K6.2 NUHM

ASHA Scheme

Chapter-1 ASHA Scheme (K 6.2) ASHA SCHEME:

The National Rural Health Mission (NRHM) launched in the year 2005, has

completed eight years of implementation and is now commencing its second phase.

The ASHA programme was introduced as a key component of the community

processes intervention. Over the eight year period, the ASHA programme has

emerged as the largest community health worker programme in the world, and is

considered a critical contributor to enabling people’s participation in health.

ASHA functions as a healthcare facilitator, a service provider and a health activist.

Broadly her functions involve providing preventive, promotive and basic curative care

in a role complementary to other health functionaries; educating and mobilizing

communities particularly those belonging to marginalized communities, for adopting

behaviours related to better health and create awareness on social determinants,

enhancing better utilization of health services; participation in health campaigns and

enabling people to claim health entitlements.

ASHA programme is totally incentive based wherein women who volunteer from

local community are being selected and trained to reinforce community action for

universal immunization, safe delivery, newborn care, prevention of communicable

and non – communicable diseases, improved nutrition, care of the senior citizens and

promotion of household / community toilets.

In Delhi one ASHA is envisaged for 2000 population. The Scheme is being

implemented in all eleven districts of the State in the identified vulnerable

areas – Slums, Jhuggi Jhopdi Clusters, unauthorized colonies, resettlement

colonies / villages. 5018 ASHAs were visualized for the 109 lakh vulnerable

population of the State.

To facilitate selections and trainings, effort has been made to club two or three

health centers with a total population of 100,000, this group is called an ASHA Unit.

50% of the ASHA units have centers of Municipal Corporation of Delhi / New Delhi

Municipal Corporation. Each ASHA Unit has around 50 ASHAs.

Population of one ASHA unit is 100,000, Two centres , 50 ASHAs ( 25 per

center) , 10 ANMs ( 5 per centre) , Unit level trai ner / Mentor Group

members -- 5

ASHA Scheme is dealt with under following main comp onents:

1. Selection of ASHAs.

2. Training and Capacity Building.

3. Provision of the basic logistics / Stationary and ASHA kits.

4. Mentoring and Monitoring Mechanisms.

5. Incentives for ASHAs.

6. Grievance Redressal Mechanism.

Selection of ASHAs (K 3.6)

ASHAs are selected through a completely decentralized mechanism approved by

the State. The selection is carried out at the unit level with the help of facilitators

and Unit level Committees. This is an ongoing process as there is a cumulative

attrition rate of 24% and an annual attrition rate of 14%. ASHAs leave due to

certain reasons or are deleted because of non performance. Funds have been

projected for selection and these shall be used for selecting new ASHAs as well as

ASHAs selected to fill in gaps in already existing ASHA units.

Status as on 31 st Dec. 2013. ASHA-

Annexure-I

Number of ASHA Required as per

vulnerable population ( as projected by the districts

Number of ASHA engaged

(Atleast trained in 1st Module)

Shortfall Target for 2014- 15 (shortfall+

15% attrition on number of

engaged ASHAs) 5018 4044 974 1549

Sr. No. (a)

Districts (b)

Number of ASHA

Required as per

vulnerable population

(c)

Number of ASHA

engaged (Atleast

trained in 1st Module)

(d)

Shortfall (e)

Attrition approx. 15%

on no. of existing ASHAs

(f)

Target for 2013-14 (e)+(f)

1 Northwest 550 399 151 58 209

2 North 462 342 120 49 169

3 West 750 627 123 83 206

4 Southwest 570 542 28 74 102

5 South 345 217 128 32 160

6 Southeast 654 407 247 60 307

7 East 400 372 28 48 76

8 Shahdara 300 234 66 37 103

9 Northeast 500 472 28 77 105

10 Central 257 224 33 34 67

11 New Delhi 230 208 22 23 45

Total 5018 4044 974 575 1549

4.B.1.2 TRAINING & CAPACITY BUILDING:

ASHA Trainings are modular trainings comprising of Induction and Refresher

trainings. Induction trainings are to be given through the seven modules provided

by GOI.

The trainings are being carried out in a decentrali zed cascade fashion.

State Level

District Level

Unit Level

Training Modules: In Delhi the first four GOI ASHA Modules were translated in

Hindi, adapted to Delhi specifics and condensed to three modules – 1, 2 and 3. In

order to ensure quality and uniformity in the trainings, the State and District level

Master trainers have been trained at the State level. Total of 116 State and District

level Master Trainers (Module 1 to 3) have been trained with the help of Faculty

members from NIHFW, Nutrition Foundation of India, distinguished faculty from the

Master

Trainer

Training of Trainers (TOTs)

ASHA ASHA ASHA ASHA

State hospitals, State Program Officers of respective programs and in house

resource persons with experience of implementing ASHA scheme in Delhi for four

years. With the arrival of GOI Module V, it was adapted to Delhi (Module IV) and

training of Master Trainers for Module V was carried out in collaboration with the

National Health System Resource Center. With the arrival of Modules 6 & 7, 63

State / District level Master trainers were trained for Module 6 & 7 with the help of

National level Trainers from National Health System Resource Centre.

Status of trainings as on 31st December 2013:

S. No.

Category of Trainee Name of the Training Number

I. Master Trainers 4. State / District level 1,2,3 Modules 113 Module 4 ( Module 5) 49 State / District level Module 6 & 7 Round -2 63

II. Unit level trainers 2. Unit level trainers Module 1 to 3 364 Module 4 ( GOI 5) 257 3. Unit level trainers Module 6 Round 1 285 4. Unit level Trainers Module 7 Round -2 287 III. ASHAs 2. ASHAs Module 1 to 5 4044 3. ASHAs Module 6 Round -1 2869 4. ASHAs Module 7 Round -2 2264

Training of ASHA facilitators:-

Under the ASHA program, the ASHA is selected from her own community and she is

trained to support the largest community intervention process through spreading

awareness, counseling and escorting the beneficiaries to the present health services

for those who are not able to access the existing health services due to various

social, occupational and financial reasons.

In the process ASHA also needs hand holding support to polish her skills and

efficiency during interface to the community time to time. ASHA facilitator is

imperative support structure has been visualized under this program and the ASHA

facilitator is expected to mentor, guide, counsel the ASHA time to time in her

allocated area. Meanwhile ASHA facilitator is one of key resource person who will

interact with ASHA for their monitoring , guidance & supervision on regular basis .

So, it has been projected that ANM will act as ASHA facilitator.

The training status of ASHA facilitators are as under:-

S.No. District No. of ASHAs required as per vulnerable population

Target for ASHA Facilitators (ANMs)

No. of ANMs trained as ASHA Facilitators (13-14)

Target for ASHA facilitator trainings (14-15)

1. Northwest 550 110 0 110 2. North 462 119 119 0 3. West 750 150 71 79 4. Southwest 570 114 100 14 5. South 345 71 71 0 6. Southeast 654 131 43 88 7. East 400 80 66 14 8. Shahdara 300 60 0 60 9. Northeast 500 100 67 33 10. Central 257 57 57 0 11. New Delhi 230 46 43 3

Total 5018 1038 637 401

The targets for 2014 -15, District wise / Module wise along with financial implications are

given below:-

S. NO Particulars Duration

Batch size: 30 District wise Participants ASHAs an d ANMs (One ANM for every 5 ASHAs )

East West South Southeast South West North Northeast Shahdara Central New

Delhi Northwest Total

1

Module 1-5 (No. of

ASHAs+ANM) 5 days

1 1 5 3 5 3 7 1 2 2 1 4 34

Batches

Estimated financial

Implications 0.57 0.57 2.85 1.71 2.85 1.71 3.99 0.57 1.14 1.14 0.57 2.28 19.38

2

Module 6&7 Round one

(No. of ASHAs+ANM)

7 days Batches

1 1 4 3 4 2 5 1 2 3 1 4 30

Estimated financial

Implications 0.78 0.78 3.12 2.34 3.12 1.56 3.9 0.78 1.56 2.34 0.78 3.12 23.4

3

Module 6&7 Round two

(No. of ASHAs+ANM)

7 days Batches

1 5 10 3 5 3 7 1 2 2 2 9 50

Estimated financial

Implications 0.78 3.9 7.8 2.34 3.9 2.34 5.46 0.78 1.56 1.56 1.56 7.02 38.22

4

Module 6&7 Round three

5 days Batches

1 2 0 2 0 2 0 2 2 2 2 0 14

Estimated financial

Implications 0.57 1.14 0 1.14 0 1.14 0 1.14 1.14 1.14 1.14 0 7.98

TOTAL 6.39 13.77 7.53 9.87 6.75 13.35 3.27 5.4 6.18 4.05 12.42 88.98

S.N Particulars Duration

Training of Unit Level Trainers

Batch Size : 25

East West South Southeast

South West North Northeast Shahdara Central New

Delhi Northw

est Total

5

Module 6&7 Round three

5 days (Batches) 1 1 0 1 0 1 0 1 1 1 1 0 7

Estimated financial

Implications @ 2447 Rs./ person

2447 Rs. per

person 0.64 0 0.64 0 0.64 0 0.64 0.64 0.64 0.64 0

4.48

*New Delhi district can merge their trainees with South west district

Refresher Trainings Batch Size 25

S.N Particulars Duration East West South Southeast South West North North

east Shahdara Central New Delhi Northwest Total

7 Refresher Trainings 1

day (Batches)

15 25 9 16 22 14 19 9 9 8 16 162

Batches x months

1x 5 months 75 125 45 80 110 70 95 45 45 40 80 810

Financial Implications 0.11

8.25 13.75 4.95 8.8 12.1 7.7 10.45 4.95 4.95 4.4 8.8 89.1 Total 8.25 13.75 4.95 8.8 12.1 7.7 10.45 4.95 4.95 4.4 8.8 89.1

Grand Total 15.55 28.33 13.12 19.75 19.76 21.05 14.63 11.53 11.77 9.09 22.3 186.88

ASHA Facilitator Trainings Batch Size 25

S.N Particulars Duration East West South Southeast South

West North

North

east Shahdara Central

New

Delhi Northwest Total

6

ASHA Facilitator Trainings

2 days Batches

1 3

4 1

1 2

0* 4 16

Financial Implications 0.27 0.27 0.81 1.08 0.27 0.27 0.54 1.08 4.32

• State Level TOT (Master Trainers) : 0.85 x 4 ( 2 batches each of induction 1-5 , Round three , Per Batch : Total 5 days , Batch size 30 trainees / 5 resource persons / 4 support staff) = 3.4 lacs

• ASHA Modular Trainings: 88.98 lacs • Unit Level Trainings: 4.48 lacs • ASHA Facilitator Trainings: 4.32 lacs • Refresher Trainings: 89.10 lacs • These targets are dynamic as the number of ASHAs ke eps changing due to attrition and new ASHAs get sel ected.

• To get maximum benefit from the scheme and optimum ANM – ASHA synergy, it is mandatory that ANMs are also trained in the Modules . Necessary provisions for the training material and lunch are being projected for the ANMs (one for every five ASHAs) part of the ASHA Trainings.

The training budget is based on certain assumptions of uniform performance in all the districts and al l Modules which may not be the case despite all efforts. In v iew of past expenditure and variability in performa nce in different districts and across the Modules, a mode st target has been set and funds asked accordingly. The tentative district wise and module wise plan has be en incorporated above which might need revision as per the actual pace of implementation. This change shall be within the approved total trainings budget . ---- --------

K 6.2.2 PROVISION OF ASHA KITS BASIC LOGISTICS / ST ATIONARY

1. ASHA Kit:

i. ASHA Bag: All ASHAs , once given the induction training are provided with a sturdy

bag to carry the basic kit which includes the basic drugs , her IEC kit , her Diary and

any other required logistics .The bag carries the NRHM / ASHA logo. The same has

been budgeted @ 150/- per bag.

ii. IEC Kit: IEC / BCC is an important part of ASHAs activities. She can be aided in the

field by a variety of tools to do this more effectively. A set of pictorial Cards have been

prepared for her .Two folders for ASHA use in the field – On Antenatal and Birth

preparedness / Newborn and postpartum care have been prepared. Folder on Breast

feeding is in process of being printed. Rs. 200/- per ASHA per year has been

projected for IEC kit.

iii. Diary: The important tool of a formatted work record diary has been provided to the

ASHAs from the very beginning and is renewed annually. The diary has the required

pages for every month, and the summary pages (Cluster Need / Plan) at the end of the

diary. It allows her to plan her work, track the beneficiaries and record the follow up

with dates. It also provides for the records to be verified by the ANMs especially the

incentivized activities. In addition to the work record, the diary also provides the record

of incentives and the incentive pages are in duplicate and one set of monthly incentive

record with the activities is retained at the center for record and random checking. The

Diary also provides the address / telephone numbers of the referral centers and thus is

an important part of her kit. In the latest edition of the Diary, the Stock of drugs /

logistics has been incorporated. Budgeted at Rs.150/-.

iv. Medicines: ASHA kit also contains basic medications like Paracetamol Tablet , ORS

Packets , Iron and Folic Acid , antiseptic , Oral contraceptives , bandage , Cotton roll ,

Chlorine Tablets, condoms etc. These supplies are provided from the health center to

which the ASHA is attached and replenished thereafter on a need basis. No budget has

been proposed for the medicines.

v. Home Based Newborn Care Kit: Baby Suspension Wei ghing Machine with

suspension, Digital Thermometer, Stop Watch are required for the ASHA to fulfill

her role in Home based Newborn examination. These have already been provided to

the districts and distributed to the ASHAs who have completed Module Six training. A

baby blanket and a warm bag is being provided and the tender is in process.

ASHA HBNC Kit comprises of:

S.No. Item Per unit price*

1. Digital Thermometer Rs. 100/-

1.a Digital Thermometer cell Rs. 30/-

2. Stop Watch Rs.120/-

2.a Stop Watch Cell Rs. 30/-

3. Torch 100/-

3.a Torch Cell Rs. 30/-

4. Warm Bag 120/-

5. Baby Blanket 120/-

6. Suspension Weighing Machine Rs. 300/-

*These are tentative costs used for preparing budgets and actual expenditure shall be as per the costs arrived after duly prescribed tendering processes.

Other Logistics under ASHA Support:

• ASHA Coats / Umbrella K 6.2.2 : ASHAs are being provided with a coat with logo

embroidered on it. This helps in raising her self esteem, in getting identified as a

part of the health system, getting recognition in the hospitals / referral centers /

community. It also instills a feeling of kinship while in trainings. Around 1549

ASHAs are expected to be added in 2014 -15. Budget for coats is sought only for

gap ASHAs. Funds have been projected to provide umbrellas for ASHAs. Budgeted

@ ASHA Coats (2 per ASHA) 750/- & Umbrella: Rs. 120/- per ASHA.

• Household Survey Books (Registers) K 6.2.2: ASHA has to carry out the survey

of the households in her defined area. This familiarizes her with the families she is

supposed to be taking care of, provides her with the denominator of her expected

beneficiaries, gives the opportunity to the families to meet her and is able to identify

and line list her target beneficiaries. Part of the requirement has been met with in

the year 2013 -14, but survey is an ongoing activity and more ASHAs shall be

joining and many families migrate especially in the vulnerable areas. Therefore

funds have been sought in current year.

• I – Cards / Addressed Postcards for grievance redre ssal / Area Code Cards:

All ASHAs are given Identity Card. It is proposed to provide each ASHA with two

Postcards with address of the District / State Units for any suggestions / grievances

they might have. Small laminated area code cards for distribution to the

households. This would facilitate immediate identification of the health center /

ANM / ASHA if an individual visits a hospital directly.

• Communication support: A mobile phone with connection @1000 with monthly

plan including onetime cost of instrument and recurrent cost of monthly plan for

around Rs. 100/- per month for 10 months is also proposed during F.Y. 2014-15.

• IEC Material for ASHA Grievance Redressal Mechanism: Rs. 1,00,000/- is

being proposed at the state level.

• Grievance redressal toll free number at state level : 1,00,000/-

District wise requirements for different kit items is given below:

S. No. Particular Item With proposed

Amount Central North Northea

st Shahda

ra East South Southea

st Northw

est Southw

est West New Delhi Total

1 Bag @ 150/- per bag 67 169 105 103 76 160 307 209 102 206 45 1549 0.1 0.25 0.16 0.15 0.11 0.24 0.46 0.31 0.15 0.31 0.07 2.31

2 Thermometer @100/- 67 169 105 103 76 160 307 209 102 206 45 1549

0.07 0.17 0.1 0.1 0.08 0.16 0.31 0.21 0.1 0.21 0.05 1.56

3

Thermometer cell 257 462 500 300 400 345 654 550 570 750 230 5018

Cell @ Rs. 30 0.08 0.14 0.15 0.09 0.12 0.1 0.2 0.17 0.17 0.23 0.07 1.52

4 Suspension weighing machine

baby @ 300/-

67 169 105 103 76 160 307 209 102 206 45 1549

0.2 0.51 0.31 0.31 0.23 0.48 0.92 0.63 0.31 0.62 0.13 4.65

5 Torch @100/-

257 462 500 300 400 345 654 550 570 750 230 5018

0.26 0.46 0.5 0.3 0.4 0.34 0.65 0.55 0.57 0.75 0.23 5.01

6

Torch cell 257 462 500 300 400 345 654 550 570 750 230 5018

Cell @ Rs. 30 0.08 0.14 0.15 0.09 0.12 0.1 0.2 0.17 0.17 0.23 0.07 1.52

7 Digital stop watch @120/- 67 169 105 103 76 160 307 209 102 206 45 1549

0.08 0.2 0.13 0.12 0.09 0.19 0.37 0.25 0.12 0.25 0.05 1.85

8 Digital stop watch cell 257 462 500 300 400 345 654 550 570 750 230 5018

Cell @ Rs. 30 0.08 0.14 0.15 0.09 0.12 0.1 0.2 0.17 0.17 0.23 0.07 1.52

9 Baby Blanket@120/-

257 462 500 300 400 345 654 550 570 750 230 5018

0.31 0.55 0.6 0.36 0.48 0.41 0.78 0.66 0.68 0.9 0.28 6.01

10 Warm Bag@120/-

257 462 500 300 400 345 654 550 570 750 230 5018

0.31 0.55 0.6 0.36 0.48 0.41 0.78 0.66 0.68 0.9 0.28 6.01

11 ASHA Diary @150/-

257 462 500 300 400 345 654 550 570 750 230 5018

0.39 0.69 0.75 0.45 0.6 0.52 0.98 0.83 0.85 1.13 0.34 7.53

12

IEC Kit @200/- 257 462 500 300 400 345 654 550 570 750 230 5018 (50% i.e. Rs. 100 will be utilized

for preparation of material at State level) 0.51 0.92 1 0.6 0.8 0.69 1.3 1.1 1.14 1.5 0.46 10.02

13 Postcards/ ID Cards and other

formats @ 50/- per ASHA

257 462 500 300 400 345 654 550 570 750 230 5018

0.13 0.23 0.25 0.15 0.2 0.17 0.33 0.27 0.28 0.37 0.11 2.49

14

Communication support @100/- per ASHA for 6 months in

position ASHAs (CUG connection) 1.34 2.05 2.83 1.4 2.23 1.3 2.44 2.39 3.25 3.76 1.25 24.24

Total 3.94 7 7.68 4.57 6.06 5.21 9.92 8.37 8.64 11.39 3.46 76.24

ASHA Monitoring and Mentoring Mechanisms K 6.2.2:

The State and District level mechanisms are

1. Unit level Mentor groups for all ASHA Units Unit Level ( Block) 2. District Mentor Groups. District Level 3. District level Monitoring Committees. District Level 4. State level Mentor Group State Level 5. ASHA Resource Center State Level 6. State level Monitoring Committee State Level

Formation of Mentor groups:

Formation of State / District / Unit level mentor / support groups is essential to have an ongoing

support system for the scheme to become successful.

I. Unit level Structures for Mentoring / Training a nd Monitoring:

Each ASHA Unit comprises of one lac population and two or more health centers, one for 50,000

population each. The centers may belong to GNCTD, MCD or NDMC. One of the centers is designated

as the Unit Head Quarters and the MO I/C of this center is designated as the ASHA Unit Nodal Officer

and ASHA funds are released to the Unit Head Quarters. Each ASHA Unit has 50 ASHAs attached (25

to each center) @ one ASHA per 2000 population.

Each ASHA Unit had a group of five unit level trainers now part of the mentor group which comprises

of members drawn from the any of the following categories:

1. Unit Medical Officer. Any one of the medical officer belong to the two centers of the ASHA Unit including the AYUSH doctors. 2. Public Health Nurse / Lady Health Visitor if available in any of the two centers. 3. ANM of the Unit. 4. Local NGO Member 5. Local ICDS Functionary. 6. Local RWA member.

Monthly Meeting of ASHAs is mandated, can be made more frequent if possible.

The Mentor group earlier functioning as the Trainer group continues to discharge its function of

refresher trainings. These trainers are trained by the State / District level Master trainers.

Mandated Functions of the Unit level Mentor Groups:

• Conduct of refresher trainings. • Providing hands on training in the field. • Addressing the communication roadblocks in the community. • Helping establishment of credibility in community and faith of people in ASHA. • Helping her liasoning with the ICDS functionaries. • Introducing her to the local water / sanitation functionaries and helping her in formation of self

help groups / health and Sanitation Committees. • Facilitate conduct of Health and Nutrition days. • Ensuring continuous availability of logistics.

• Evaluation of ASHA performance. • Ensuring timely disbursal of incentives available under different programmes.

District level Structures:

District level Mentor Group with following function s has been formed:

1. Evaluation of the capacity building (Process and Outcomes) of the District and Unit level Trainers , ASHAs and ANMs

2. Strengthening the training content and conduct / adding new contents as per the feedback, local / emerging needs.

3. Ensuring evaluation at the ground level . 4. Evaluate the ASHA – ANM Synergy and advise for improvements in the implementation

mechanisms. 5. Help in solving unit level / district / generic problems being faced by ASHA Units. 6. Ensuring a district level database and a functional MIS / periodic report generation and onward

transmission to state.

District level Monitoring Committee: District ASHA Nodal Officers and District Level ASHA

Committees already exist which have been supervising the ASHA selection processes and

implementation of the Scheme.

S No. Name of the district

District Mentor Group formed

District Monitoring Committee

Unit level Mentor groups

1. Northwest Formed Formed Formed 2. North Formed Formed Formed 3. West Formed Formed Formed 4. Southwest Formed Formed Formed 5. South Formed Formed Formed 6. South East Formed Formed Formed 7. East Formed Formed Formed 8. Northeast Formed Formed Formed 9. Shahdara Formed Formed Formed 10. Central Formed Formed Formed 11. New Delhi Formed Formed Formed

Functions:

1. Field visits and monitoring of centers of the ASHA Units. 2. Ensuring the logistic and service delivery support for ASHAs. 3. Functioning of the ASHA Unit – Fulfillment of enhanced needs generated by ASHA Activity. 4. Ensuring periodical evaluation. 5. Solving unit level / district / generic problems being faced by ASHAs Units 6. Ensure smooth and timely incentive disbursal and Grievance redressal if any. 7. Monitoring of the ANM / ASHA Synergy in the field. 8. Record keeping and Filling up of ASHA Diaries

MONITORING & MENTORING MECHANISMS:-

The system of monitoring and mentoring has already been developed in Delhi

State to observe the ASHAs performance / functionality and outcomes of her

performance at district level, unit level. ASHAs are mainly engaged in household

surveys and home visits, some identified basic services , escorting services and

record maintenance. Therefore, a functional criterion had been devised to evaluate the

ASHA performance on certain parameters. If an ASHA is performing more than 50%

of the expected parameters then she will be considered as functional ASHA and

become eligible for a certain core incentive. An ASHA who is performing below 50%

will be counseled and facilitated by the MOIC/ANM to help her in enhancing her

performance. In case her performance doesn’t improve over next three months, her

name will be recommended for further deletion. These core criteria have been

modified according to the Guidelines developed by GOI and are given below :

S.no. Core activities in the given month

Crit eria of functional

functional ASHA gets Score 1

1. Complete Immunization (less than one year)

Achievement of 80% or more is expected 1

2. Complete Immunization (one to two year)

Achievement of 80% or more is expected 1

3. Family planning activity ( OCs/CuT/Vasectomy /Tubectomy)

Addition of a protected couple through use of OCs/CuT/ Vasectomy/tubectomy

1

4. New Pregnant woman registered

Registered of all pregnant women in her area 1

5. Pregnant woman registered in first trimester

50% of those registered in their first trimester. 1

6. Institutional deliveries facilitated 80%or above institutional deliveries out of expected deliveries.

1

7. Post natal visits made • 100% of newborns delivered at home are visited within 24 hrs. • 100% of newborns delivered in an institution are visited within 48 hrs to seven days. • In case of ASHA trained in HBNC ,50% or more of the delivered women/newborns are visited as per the home based care schedule.

1

8. Health & Nutrition day /Adolescent group meeting /outreach session

Participation in one or more of these events 1

9. Attended the monthly review meeting/ refresher training

Attendance in either or both of these events 1

10. Follow up of malnourished/ anemic individual/high risk pregnant women

Identification /accompanying the malnourished individual to the center/NRC/IYCF for management and follow up.

1

11. Screening of senior citizen Achievement on either or both of these 1

/cataract surgery facilitation activities. 12. Entry of records in diary

/updation of dairy Timely visits and service updation in her diary, especially the marginalized households and those having potential beneficiaries.

1

There is a Diary in which the ASHA records her work plan and the achievement in which the

ANM / MO verifies the activities undertaken by her. Based on these her functionality is

assessed. The Diary also records her other activities for which an incentive becomes due. The

information regarding the activity wise functionality score obtained by ASHA is fed in the

simple single screen on a web-based system by the supervising ANM. This then automatically

generates the report of each center / district and generates the activity wise grading.

Web Based ASHA Portal:

A web based software has been developed which captures the databases on ASHAs, physical

and financial achievements , trainings , Grading of the centers / districts on functionality

criteria, activity wise incentive disbursal etc. The system has become operational from April,

2013 which is helping in following areas:-

The screen for entering functionality:

District wise Grading Report:

District wise Activity wise Grading Report :

To keep the records, updated databases, monthly performance reports, calculate

incentives and be able to analyze the performance of these 3900 community

health volunteers is indeed a challenge. A software has been developed to make

the reporting, record keeping, incentive calculation, maintaining real-time updated

databases available for the ASHAs. This web based application has enabled the

unit / district level / State level Planners, to monitor, to assess and plan for the

scheme, to generate the necessary reports.

The software includes the District wise Health Center Entry , Entry of the ASHA

Unit , Centers under the ASHA units , Health Center wise MO , ANM , ASHA

entry . ASHA Area Detail Entry. It includes updation on ASHAs selected, deleted,

resigned with reasons. It includes training schedules / actual trainings with details

of participants / expenditure records. The software has been prepared and

implemented in all districts.

The functionality status of ASHAs / corresponding grading of the centers / districts

/ activitywise grading of the centers / districts can be compiled and displayed on a

realtime basis.

Another unique feature of the software is the direct online payment of ASHA

incentives into the bank accounts of ASHAs from the district account upon online

authorization by the concerned Medical Officers. This obviates the need for

transferring the funds to the individual centers , then seeking UCs, fund requests ,

fund release processes, changes in MO I/Cs and subsequent change of

signatories in the Banks which were all leading to delays in her payments. Also

the exact amount paid for which activity can be seen at the center / district / state

level. This also allows monitoring of timely payments to ASHAs.

To facilitate review at higher levels, a desktop based dashboard has been

developed and placed on the desktops of the Mission Director / Secretary (

H&FW) , CDMOs to allow them to see the Functional Grading and Payment status

in different districts / centers . They do not have to browse or go through a

Website. They just have to click on the Icon placed on their desktop and if the

internet is on, they get directly navigated to the active dashboard .

A click on the icon opens the dashboard :

State level Structures:

ASHA Resource Center:

State Level Structures: State ASHA Resource Centre

Budget Head – K.6.2.2

ASHA Resource Centre

SNo. Activity Estimated Expenditure

Status

I. Manpower

1 State ASHA Coordinator (2) 40761 X 2 X 12= 9.78

lacs 2 in position

2 Data Assistant (2) 15645 x 2 x12 = 3.75

lacs 2 in position

3 Accounts Assistant (1) 17388x 12 = 2.09

Lacs 1 in position

II. Logistics / Mobility

1 AMC for the hardware 0.25 lac

These are for the five old computers being used by the State ASHA Coordinators & CDEOs. These are now out of warranty.

2 Monitoring and evaluation 0.5 lac

3 Stationary & running cost. 0.25 lac

4 Mobility support 0.5 lac For ARC Staff: field visits to ASHA

centers / units / related events. Contingency (4%) 0. 71lac

Total(Estimated Expenditure + 4% contingency )

17.82 lacs

State Monitoring Committee

Functions:

• Periodic review of the implementation processes / Outputs. Policy decisions and

necessary approvals.

• Monitoring of the State / district level implementation.

State Mentor Group:

• This Mentor group shall be supported by an ASHA resource center with the necessary

support staff for discharging its mandated functions.

Function of ASHA resource centre and State Level Me ntor Group:

• Conduct / monitor outcome of the State level capacity building for communitization

processes – ASHA / Health and Sanitation Committees / Rogi Kalyan Samitis.

• Generate and maintain an updated database of all aspects of ASHA Scheme.

• Ongoing Monitoring and Evaluation of the efficacy and outcomes of schemeSuggest

/ formulate changes / additions in the scheme and getting the necessary approvals.

• Document the implementation and progress of the scheme.

• Compile the best practices / ASHA experiences in other States and circulate amongst the stakeholders.

• Adaptation of ASHA modules provided by the Government of India to Delhi specifics and also designing of other training material in consultation with the training division.

• Getting the State level publicity / IEC material designed as per need by the State BCC Unit.

Unit / District / State level Mentor groups shall be provided with a fund of Rs. 5,000/- /

10,000/- and 25,000/- per year respectively for any meetings / holding community events /

stationary / any local IEC material generation / preparation & photocopying of required

formats .

District level Structures:

Budget Head – K.6.2.2

SNo. Activity Estimated Expenditure

Status

I. Manpower

1 District ASHA Coordinator (11

@ 1 per district) 32435 X 11 X 12= Rs.

42.81 lacs 11 District ASHA Coordinators in

position II. Logistics / Mobility

1 Computer with printer (@Rs.

60,000/- per district) Rs. 6.6 lac

2 Mobility support Rs. 2.64 lac

For concerned district officer : field visits to ASHA centers / units /

related events. Upto Rs. 2,000/- per mth/district to be reimbursed (as per prevailing

state govt. norms) on actual expenditure incurred

Total Rs. 52.05lacs

Human Resource under the Scheme:

ASHA- Annexure-V

Human Resource

Required as per

norms

Approved 2013-14 Approved 2014-15 No. In positi

on

Monthly Remuneratio

n

Total Amount

Approved No.

Monthly Remunerati

on

Total Amount

State Level 15,62,400 State ASHA

Coordinators 2 2 38,820 9,31,680 2 40,761 9,78,264

Computer Data Entry Operators

2 2 14,900 3,57,600 2 15,645 3,75,480

Account s Assistant 1 1 16,560 198,720 1 17,388 2,08,656

District Level 42,81,420 District ASHA Coordinators 11 11 30,890 20,38,740 11 32,435 42,81,420

Block level x x x x x x x

Cash Awards for ASHAs K 6.2.2:

Certain cash awards are proposed at 3 levels – Unit Level, District Level & State Level. These

shall be annual awards. The amount for 1st IInd & IIIrd ASHAs at the Unit Level shall be Rs.

5000, 3000 & 2000 respectively. The amount proposed for 1st,IInd & IIIrd ASHAs at the district

level shall be Rs. 5000, 3000 & 2000 respectively .The amounts proposed at the State level

for 1st, IInd & IIIrd ASHAs 10,000, 8000 & 5,000/- respectively.

While selecting 1st, 2nd & 3rd ASHAs the following 10 essential parameters shall be kept in

mind:

i. Working for at least six months after completion of first module.

ii. Completed first Modular training.

iii. Completed Household Survey.

iv. List of beneficiaries at the end of the Diary duly completed and regularly updated.

v. Diary duly filled & utilized for tracking pregnant women / children / eligible couples etc.

vi. Attendance in the Refresher Trainings / Monthly meetings / Ground level Convergence meetings.

vii. Total ANC registrations and the First Trimester registrations in last six months.

viii. Institutional Delivery rate.

ix. Average number of IUCD insertions and Tubectomy / Vasectomies (Taken together) in

last six months.

x. Children completely immunized out of the children eligible for immunization in last six months.

These are suggestive indicators. The state / districts may add / modify their own indicators and

make suitable formats / questionnaire for assessing on these parameters in consultation with

the State / District Mentor Group and the same may be used after approval by IDHS. In case

of exceptional circumstances other parameters may be used in keeping with the local

conditions of the ASHA Area in consultation with the District ASHA Mentor Group and after

due approval of the IDHS.

These ASHAs shall be felicitated at the ASHA Sammelans which shall be annual events at the

district and State Level. The funds proposed for these Sammelans shall be:

ASHA Sammellans (District Level) funding shall be proportionate to ASHAs:

• For districts having < 250 ASHAs ( Rs. 25000/-)

• For districts having 250 to 500 ASHAs ( Rs. 35,000/-)

• For districts having > 500 to 1000 ASHAs ( Rs.75,000/-)

• State Level ASHA Sammellan (Upto1 lac/-)

During the financial year 2013-14 ASHA sammelans were organized at South, Southwest and

West districts to recognize the efforts of ASHAs for improving the health seeking behavior

among vulnerable population. These cash awards also motivate them to enhance their

performance in future.

Sponsorship initiative for ASHAs K 6.2.2:

The objective of ASHA sponsorship program is visualized for ASHAs to motivate them for

making their best efforts in community services and also enable them towards career

opportunities through enrolling in the open School systems to obtain class X & XII

qualifications.

As part of the career progression for the ASHAs, at initial stage, State has identified 200 ASHAs

from all districts who are willing to pursue their qualifications further. The state would

support their registrations for distance learning in National Institute of Open School, an

autonomous organization with an estimated amount of Rs. 10 lacs in PIP 14-15.

DISTRICT / STATE WISE Budget requirements under pre scribed heads

Dis

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ASHAs Budget (In lakh)

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(K6

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Northwest 10 550 399 151 209 0.4 22.3 0.6 153.68 1.57 0.25 8.37 1.1 0.75 4.73 2.20 11.97 2 2 3.59 215.51

North 10 462 342 120 169 0.32 21.05 0.6 129.6 1.27 0.2 7 1.1 0.35 4.73 1.85 10.26 2 2 3.08 185.41

West 13 750 627 123 206 0.39 28.33 0.75 215.78 1.55 0.25 11.39 1.4 0.75 4.73 3.00 18.81 2 2 5.64 296.77

Southwest 14 570 542 28 102 0.19 19.76 0.8 168.9 0.77 0.12 8.64 1.5 0.75 4.73 2.28 16.26 2 2 4.88 233.58

South 7 345 217 128 160 0.3 13.12 0.45 93.9 1.2 0.19 5.21 0.8 0.35 4.73 1.38 6.51 2 2 1.95 134.09

Southeast 15 654 407 247 307 0.58 19.75 0.85 177.68 2.3 0.37 9.92 1.6 0.75 4.73 2.62 12.21 2 2 3.66 241.02

East 8 400 372 28 76 0.14 15.55 0.5 117.9 0.57 0.09 6.06 0.9 0.35 4.73 1.60 11.16 2 2 3.35 166.90

Northeast 10 500 472 28 105 0.2 14.63 0.6 147.9 0.79 0.13 7.68 1 0.35 4.73 2.00 14.16 2 2 4.25 202.42

Shahdara 8 300 234 66 103 0.19 11.53 0.5 85.05 0.77 0.12 4.57 0.8 0.35 4.73 1.20 7.02 2 2 2.11 122.94

Central 11 257 224 33 67 0.13 11.77 0.65 74.63 0.5 0.08 3.94 1.2 0.35 4.73 1.03 6.72 2 2 2.02 111.75

New Delhi 7 230 208 22 45 0.09 9.09 0.45 67.35 0.34 0.05 3.46 0.8 0.25 4.73 0.92 6.24 2 2 1.87 99.64

State

13.12

11.15

2* 0.23 1 17.85 0 8 8 1.63 62.98 (0.25

+10.0^+

0.9 ^^)

Total 113 5018 4044 974 1549 2.93 200 17.9 1432.37 11.63 1.85 78.24 12.43 6.35 69.88 20.07 121.32 30 30 1.63 36.4 2073.00

^^ Monthly review meetings for ASHA facilitators at district level @ Rs. 25/- per ASHA facilitator (600) x 6 months # Total financial implications of trainings- 305.11 lacs but only 200 lacs (66%) is being projected in view of available resource envelope an d expenditure of previous year. In case more is required, it will be sought in supplementar y PIP (Budget head: K.3.6)

Budget Summary:

Activities Amt. in Lakhs

a. Total excluding incentives 421.25

PUHC Review meeting incentive to ASHAs (K6.2.1) (@150/- x 6 months x 4044 ASHAs) 36.40

HBNC incentive (K6.2.1) 30.00

FP-PPIUCD @150x20,000 (K6.2.1) 30.00

Household resurvey incentive (K6.2.1) (@500xin position ASHAs x 6 months) 121.32

Adolescent Health incentives (K6.2.1) (for support to PE @ 0.13 lakh & for mobilizing adolescents for AHD @ 1.5 lakh)

1.63

Grand total (excluding State incentive) 640.60

Budget Head

Activities Total Financial implication proposed for 2014-15

K3.6 ASHA Selection & Trainings 202.93 lacs

K6.2.1 ASHA Incentives 219.35 lacs (excluding State incentive)

K6.2.2 The HBNC kits, support structure, coats, umbrellas, ARC, awards, printing, CUG connection, HR, IEC material etc. are included here.

218.32 lacs

Total 640.60lacs

token of appreciation for her effort and commitment, she is given incentives for some of the

activities performed by her under various National and State health programmes.

ASHAs carry out the survey of their allotted households and submit a copy to the unit head

quarters. For this the GOI Format was adapted, translated before use. Recently it has been

modified further and made more computer friendly. ASHA gets Rs. 10 for each Household

surveyed. A resurvey household incentive @ 500/-per ASHA has been allowed by GOI and is

being projected for 2014-15.

Using the information she has collected from the household surveys she has to list out the basic

needs in her cluster in the Diary provided. She continuously updates the entries by her ongoing

field work. This gives her the quantum / nature of work required in her area. The local health

activities carried out are recorded in her diary and accordingly the work done evaluated and

incentives calculated.

The incentive structure is a three tier package. The first tier comprises of a certain amount (Rs.

1000/-) which is given if the ASHA is functional. Functionality of ASHAs is decided by her

performance on certain identified indicators as prescribed by GOI. The functionality assessment is

done at the Unit level. Certain activities have been identified for add on incentives and these form

the second tier. The third tier comes from the individual National Programs having inbuilt

provisions for the ASHAs.

The tier one and two incentives are disbursed at the unit level through a single window. Tese are

funded by the State Government. The National Program incentives come from National programs.

Immunization / JSY incentive though coming from the concerned programs are also disbursed

from the Unit level through a mechanism wherein the funds with guidelines are placed at the unit

level.

Incentives to ASHAs has been proposed for attending the PUHC review meetings (Rs. 150/- per

ASHA) for six months which has been approved in the meeting of MSG of NHM dated 6th

December 2013.

In order to get sufficient number of volunteers and to keep them motivated enough to stay in the

program, the incentive package was revised in 2010. Some of the existing incentives were

enhanced .Certain thrust areas required a more active participation of ASHAs like care of senior

citizens, increasing the use of IUCDs as spacing methods and tracking of malnourished and

severely anemic individuals for which introduction of new incentives were introduced. In 2013

April certain new incentives were added including the enhancement of functional ASHA incentive

from 500/- to 1000/- . The incentive of PPIUCD has been allowed by GOI and is being projected

in the year 2014-15.

In the current financial year NVBDCP department of South & East Municipal Corporation sought

involvement of ASHAs for Dengue household survey activities in their assigned households. The

around 15 .0 lac household visits were made.

Detailed Incentive structure is annexed.

In order to cut down on delays, State has also developed a mechanism of online incentive

calculation and its monitoring. Screen for calculation is placed below:

The ANM enters the number of activities performed under each activity and the amount gets

calculated. This is verified by the MO In charge. A remuneration slip is available and a printout

can be given to the ASHA if she so desires.

Online Payments in ASHAs Account: In order to prevent the delays in payments which were

due to delay in release of funds to the health centers / UCs etc a direct online payment system

has been functionalized wherein the MO In charge shall authorize the payments online through

the web based ASHA portal and the payments shall be made directly into the ASHAs Bank

account from the district account. In addition to saving on time and effort this shall also

make the process more transparent. After some technical hiccups at the exercise has been

carried out successfully for one district. It shall be completed for the rest in next two months.

S.No. Training of Master Trainers Expenditure per unit

1. Honorarium to the Trainer of Master trainers 500

2. Per diem for Trainees 200 3. Training Material for trainees and trainers. 150 (per module training) 4. Lunch & tea for trainees, Trainers, support staff. (30 +5+ 4) 150 5. Over head expenses ( 10%)

Training of Unit level trainers Module :

1. Honorarium to the Trainer of Trainers 250

2. Per diem for Trainees 150 3. Training Material for trainees and resource persons 150 (per module training) 4. Lunch & tea for trainees, Trainers, support staff. (25 +5+ 4) 150

5. Over head expenses ( 10%) .

Modular Training of ASHAs :

1. Honorarium to the Trainer of Trainers 200

2. Per diem for Trainees 100 3. Training Material for trainees and resource persons (and

upto one ANM for every five ASHAs).

150 ( Per Module)

4. Lunch & tea for trainees, Trainers, support staff( upto four support staff permitted) and upto one ANM for every five ASHAs.

150

5. Over head expenses ( 10%)

Refresher Training for ASHAs:

1. Honorarium to the Trainer of Trainers 200

2. Per diem for Trainees 100 3. Training Material for trainees and resource persons (and

upto one ANM for every five ASHAs). 25

4. Lunch & tea for trainees, Trainers, support staff (upto four support staff permitted) and upto one ANM for every five ASHAs.

150

5. Over head expenses ( 10%)

Durations of different trainings :

S. No. Training Duration Master Trainers :

1. Round 3 5 days 2. Round 4 5 days

Unit Level Trainers 1. TOT Trainers Module 1-5 5 days 2. TOT Trainers Module 6 7 days 3. TOT Trainers Module 7 7 days.

ASHA / ANM Trainings 1. Training of ASHAs Module 4 ( 5 GOI ) 5 days 2. Training of ASHAs Module 6 7 days 3. Training of ASHAs Module 7 7 days 4. Training of ASHAs Refresher Training 1 day