A Study To Evaluate Knowledge, Attitude And Practice Of Accredited Social Health Activists (Ashas) Invijayapurdistrict

Abstract

Introduction: The Government of India launched National Rural Health Mission (NRHM) on 12th April 2005 to address the health needs of rural population, especially the vulnerable section of the society. One of the key components of the National Rural Health Mission is to provide every village in the country with a trained female community health activist or Accredited Social Health Activist (ASHA) selected from the same village. In general each ASHA will cover a population of 1000. However, this norm is relaxed in the hilly and tribal areas depending on the local situations. ASHA will be the first port of call for any health related demands of deprived sections of the population, especially women and children, who find it difficult to access health services. She 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. Her responsibility is prevention of diseases and promotion of good health. However she will also provide a minimum package of curative care which are appropriate and feasible for that level and make timely referrals. The Ministry of Health & Family Welfare (MOHFW) has developed a 23-day basic training schedule to provide the necessary knowledge & skills to women identified as ASHAs and there is also regular re-orientation trainings organized at the district levels. ASHA are given performance based compensation/remuneration. She can earn good amount of money by taking responsibility of patients by promoting institutional deliveries (allowance under Janani Suraksha Yojana), VHSC, nutritional and national XII programs. There is a provision for non monetary compensation in the form of recognition, awards given at state level meetings of ASHA. The study aims to investigate the factors contributing to Knowledge, Attitude and Practice of ASHAs regarding their training, selection, job responsibilities and their incentives. There are no published studies available on KAP of ASHAs especially those who are working in Northern Karnataka. In this background the present study will be conducted in Vijayapur District of Karnataka. Objective: 1. To describe the socio-demographic profile of ASHAs working in Vijayapur District 2. To evaluate the Knowledge, Attitude and Practice of ASHAs towards their roles and responsibilities. Methodology: A cross sectional study was carried out in Vijayapur district. All the ASHAs working in Vijayapur taluk, Basavana Bagewadi taluk and Muddebihal taluk under 39 PHCs were selected for the study. The purpose of the study was explained to District Health Officer and after obtaining permission, the study was conducted. ASHA workers were contacted in their respective PHCs on a pre-fixed date. After explaining the purpose of the study and obtaining oral consent, data was be collected in a pre designed, semi-structured proforma by interview technique. Results: Maximum numbers of ASHAs belonged to the age group of 30-39 (52.4%). About 86.1% of ASHAs underwent 23 days of training with 5.2% of ASHAs opining that it was over crowded. In our study ASHAs had good knowledge about ANC care, with 69% of the ASHAs told they know the correct procedure of registering a XIII pregnant woman. Also, nearly 70% of the ASHAs could give proper details about the minimum number and details of ANC visits required by a pregnant woman. 88% of ASHAs gave positive response saying that they accompany pregnant woman and stay until the delivery is over. About 94% of ASHAs had proper knowledge about Exclusive breast feeding and weaning and only 23.4% of ASHAs had proper knowledge of duration of EBF and weaning. Nearly half (48.6%) of the ASHAs revealed that they are catering to population of more than the stipulated norm of 1,000. Nearly 86.7% of ASHAs told that they were well aware of immunisation dates in their concerned PHCs and assist ANMs on immunisation days. 97% of ASHAs revealed that they encourage mothers to start breast feeding within 30 minutes of delivery and educate mothers on exclusive breast feeding. Only 16.3% of ASHAs revealed that they work as DOTS agent. About 83.3% of ASHAs reported that were not happy and content with their incentives and demanded fixed salary on a monthly basis. Conclusion: ASHAs form the backbone of the community and are meant to be selected by and be accountable to the village. There is a need for comprehensive monitoring into the performance of ASHAs in terms of her responsibilities and work. In spite of the performance based incentives and other benefits there is also an opinion that the ASHAs need some sort of job security. Special effort is needed to focus on the induction training quality and the regular orientation trainings to enhance her knowledge and practical skills regarding her job responsibilities. Key words: ASHA, Maternal Care, Child Health, Drug Kit