The accredited social health activists (ASHAs) — the first port of call for health care under the National Rural Health Mission (NRHM) — will be entrusted with additional responsibilities, albeit with better monetary incentives, as the Mission Steering Group – the highest decision making body of the NRHM — has approved the proposal for involving them in activities such as spacing between births, promoting iodised salt and village sanitation.
The ASHAs will now have a major role to play in counselling newly-married couples and those with one child to have their first child after two years of marriage and space their children for at least three years. For this, the ASHAs would be paid an incentive of Rs. 500 per couple she manages to convince for spacing between births.
And, as part of the communitisation strategy of the NRHM, it has been decided to involve ASHAs in organising the monthly village health sanitation and nutrition committee (VHSNC) meeting for which she will be paid an incentive of Rs. 150 a month. This meeting will be followed by the meeting of women and adolescent girls where the health and sanitation needs of adolescent girls would be discussed. There are 5 lakh VHSNCs but frequency and performance of these meetings and involving ASHAs could help in streamlining this.
Importantly, it has also been decided to further incentivise ASHAs by providing an additional Rs. 100 for every child who receives complete first year immunisation and Rs. 50 for every child who further completes two years of immunisation as per the stipulated schedule. As of now, ASHA gets Rs. 150 for mobilising children to immunisation session sites.
The Centre has also identified 303 anaemia endemic districts in the country where each ASHA will be given an honorarium of Rs. 25 a month for testing 50 salt samples for checking iodine content.
Iodine is an essential micronutrient and is the most effective and cheapest source of reducing iodine deficiency that can result in perinatal and infant mortality, cretinism, dwarfism, still births, and mental retardation. Only 51 per cent households in the country consume adequately iodised salt. ASHAs are expected to test the commonly used salt for its iodine content and create awareness among the people regarding the importance of iodised salt consumption.
Universal Immunisation Programme (UIP) of India is one of the largest immunisation programmes in the world targeting 2.6 crore infants and three crore pregnant women each year. Under UIP, vaccination is provided against Diphtheria, Pertusis, Tetanus, Polio, Hepatitis B, Measles, and Tuberculosis.
At present the full immunisation coverage of children is 61 per cent at the national level with wide geographical variations. The year 2012-13 has been declared as the year of intensification of Routine Immunisation for which involvement of the community is necessary, particularly in the rural and backward regions of the country.
Contraceptive use remains low at 46 per cent and the use of spacing methods is poor. The Centre believes that spacing between births could have a positive impact on reducing maternal mortality as 45 per cent of total maternal mortality is contributed by the 15-25 age group who cannot be persuaded for sterilisation.