Accredited Social Health Activist

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Accredited social health activists (ASHAs) are community health workers instituted by the government of India's Ministry of Health and Family Welfare (MoHFW) as part of the National Rural Health Mission (NRHM).[1] The mission began in 2005; full implementation was targeted for 2012. Once fully implemented, there is to be "an ASHA in every village" in India, a target that translates into 250,000 ASHAs in 10 states.[2] The grand total number of Ashas in India was reported in July 2013 to be 870,089.[3]

Roles and responsibilities[edit]

ASHAs are local women trained to act as health educators and promoters in their communities. The Indian MoHFW describes them as:[4] activist(s) in the community who 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.

Their tasks include motivating women to give birth in hospitals, bringing children to immunization clinics, encouraging family planning (e.g., surgical sterilization), treating basic illness and injury with first aid, keeping demographic records, and improving village sanitation.[5] ASHAs are also meant to serve as a key communication mechanism between the healthcare system and rural populations.[6]


ASHAs must primarily be female residents of the village that they have been selected to serve, who are likely to remain in that village for the foreseeable future. Married, widowed or divorced women are preferred over women who have yet to marry since Indian cultural norms dictate that upon marriage a woman leaves her village and migrates to that of her husband. ASHAs must have class eight education or higher, preferably be between the ages of 25 and 45, and are selected by and accountable to the gram panchayat (local government). If there is no suitable literate candidate, a semi-literate woman with a formal education lower than eighth standard, may be selected.


Although ASHAs are considered volunteers, they receive outcome-based remuneration and financial compensation for training days. For example, if an ASHA facilitates an institutional delivery she receives Rs. 600 and the mother receives Rs. 1400. ASHAs also receive Rs. 150 for each child completing an immunization session and Rs. 150 for each individual who undergoes family planning.[7] ASHAs are expected to attend a Wednesday meeting at the local primary health centre (PHC); beyond this requirement, the time ASHAs spend on their CHW tasks is relatively flexible.

Monitoring and evaluation work[edit]

The Indian government has set up the following indicators for monitoring ASHAs:

Process indicators[edit]

  • Number of ASHAs selected by due process
  • Number of ASHAs trained
  • Percentage of ASHAs attending review meeting after two year

Outcome indicators[edit]

  • Percentage of newborns who were weighed and families counselled
  • Percentage of children with diarrhoea and who received ORS
  • Percentage of deliveries with skilled assistance
  • Percentage of institutional deliveries
  • Percentage of completely immunized children in the 12–23 months age group
  • Percentage of unmet need for spacing contraception among people below the poverty line
  • Percentage of people who received chloroquine within first week in a malaria endemic area

Impact indicators[edit]

  • Infant mortality rate
  • Child malnutrition rates
  • Number of cases of tuberculosis or leprosy reported as compared to the previous year.

Monitoring and Evaluation under National Rural Health Mission[edit]

A baseline survey is to be taken at the district level. It is for fixing decentralized monitoring goals and indicators. The community monitoring would be at the village level. Planning commission would be the eventual monitor of outcomes. External evaluation will be taken up in frequent intervals.

ASHAs and improvements for rural Indian women living with HIV/AIDS[edit]

According to a June 20, 2013 news article of the UCLA Newsroom, at the University of California at Los Angeles (UCLA),

"A multidisciplinary team of researchers from UCLA and India has found that a new type of intervention program, in which lay women in the rural Indian province of Andra Pradesh were trained as social health activists to assist women who have HIV/AIDS, significantly improved patients' adherence to antiretroviral therapy and boosted their immune cells (increased immune cell counts) and nutrition levels."[8]

"The lay women were trained by the research team to serve as accredited social health activists, or ASHAs, and their work was overseen by rural nurses and physicians. These ASHAs then provided counseling and social support to the women with HIV/AIDS, as well as assistance aimed at removing the barriers they face in accessing health care and treatment. 'For rural women living with AIDS in India, stigma, financial constraints and transportation challenges continue to exist, making lifesaving antiretroviral therapy difficult to obtain,' said lead researcher Adey Nyamathi, distinguished professor and associate dean of international research and scholarly activities at the UCLA School of Nursing. In India, 2.47 million people are affected with HIV/AIDS, and more than half are women. The AIDS epidemic is shifting from urban to rural areas, and the rice-producing Andhra Pradesh district in southeastern India is at the epicenter; this area has the highest total number of HIV/AIDS cases of all states in the country, with nearly 20 percent of the population infected. For the intervention study, women with HIV/AIDS in Andra Pradesh were randomly selected to participate either in the intervention, called AHSA-LIFE (AL), or in a control group. Over a six-month period, the ASHAs visited the women in the AL group to monitor the barriers they faced in accessing health care and adhering to their antiretroviral therapy and provided assistance to help mitigate these barriers. The ASHA also provided counseling to help women develop coping strategies to deal with discrimination. The intervention group also received monthly supplies of high-protein foods, such as black gram and pigeon pea."[9]

"In addition, the women in the AL group participated in six education sessions ... including learning about HIV and AIDS, adhering to antiretroviral therapy, overcoming barriers and dealing with the illness. The courses also focused on improving coping, reducing HIV/AIDS stigma, caring for family members and children, the basics of good nutrition and benefits of participating in a life skills class. Women in the control group also attended the education sessions, but they did not receive visits and supportive services from the ASHAs. They received only standard protein supplementation, not the high-protein supplements of the intervention group. Among the women in the AL group, the researchers found significant increases in therapy adherence and CD4+ T-cell levels, as well as significant reductions in internalized stigma, avoidance coping and depressive symptoms, compared with the control group. The women in the AL group also showed significant increases in body mass index (BMI), muscle mass and fat mass, compared with the other women."[10]

See also[edit]


  1. ^ Ministry of Health and Family Welfare (MoHFW). (2005c). ASHA. Government of India. Accessed July 20, 2008 from
  2. ^ MoHFW. National Rural Health Mission 2005-2012: Mission Document
  3. ^ MoHFW. Update on the Asha programme, July 2013
  4. ^ National Institute of Health and Family Welfare. (2005) “Frequently Asked Questions on ASHA.” Government of India. Accessed April 23, 2007 from
  5. ^ Ministry of Health and Family Welfare (MoHFW). (2005c). ASHA.. Government of India. Accessed July 20, 2008 from
  6. ^ Ministry of Health and Family Welfare (MoHFW). (2005a). National Rural Health Mission: Mission Document. Government of India. Accessed July 1, 2008 from
  7. ^ Ministry of Health and Family Welfare (MoHFW). (2005b). Reading Material for ASHA. Government of India. Accessed April 1, 2008 from
  8. ^ Laura Perry, Innovative intervention program improves life for rural women in India living with HIV/AIDS, UCLA Newsroom, June 20, 2013
  9. ^ Laura Perry, Innovative intervention program improves life for rural women in India living with HIV/AIDS, UCLA Newsroom, June 20, 2013
  10. ^ Laura Perry, Innovative intervention program improves life for rural women in India living with HIV/AIDS, UCLA Newsroom, June 20, 2013