Support Structure and ASHA Facilitator

ASHA Nodal Officer at Health Facility level

ASHA Facilitator

Terms of Reference

  1. The Context:
    Recognizing the importance of Health in the process of economic and social development and improving the quality of life of citizens, the Government of India launched the National Rural Health Mission on 12th April 2005 to carry out necessary architectural correction in the basic health care delivery system. The Goal of the Mission is to improve the availability of and accessibility to quality health care by people, especially for those residing in rural areas, poor, women and children. Public health is a major challenge in our country and the Government of Tripura has also give special effort to bring about changes in public health care domain with the introduction of various health care schemes under National Rural Health Mission. The State Government has made all possible efforts to work with the wider determinants of health care like nutrition, sanitation, social empowerment & women empowerment.
    The mission document of National Rural Health Mission spells clearly the importance of community participation as part of the decentralized process of health care management. Community participation can be seen as an essential element in national health strategic plans or policies of India under NRHM. One of the key components of the National Rural Health Mission is to provide every village in the country with a trained female community health activist – ‘ASHA’ or Accredited Social Health Activist. ASHA is the first port of call for any health related demands of deprived sections of the population, especially women and children, who find it difficult to access health services.
    The mission document of National Rural Health Mission spells clearly the importance of community participation as part of the decentralized process of health care management. Community participation can be seen as an essential element in national health strategic plans or policies of India under NRHM. One of the key components of the National Rural Health Mission is to provide every village in the country with a trained female community health activist – ‘ASHA’ or Accredited Social Health Activist. ASHA is the first port of call for any health related demands of deprived sections of the population, especially women and children, who find it difficult to access health services.
    ASHA programme is one of the core activities of NRHM as it acts as a mechanism to permeate every scheme of NRHM to incite public health services. The state has registered successful implementation of ASHA scheme with overall strength of 7767 ASHA trained upto 6th Module (1st Phase). Each ASHA has to her credit 350/400 population in Tripura. ASHA programme in the State is supported by ASHA Mentoring Group (AMG).
  2. Concept of ASHA Facilitator:
    ASHA Facilitator is a paid worker, who will have to handhold the activities of ASHA workers. ASHA Facilitator is the person to be in direct touch with the frontline workers and providing supportive supervision is the main role of ASHA Facilitator.
    1. Purpose of engaging ASHA Facilitator:
      National Rural Health Mission emphasizes on the ASHA Facilitator facilitating the activities of ASHA and also to ensure the outcome of ASHA programme primarily through providing support, supervision and on the job training to the ASHA in their villages.
    2. Selection criteria of ASHA Facilitator:
      The concerned M.O.i/c is to get in touch with the Panchayat Members for selection of ASHA Facilitator. The M.O.i/c in consultation with them is to finalize the modalities of selecting eligible candidates for the post of Facilitator. This would be done to ensure selection of local candidates so that facilitator stays with ASHAs and can guide. The initial selection of ASHA Facilitator has been done for Nine months only.
      Sl. No. Category Candidature of ASHA Facilitator Qualification
      01. Fresh Candidate Minimum H.S( +2) passed
      02. 5th Module ASHA Trainer Minimum H.S  (Priority should be given to these candidates)
      03. Existing ASHA Minimum Madhyamik passed/ appeared Recommended by concerned RKS for her outstanding work in the community.

    3. Number of selection of ASHA Facilitators:
      • The ASHA Facilitator will serve as the link between the ASHA and support structure at the CHC/PHC level for the community processes programme under National Rural Health Mission.
      • Each ASHA Facilitator will at least support the activities of approximately 18 to 20 ASHAs covering one/two/three sub-centres and 18-20 AWCs under one SDH/CHC/PHC. For hilly areas and hard to reach areas one ASHA Facilitator may be selected against 15 ASHAs. This is indicative, but subject to change number of ASHA Facilitator on the basis of total number of ASHAs and geographical scenario of locality.
    4. Honorarium to ASHA Facilitator:
      It is proposed that ASHA facilitator will get a fixed honorarium of Rs.1000/- Per month and the remaining part of the honorarium is linked with field visit like Rs.100/- per visit for maximum 10 visits per month, which would be regulated through the system of submission of monthly tour dairy by ASHA facilitation to her immediate supervising officer nor below the rank of MO/IC of PHC/CHC for approval of tour dairy.
    5. Basic objectives to which facilitation is related: Key Tasks:
      ASHA Facilitator is the main vehicle of monitoring, supportive supervision and onsite assistance for ASHA. The ASHA Facilitator is expected to be a mentor, guide and counsellor to the ASHA.
      • Supportive Supervision: The supportive supervision is done through the (a) Village Visits (b) Cluster visits (c) Attending monthly meeting
        1. Village Visits includes accompanying ASHA on household visits, conducting community / VHSC meetings / attending Village Health & Nutrition Days etc. Effective village visits improves the performance of ASHA and thereby quality of health care services.
        2. All ASHAs under one ASHA Facilitator meet at one designated place / health institutions, which is easily accessible by most of ASHAs. It is called cluster visit/ meeting. ASHA Facilitator is to organize monthly cluster meeting to analyze the performance and outcome of ASHA programme.
        3. ASHA Facilitator to attend monthly meeting organized by SDMO/MO/IC of concerned health institutions to interact with health workers in a single platform.
      • Supporting ASHA Training during training rounds:
        1. Ensuring ASHA attendance in training rounds
        2. Supporting ASHA trainers in the training workshop in organizing group work, supporting field practice and other ancillary training functions.
      • Facilitating selection of new ASHA:
        1. Identifying poor performing ASHAs and analyze the reason
        2. Enable non-performing ASHA to intimate in writing, so that new ASHA may be selected
      • Enabling Grievance Redressal System for ASHA
  3. Place of work:
    Primarily field based assignment within the local villages and total numbers of Anganwadi Centre and Sub-Centre under Concerned Health Institutions (SDH/CHC/PHC) specified and assigned to each ASHA Facilitator in the engagement letter, subject to further orders from time to time by the CMO/other authorized officers.

  4. Working Days:
    Total Working Days – 30 days per month
  5. 2.8 Duration (Time) of Work:
    ASHA Facilitator has to work, visit and to support the respective ASHAs under the assigned Sub-Centres/ AWC. There is no official time to be stipulated for ASHA Facilitator as their service is primarily field based. She has to work as per convenience time of ASHAs and the people living in the community to interact with them and also to attend the community meetings / VHND/ VHSC meetings/ Immunization session / IEC programmes / ASHA training programmes / ASHA Varosha Divas / Monthly meetings as per the schedule of the respective meetings / programmes.

  6. Norms of Mandatory Assignments and Field visits:
    1. ASHA Facilitator is responsible to carry out her assigned tasks 30 days in a month as per said norms, out of which ASHA Facilitator should attend the following activities, which are mandatory for each Facilitator:

      • ASHA Varosha Divas in concerned SDH/CHC/PHC
      • Monthly Health Institution level meeting by respective in charge
      • Monthly Sub-Centre level meeting with ANM/MPW/ASHAs
      • Cluster meeting organized by each ASHA Facilitator
      • Monthly meeting with Sub-Divisional ASHA programme Manager
      • Monthly meeting with Sub-Divisional ASHA programme Manager
      • ASHA Training programme
      • Local PRI meeting to discuss health issues
      • VHSC Meeting
      • Village Health & Nutrition Day
      • Mother Child Tracking System (MCTS)
    2. Apart from the said assignments, ASHA Facilitator should carry out 10 field visits to interact, facilitate and support ASHAs day to day work in the field including accompanying ASHA on household visits, for which she will get Rs.100/- per visit.
    3. The 10 field visits will not include the mandatory activities/ assignments mentioned at para ‘A’ above.

  7. Supervisor:
    ASHA Facilitator will work under the overall supervision of SDMO/MO-IC of concerned Health Institutions. She will closely coordinate with respective ANM/MPW/AWW for her day to day activities. She will also be responsible to the concerned Sub-Divisional ASHA Programme Manager at Sub-Division level regarding monitoring and supervision, technical updates and evaluation of ASHA programme etc. SDAPM, In-charge of Health Institutions may assign tasks to Facilitators on need basis for smooth implementation of ASHA programme.
  8. Accountability, Appraisal and Continuation of engagement:
    The effectiveness of ASHA programme and the performance of the ASHA Facilitator will be evaluated by concerned Medical Officer-In-Charge of respective health institution and concerned Sub-Divisional ASHA Programme Manager of the respective SDH. The evaluation will be made on the basis of followings:

    • Monthly Reporting Matrix submitted by ASHA Facilitator
    • The Matrix regarding Indicators for successful implementation of ASHA programme
    • Monthly Reporting Format for ASHA to be filled up by Facilitator
    • Field Interactions with ASHAs regarding contribution of Facilitator
    Concerned Medical Officer-In-Charge of respective health institution and Sub-Divisional ASHA Programme Manager of respective SDH will send an appraisal report based on the evaluation done to the Chief Medical Officer and on the basis of which the next continuation will be given by respective District Society.
  9. Job Responsibilities of ASHA Facilitator:
    1. Each ASHA Facilitator is a voluntary worker, who will have to do handhold of the activities of 18-20 nos. of ASHAs as decided by the SDMO/ MO/IC) of the respective health institutions.
    2. The ASHA (Accredited Social Health Activist) is a voluntary worker and is respected by the community. Bearing this in mind the facilitator will have to facilitate the smooth functioning of the ASHAs in the village and motivate them to perform their job responsibility willingly and knowingly. ASHA Facilitator should facilitate day to day work of ASHA in the respective areas.
    3. ASHA Facilitator will have interaction with Gram Panchayat Members for functioning of Village Health Sanitation & Nutrition Committee, Public Health Engineering Department for Implementation of Total Sanitation Campaign, ICDS Personnel (AWW and Supervisors) for implementation of Nutritional Programme including Village Health and Nutrition Day.
    4. ASHA Facilitator will have to know about the Health Care Delivery System in order to implement ASHA’s Scheme successfully and see that all the following institutions within her area of operation are functioning i.e., Sub Centre, Sectoral PHCs, (SD/SHC/MPHC), Block PHCs and CHCs. ASHA Facilitator will have to coordinate with the functionaries of these institutions in her area.
    5. ASHA Facilitator should visit each ASHA in her village and accompany her on visits to the doorstep of the community. She must prioritize home visits to those household where ASHA needs additional support in motivating such families to adopt healthy behaviours, utilize ASHAs services or access referral.
    6. She should facilitate also to enable ASHA to identify and to reach poorest and most marginalized sections (Female headed household, landless families, migrant families, caste households, household with disabled children, families living in distant hamlets) of the society to get health care services.
    7. ASHA Facilitator should assist ASHA to organize community meetings or community health education meeting. She should help ASHA to involve all the women in the area and members of the VHS&NC. She has to work with VHS&NC in identifying those parts of the village / communities where there is poor performance (higher home deliveries, less immunization coverage etc.)
    8. ASHA Facilitator should meet respective Gram Panchayet Pradhan / Members in a regular interval to enhance their awareness of the health situation, enable support for the ASHA and help them view the work in a positive way.
    9. ASHA Facilitator should support ASHA in mobilizing women and children to attend Village Health & Nutrition Day and also ensure that ASHA convey key health messages through conducting inter-personal communication in VHND.
    10. ASHA Facilitator should check the content of drug kit and should ensure that requisitions for the supplies are sent when the stocks of ASHAs have decreased to around 25%. She can also make a quick assessment of the date of manufacture of these drugs and make certain that no expired drugs are being carried.
    11. The ASHA drug kit has to be refilled at PHC on the day of the PHC level monthly meeting. It could be done on monthly or bi-monthly basis, and the ASHA facilitator would be responsible for the refilling.
    12. ASHA is not expected to collect data or maintaining records. So it is the facilitator’s task to obtain information from ASHA on the key activities that she undertakes for monitoring progress of individual ASHA in their given area.
    13. ASHA Facilitator will organize a monthly cluster meeting of all ASHAs in her area for performance review and planning, discuss common issues and problems faced by ASHA during the month, highlight those actions which need to be discussed at monthly PHC review meeting, keep ASHAs updated about guidelines.
    14. ASHA facilitator should attend monthly meeting organized by SDMO/MO/IC of concerned health institutions to interact with health workers in a single platform.
    15. ASHA Facilitator should address the grievances of ASHA immediately if possible. She should encourage ASHA to give all complaints during work in written.
    16. There has to be 10 days of field visit of each ASHA Facilitator in the respective areas. A monthly tour dairy to be maintained and get it approved by the concerned In-charge of Health Institutions. Accordingly, on the basis of the tour dairy, she will weekly report to the concerned ANM of the SC. She will sign on the registrar of SC, when she will visit the sub-centre.
    17. She has also to submit field report within 30th of every month before travel claim for each month. The payment will be disbursed by the concerned health institutions only after approving the tour dairy.
    18. The monthly field report to include village /ASHA wise findings as per the prescribed format and highlight those finding for necessary action during SDH/CHC/PHC Review Meeting.
    19. ASHA Facilitator should attend ASHA Varosha Divas in respective health institutions and to sensitize ASHA on different issues and also to complete filling up of the prescribed format of ASHA and to submit the same to Sub-Divisional ASHA Programme Manager on the day of monthly meeting with SDAPM.
    20. ASHA Facilitator will assess the training need of ASHAs during her field level interaction/ meeting with ASHAs. ASHA Facilitator will also facilitate the need-based training for ASHAs in consultation with Block level officials. She will ensure follow up activities of different training, which will be imparted to the ASHAs.
    21. Each ASHA Facilitator will have to attend the meeting of ASHA at the Sub Centre on every month and to discuss the issues and solve the problems of ASHAs.
    22. To extract timely action from ASHA. The ASHA Facilitator will have to ensure that the ASHA gets the prescribed incentives in time.
    23. In each visit, ASHA Facilitator must sign in the ASHA Diary mentioning her date of visit.
    24. ASHA Facilitator to undertake frequent field visits to support NGO and other activities related to community processes implementation.
    25. The checklist is a useful tool for supervision since it systematically examines all the items which need to be looked at during a field visit by ASHA Facilitator. The Facilitator should be familiar with ASHA Incentive list, supervisory checklists, reporting formats etc. The checklist for supervision by ASHA Facilitator is enclosed Annexure-I.
    26. A monitoring system to be maintained by each ASHA Facilitator to monitor the functionality as well as the outcomes of ASHA programme. The success of the ASHA and the outcome of ASHA scheme would be determined by the indicators. The matrix of indicators, by which ASHA facilitator can monitor the performance of ASHA, is enclosed at Annexure-II. The same is to be shared with Sub-Divisional ASHA Programme Manager (SDAPM) and SDMO/ MO/IC quarterly basis.
    27. ASHA Facilitator should submit the Monthly Report to the concerned health institutions with a copy to SAPM as per monthly reporting matrix at Annexure-III.
    28. ASHA Facilitators shall effectively contribute to MCTS field data collection through herself, ANM, AWW and ASHA worker within her area of operation.