ASHA’s are Empowered Feminist Workers in Indian Healthcare Sector: Truths and Myths from Case Studies in West Bengal

Abstract

Introduction: Community participation in Primary Healthcare in rural areas was missioned to be accomplished by implementation of Accredited Social Health Activist (ASHA) Programme under National Rural Health Mission in 2005. Primary Healthcare system expected ASHA the female squads to be an optimal vehicle for extending primary healthcare in rural areas by promoting immunization, referral and escort services for reproductive and child health and other health delivery programmes. To fulfil this responsibility ASHAs need to transform into ray of hope by lot of training and empowerment. Aim: In this context, the present paper aims to identify in short and long term the actual empowerment level achieved by ASHA’s to cater to the deprived communities. Objective: To fulfill this aim, the paper examines the whole arena of current provisions of the assignments, roles and responsibilities, recruitments, training, remuneration of ASHA’s in Khargram Block of Murshidabad District in West Bengal. Method: The analysis is based on primary survey through questionnaires of 200 ASHA’s in Khargram Block (100 % enumeration). Student-T test is conducted to reflect the ASHA-ANM response gap, Factor analysis based Performance Index and Logistic Regression is calculated to summarize the existing gap between the expected and actual performance of ASHA’s. Result: Results show that non-recognition, excessive focus on curative care, priorities of work as extended arm of Primary Healthcare system, lack of induction training and demotivation due to performance-based incentive instead of fixed income, lack of basic infrastructure has hindered ASHA’s from being “an interface between the rural community and rural healthcare delivery system”.