Naveen Jain
Mission Director
National Health Mission,Rajasthan

Since the inception of National Rural Health Mission (2005), Accredited Social Health Activist (ASHA) component has played an important and critical role in the implementation of NRHM activities. The ASHA programme was introduced as a key component of the community process intervention and over the period of eight years, this programme has emerged as the largest community health worker programme in the world and is considered of critical importance in enabling peoples participation in health. ASHA is a community, whose role is to generate awareness on health issues and it also acts as an interface between community and health services. In Rajasthan, it is known as ASHA Sahyogini, as it works jointly between Department of Medical Health and Department of Women and Child Development. ASHA is selected by Gram Panchayats and works with the help of Anganwadi Centres. Before it starts functioning, it has to undergo intensive induction training.

To reduce the Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR), to ensure better health services and to prevent other diseases, at present, approximately 47000 ASHA Sahyoginis are functional in the state. ASHA Sahyoginis are paid incentives against providing various health services to pregnant mother and child and also for providing health services to the community. The roles and responsibilities of ASHA include the functions of a healthcare facilitator, a service provider and a health activist. It coordinates as a bridge between health and WCD in delivering key services and message for Child and Maternal health. Besides, ASHA Sahyogini also renders important services under National Disease Control Programme (NCDC) such as malaria, TB, leprosy, cataract and many more health provisions.

ASHA are paid incentives against 26 types of activities and that also at different time period and from various channels. These complexities in their payment system cause various problems for ASHAs payments. Because of not being paid on time, ASHAs were getting de-motivated to render proper services to the community. Getting payment for every activity on time is a challenge, which has been acting as disincentive to them.

Objectives
To ensure their timely and seamless online payment, ASHA software popularly known ASHA Soft has been conceptualised. It is a unique initiative by the NHM, Rajasthan. The software has been developed in a very short time span because of the keen interest shown by the authority to solve the major problem of ASHAs delayed and partial payment, which was being faced at grass root level. ASHA Soft is an online system which facilitates the user to capture beneficiary wise details of services given by ASHA to the community, online payment of ASHA to their bank accounts and generate various kinds of reports to monitor the progress of the programme. Objectives To ensure their timely and seamless online payment, ASHA Soft has been conceptualised with objectives to monitor the performance of each and every ASHA every month. To identify the gap area and need assessment for rendering better services at community level. Assessing the quality of services in remote and vulnerable areas, it would be easier to assess the service delivery of ASHA in remote areas and marginalised community. Further, timely payment of incentives to ASHAs will maintain their motivation level. Methodology, the software has been developed by NIC, Rajasthan state unit and the NHM core group constituted for this purpose under the directions of the Mission Director, NHM, Rajasthan. Master data for each and every ASHA was created constituting their personal profile including their educational qualifications, level of trainings, any other skills etc. All the concerned functionaries have been oriented and trained for their responsibilities. Directions and circulars have been issued to states, districts, blocks, PHC officials. A detailed manual has been prepared and circulated to all data entry points and various stake holders. Training for filling up the claim form has been done in all the districts up to PHC and ASHA level. For online payment, Bank of Baroda has been selected, which provides services without any additional charges.

Implementation Process
This online payment process has been implemented all over the state from 26th December 2014. The payment process includes steps where ASHA would prepare their monthly claim form (self appraisal forms). ANM will verify their claim form (self appraisal forms). Verification and entry of data would be done by IA or Data entry operator or PHC or ASHA Supervisor. ASHA wise data entry would be done of self appraisal form and line listing. Sanction of payment will be done by MOIC with assistance of accountant or LHV and release of payment through digital signature of the CM and HO by the seventh of every month. The payment will be transferred to ASHAs bank account. ASHA will receive SMS on their mobile regarding the transfer of payment.

Also read: Co-operating Community healthcare

ASHA Soft Analysis Report
From the analysis of first months payment disbursement through ASHA Soft, various patterns related to ASHAs functioning have emerged. The pattern of payment draws a picture of ASHA programme all over the state. For instance, it was found that in most of the district in Rajasthan, the majority of services rendered belong to monthly meeting and routine activities of ASHAs followed by maternal health, immunization services and family planning services. There is a very negligible proportion of National Health Programmes such as TB, leprosy, cataract and malaria (Fig 1). Figure 3 brings out a clear picture of the ASHAs functioning in the state. In terms of rendering services under child health, there is a clear correlation with the level of training received under sixth and seventh module and the amount of services provided.

Similarly, the analysis from the payments of month January shows improvement over the December report. The temporal analysis of these two months shows the impact of persuasion to all districts after December performance. As evident from figure 4, the level of best performing ASHAs have gone up and there is a sign of healthy competition in the competent ASHAs of all the districts.

Thus, the knowledge of the ASHAs on the nature of activities and job responsibility is the pre-requisite for effective service delivery. Awareness among ASHs about their responsibilities is the most crucial factor, which has been now possible to link with performance through ASHA Soft. It is critical that through ASHA Soft Rajasthan is going to witness a new dawn in the field of its community health.

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