASHA can be engaged. In case of geographic dispersion or scattered settlements of socially and economically disadvantaged groups the “slum/vulnerable clusters” selection of ASHA can be done at a smaller population.
• In cases where a particular geographic area has the presence of more than one ethnic/vulnerable group, selecting more than one ASHA below the specified population norm will be desirable. In such a case one ASHA could be selected for and from a particular vulnerable group so that their specific needs are addressed through an appropriate understanding of the socio-cultural practices of that community.
• The selected ASHAs will be preferably co-located at the Anganwadi Centre that are functional at the slum level, for delivery of services at the door step.
• In urban habitations with a population of 50,000 or less, ASHAs will be selected as in rural areas.
• The other community volunteers built under other government schemes can also be utilized for this purpose.

Roles and responsibilities

The role of an ASHA is that of a community level care provider. This includes a mix of tasks: facilitating access to health care services, building awareness about health care entitlements especially amongst the poor and marginalized, promoting healthy behaviours and mobilizing for collective action for better health outcomes and meeting curative care needs as appropriate to the organization of service delivery in that area and compatible with her training and skills.

Compensation for ASHA

ASHA worker is primarily an “honorary volunteer” but is compensated for her time in specific situations (such as training attendance, monthly reviews and other meetings).In addition she is eligible for incentives offered under various national health programmes. She would also have income from social marketing of certain healthcare products like condoms, contraceptive pills, sanitary napkins etc. Her work should be so designed that it is done without impinging on her main livelihood and adequate monetary compensation for the time she spends on these tasks- through performance based payments should be provided.

ASHA Benefit Package

ASHAs and ASHA Facilitators to be covered under Pradhan Mantri Suraksha BimaYojana (Life Insurance). The eligibility criteria are 18-70 years. Cover is for one-year period stretching from 1st June to 31st May and benefit is as under:–

• Pradhan Mantri Jeevan Jyoti Beema Yojana (PMJJBY) with a benefit Rs. 2.00 Lakh in case of death of the insured (annual premium contributed by GOI).
• Pradhan Mantri Suraksha Beema Yojana (PMSBY) with a benefit of Rs.2.00 lakh for accidental death or permanent disability; Rs. 1.00 lakh for partial disability (annual premium contributed by GOI).
• Pradhan Mantri Shram Yogi Maan Dhan (PM-SYM) with pension benefit of Rs. 3000 pm after age of 60 years (50% contribution of premium by GOI and 50% by beneficiaries) is also available for ASHA workers.

ASHAs will get a minimum of Rs.2000/- per month from current Rs 1000/- per month as incentives for routine activities. This is effective from October 2018. This is in addition to other task based incentives approved at Central/State level.

Following additional incentives for ASHAs have been approved in the Mission Steering Group of NHM in its 7th Meeting held on 7th September, 2022:

• Provision of a cash award of Rs. 5000/- for each certification to acknowledge The achievement of the ASHAs and ASHA Facilitators who have successfully been certified in two independent certificates- (i) RMNCHA+N (ii) Expanded package of new services from Non-Communicable Diseases to Palliative Care
• Provision of an incentive of Rs. 10/- for ASHAs for each ABHA account created and seeded in various IT portals of MoHFW such as CPHC NCD Portal and RCH Portal etc.
• Provision of incentive at rate of Rs. 50/- to ASHA or community volunteer for facilitating seeding of bank account information of notified TB patient in Nikshay portal within 15 days of treatment initiation for enabling DBT payments under the National Tuberculosis Elimination Programme.
• Provision of financial incentive to ASHA/ Community Health Volunteer of Rs. 250/- per individual for successful completion of TB Preventive Treatment.
• Enhancing incentives of ASHA for referring SAM children for admission to NRCs and follow up of NRC discharged children are as under :For referring SAM child with medical complication to NRCs, ASHA incentive enhanced from Rs. 50/- per child to Rs. 100/- per child. 
• For follow up visits of SAM children discharged from NRC, ASHA incentive enhanced from Rs. 100/- per child to Rs. 150/- per child. (Rs 50 per visit for 1st and 4th visit and Rs 25 per visit for 2nd and 3rd visit).
• Additional incentive of Rs. 50/- per SAM child for ASHA n case child is declared free of SAM status after completion of all follow ups. 
• Incentivizing ASHA worker for PKOL case detection and complete treatment @ Rs. 500/. per case (Rs. 200/- at the time of diagnosis and Its. 300/- after treatment completion) in all 4 Kala-azar endemic states.
• Enhancing ASHA incentive from Rs 75/- to Rs. 200/- per confirmed case of Malaria for ensuring complete treatment. 

ASHA facilitators

As part of support mechanism, an ASHA facilitator is in place for between 10 to 25 ASHAs, to provide handholding and mentoring support, and monitor performance. She is a critical link of the support structure network. Substantial progress has been made by states in setting up support structures during the last three years, as states have increasingly become cognizant of the correlation between strong support structures and an effective ASHA programme. The ASHA facilitators are generally selected from amongst the ASHAs themselves. This position also serves as a career opportunity for ASHAs with the requisite qualifications, experience and aptitude.

There are 80,000 ASHA facilitators as on March 2022.

All states except Andhra Pradesh, Himachal Pradesh, Jammu and Kashmir, Kerala, Nagaland, Tamil Nadu, Telangana, West Bengal, Rajasthan and UTs have selected ASHA Facilitators. In these states, on-the- job mentoring support to ASHAs is provided by ANMs or, as in the case of West Bengal, by the Supervisor appointed by the Gram Panchayat or PHC supervisors at PHC level, as in the case of Rajasthan. Over half of the states (11 out of 19) that have ASHA Facilitators, have selected them from amongst a cluster of ASHAs, provided they meet all the selection criteria. These include states of Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, Uttar Pradesh, Uttarakhand, Haryana, Karnataka, Punjab and Sikkim. In other states, preference is given to ASHAs in selection of ASHA facilitators.Maharashtra, Arunachal Pradesh, Assam, Manipur, Meghalaya, Mizoram, Tripura and Gujarat. Goa does not have ASHAs.

ASHA Facilitator undertakes about 20 supervisory visits per month.  To motivate ASHA facilitators to perform better, the supervisory visit charges for ASHA Facilitators has been increased from Rs. 250/-per visit to Rs. 300/- per visit w.e.f from October 2018 (to be paid in November, 2018). Hence, ASHA Facilitators would receive about Rs 6000 per month.

Provision of a cash award of Rs. 5000/- for each certification to acknowledge the achievement of ASHA Facilitators who have successfully been certified in two independent certificates- (i) RMNCHA+N (ii) Expanded package of new services from Non-Communicable Diseases to Palliative Care. (approved in the Mission Steering Group of NHM in its 7th Meeting held on 7th September, 2022)

• Conduct village visits (comprising of accompanying ASHA on household visits, conducting community/VHSNC meetings, attending Village Health and Nutrition Days).
• Conduct cluster meetings of all ASHAs in the area once a month.
• Enable ASHAs in reaching the most marginalized households.
• Support ASHA training at the block level.
• Facilitate selection of new ASHAs.
• Facilitate grievance redressal.

Related Resources

1. About ASHA
2. Guidelines for ASHA and Mahila Arogya Samiti in the Urban Context
3. Induction Training Module for ASHAs

Source : National Health Mission