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ASHAs deliver hope for mothers, newborns

Nov 16, 2010

In Aligarh district of Uttar Pradesh, northern India, the Accredited Social Health Activists (ASHA) have been prime mover in ensuring healthy mothers and newborns. A new campaign partnered by policy makers, UNICEF India and the indigenous communities has tapped the immense potential of ASHAs and has transformed healthcare for women and infants.

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Aligarh, Uttar Pradesh: Manju, 20, is as ecstatic as her 45-year-old mother-in-law. She has just given birth to a healthy baby girl. While such an event may appear routine in most parts of the country, when it comes to Sarmastpur village of Dhanipur block in Uttar Pradesh’s Aligarh district, the normal birth of a healthy baby is cause for celebration. Aligarh district has been clocking as many as eight deaths of newborns every day. 

Twenty-two-year-old Rekha’s baby girl, who was born pre-maturely at seven months with a birth weight of just over a kilo, is also fortunate not to have become part of Aligarh’s list of neo-natal deaths. Today, as she suckles her daughter, Rekha knows that she would have lost her child if an Accredited Social Health Activist (ASHA) from her village had not brought her to the Sick and New Born Care Unit in Aligarh town, the district headquarters. As Rekha recounts with a smile, “I am happy to hold my child in my arms and see her alive and kicking. But she would not have been here today if it were not for the regular home visits of the ASHA who identified the complications I was developing and who immediately brought me here.” 

The lives of these two new mothers, Manju and Rekha, have been directly impacted by a new campaign - the Comprehensive Child Survival Programme (CCSP), in which the ASHAs of Aligarh are the foot soldiers. And going by the evidence on the ground, this could well be a movement in the making, epitomising a powerful partnership between policy makers, UNICEF India and local communities to preserve the country’s most precious asset: Its children. 

The move to use the formidable force of ASHAs began in 17 districts of Uttar Pradesh (UP) a year ago. Suman Devi, 41, an ASHA working in Sarmastpur village, explains, “As an ASHA the work I do gives me immense satisfaction because it is like saving the future generation. When I used to hear news of young mothers losing their children or developing health complications because of a lack of awareness, I used to feel bad. But now, after being trained in the CCSP programme, I feel I can do my bit to ensure that such deaths are reduced and proper care is provided to mothers and newborns.”

Through the CCSP, backed by the expertise of a reputed institution like the Aligarh Muslim University, the ASHAs of Aligarh have single-handedly managed to address factors contributing to infant mortality in the district and have ensured almost 70% institutional deliveries here. But that is not all: They have been able to usher in real behavioural change on the ground, especially by helping to dispel traditional myths with regard to breastfeeding and nutrition.

Generally speaking, for human beings, the chances of dying are highest between 0-28 days post birth. In India, the chances of newborns dying are even higher. According to some estimates, the neonatal mortality rate in the country is 36 per 1000 live births. Uttar Pradesh, as one of India’s largest and poorest states, reports an even higher neonatal mortality rate of 48 per 1000 live births, with some districts – like Aligarh – clocking numbers as dismal as 240 deaths per month or eight deaths per day.

Health experts are optimistic that the CCSP approach will turn things around. Explains Professor Noor Mohammed, Chairman and Project Co-ordinator, Sociology and Social Work Department, Aligarh Muslim University, “The focus was to build the capacity of the ASHA to provide the required services to new mothers and their infants. Under the National Rural Health Mission (NHRM), the UP government is committed to improving all the health indicators in the state. So we decided to help upgrade the newborn care provided by the state government. The AMU’s Department of Sociology and Social Work developed a support system for ASHAs, who in turn coach, support and motivate new mothers and their families to perform functions related to newborn care.”

The CCSP programme involved building a network of care givers. Prior to this module, only 13% of the 900 ASHAs in the six blocks in the district were performing home visits for newborns and only 7% were following the prescribed schedule. This has now risen to 92% and 81%, respectively. There are a total of 2,200 ASHAs in entire district of Aligarh.

According to Professor Mohammed, there has also been a significant change in traditional attitudes. “Earlier, newborns were kept hungry for three days as it was believed that mother’s milk was bad for babies. Instead they were given ‘khada’ (a local decoction made from honey, jaggery, ‘ghee’ and ‘ajwain’). ASHAs have managed to change this practice completely by counselling the families of young mothers. This has led to a 50% rise in breastfeeding within the first hour of birth,” he says.

The CCSP programme has now run for a year. It was launched in 17 districts of Uttar Pradesh in its first phase (2007-08) but because it has had such encouraging outcomes, the state government plans to implement it across all 71 districts. In addition, the supportive supervision model evolved in Aligarh is being replicated in all the CCSP districts.

The impact of the work of trained ASHAs is there for all to see. Even those who were earlier hostile to the idea of discarding old practices have had a change of heart. For example, Radha Devi, 61, now brings her pregnant daughter-in-law, Mamta Devi, to ASHA group meetings regularly. Says she, “I am a mother of five myself, and all my children were born at home. How I wish that in my time these ASHAs had existed to answer the innumerable questions that had bothered me and address the health complications that come with child birth. I certainly don't want my daughter-in-law to miss out on the care provided by the ASHA now." 

Basically, this is all about making better use of the institution of the ASHA. Rahul Kulshestra, Nodal Officer, CCSP Aligarh, puts it this way, “ASHAs, although they were around, were not being used by the government machinery and were a dormant workforce. But once the UNICEF and AMU stepped in, the skills of 2,200 ASHAs in Aligargh have been upgraded. They have now emerged as a powerful mentoring group reaching even those areas which have poor access to medical and health support.”

The sense of service and zeal of the ASHAs is admirable. A single ASHA addresses the maternal and child health needs of a population of 1,000, for a paltry performance-based incentive that comes to approximately Rs 3,000 (US$1=Rs 44.3) per month. And they certainly have the eternal gratitude of young mothers in Aligrah district now delighting in their little bundles of hope and planning furiously for their future.

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