Does ASHA end at doorstep?

One of India's greatest strengths in community outreach in healthcare is the vast network of Accredited Social Health Activists (ASHA), which stands at 1.03 million as of September 2024, and contributes to the largest volunteer health workforce in the world.

- VIJAYETTA SHARMA & ANANDAJIT GOSWAMI

As a trusted community health worker selected from within the community, she is vital in enhancing healthcare utilization and coverage under the National Health Mission (NHM).

A macro-level population study found that there has been an increase of 17% in women receiving at least one ANC visit, 5% in four ANC visits, 26% in deliveries attended by skilled birth attendants, and 28% in facility-based deliveries with the intervention of ASHA in India.

A well-equipped and well-supported ASHA is bound to improve maternal health, nutrition, immunization, and other community health outcomes through strategic interventions in different regions. The community outreach activities by ASHA, coupled with other significant health provision measures, have contributed significantly to a 61.8% reduction in Maternal Mortality Rate (254 to 97) from National Family Health Survey -3 (2005-06) to National Family Health Survey -5 (2019-21).

Although Rs 24,994.45 million (India) and Rs 414.791 million (Haryana) were expended for ASHAs in FY 2024-25, the overall spending as per National Health Mission fell over 20% since 2019-20, reflecting reduced focus and shift in priorities for advancement of ASHA. Ironically, postnatal care remains an overlooked agenda, failing data capturing on four prescribed postnatal visits by WHO, UNICEF, NFHS, and DHS etc. Despite the consistent efforts by ASHA by visiting door-to-door, the postnatal care utilization lags behind other maternal and child health services. Globally, about 30% of women and newborns did not receive postnatal care (WHO, 2022).

As noted by the authors in district Faridabad, Haryana, 84.3% of JSY beneficiaries received a visit by ASHA within seven days of childbirth, and 66.8% got postnatal counseling, but only around one-fifth (21.3%) of Janani Suraksha Yojana (JSY) beneficiaries were accompanied for all four recommended postnatal check-ups.