INFLUENCE ON ANTENATAL CARE
SERVICES THROUGH ASHA’S
INTERVENTION UNDER THE
NATIONAL RURAL HEALTH MISSION
(NRHM) IN JHARKHAND
ISITA RAY AND NANDALAL BAKSI
TAGORE SOCIETY FOR RURAL DEVELOPMENT(TSRD)
KOLKATA
ASHA is a key component of NRHM
 NRHM aims for systematic reform of Health
service delivery
 Accredited Social Health Activist (ASHA) is one of
the key components of NRHM
 Trained female community health activistselected from and accountable to the village itself
 One ASHA for every village in the country
 ASHA is the bridge between community and
public health service provider
ASHA is known as SAHIYYA in
Jharkhand

Govt. of Jharkhand (GoJ) initiated a communitybased approach called Sahiyya-Movement. A pilot
was done in 2004 .
Selection Criteria -One SAHIYYA for every hamlet
[Tola/Mohalla]
No education bar
No incentive for SAHIYYA
NGO designated for the selection- with constant
supportive supervision from the State
A strong Village Health Committee
Research Question/Objective
• To evaluate the perceptions and
experiences of women among different
social groups and frontline service
providers (ANMs& AWWs) about the Role
and Performance of ASHAs (Sahiyya)
regarding Antenatal Care
GEOGRAPHICAL BOUNDARIES
• Study Area: Patamda
block of East-Singhbhum
district of Jharkhand .
• Location : Border of
Purulia district, WB
• Multi lingual populace
(Bengali and Santhali).
• High concentration of ST
population(40.39%)
Methodology
• Stakeholders:
Service Providers: AWW(20) & ANM (15)
SAHIYYA (34)
Recipients: Beneficiaries (All women(193), who have
given birth in last 6 months)
Potential beneficiaries: Women in the
reproductive age groups
( i.e. 15-45 years)
• Sampling: Randomly Selected 10%(16) of
villages from Patamda block
Methodology
Methods of data collection:
In-depth Interviews, Survey and FGDs
 In-depth interviews for all ANMs AWWs, and
SAHIYYAs .
 Survey all women who had given birth in last six
months
 Focus Group Discussion[20 women in each group]
from potential beneficiaries in two villages,
having highest (100%) and lowest (4.74%)
concentration of tribal.
FINDINGS
SOCIOECONOMIC BACKGROUND
OF RESPODENTS
 Mostly all SAHIYYAs are from
disadvantaged groups
 Majorities of respondent
women are socio
economically backward
 Few Front Line Service
Providers belong in General
Caste
100%
32
32
80%
OBC(%)
60%
41
41
SC(%)
40%
20%
ST(%)
General(%)
24
18
3
9
0%
SAHIYYA
WOMEN
FINDINGS
KNOWLEDGE OF EXISTENCE/ ROLE OF SAHIYYA
Sahiyyas own perceptions :
24% of Sahiyyas do not know the reason and the
procedure of their selection.
Knowledge about Sahiyyas among Front Line Service
Providers:
ANMs & AWWs did not have any information and
orientation about Sahiyya Program before initiation.
Only 40% ANMs &AWWs were present in selection
meeting of SAHIYYAs
FINDINGS
Knowledge of Respondent women about Sahiyya:
• Only 9( 5%) of
respondent women who
had given birth in last six
months, are familiar with
the word Sahiyya
• Sahiyas are present in
8(53%) of ANM’s and
8(40%) of AWW’s area
• Only 5 of the respondents
familiar with the word
SAHIYYA experienced
some door step services
Knowledge of respondent women, AWW and ANM about SAHIYYA
100%
80%
7
12
60%
184
Not Known
Known
40%
8
20%
8
9
0%
ANM
AWW
Women
FINDINGSREGARDING ANC BY SAHIYYA:
SERVICES BY SAHIYYA
NO OF
BENEFICIARIES
PROVIDE INFORMATION
7
REGISTRATION
0
COUNSELING
0
ESCORTING
0
DEPOT HOLDER(*IFA)
5
FINDINGS
REGARDING TRAINING
9(27%) “Sahiyyas” are untrained
Out of 25(83%) trained Sahiyyas • 12 (48%) received one training,
• 11(43%) received two training
• 2(9%) did not know the number of training received
Language and Subject discussed were not
understood by majorities of them
 No involvement of Front line service providers
FINDINGS
ACTUAL EXPERIENCES WITH SERVICES
 9 out of 34 Sahiyyas are working.
 Front line service providers do not have
any control over Sahiyyas
 SAHIYYAs visited few homes (only 5
women respondents)
 SAHIYYAs have no knowledge and
information about JSY and VHC
Conclusions-Barriers to the program in the
studied block
 No recognition of Sahiyya by community
 No sense of teamwork with health
functionaries
 No supervision
 No clarity on roles and responsibilities of all
 Improper Institutionalization of the entire
process
 Inadequate training of Sahiyyas
 Monetary expectations, resistance from
family to allow Sahiyyas to work.
Recommendations
• Policy makers of NRHM should re-look the
existing situation.
• Community Needs should be addressed.
• Sahiyyas are should be considered as part of
Health system.
• GO-NGO Partnership should be strengthened at
all level.
• Problems of Inter-state border blocks with multi
lingual population should be considered in a
separate way
• The Block specific findings may lead to new
studies
Thanks