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 is 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]
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ASHAs are local women trained to act as health educators and promoters in their communities. The Indian MoHFW describes them as:[3]
...health 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” (i.e. surgical sterilization), treating basic illness and injury with first aid, keeping demographic records, and improving village sanitation.[4] ASHAs are also meant to serve as a key communication mechanism between the healthcare system and rural populations.[5]
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.[6] 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.