Abstract
The National Rural Health Mission (NRHM) in India relies on Accredited Social Health Activists (ASHAs) to act as a link between pregnant women and health facilities. All ASHAs are required to have a birth preparedness plan and be aware of danger signs of complications to initiate appropriate and timely referral to obstetric care. To examine the extent to which Accredited Social Health Activists (ASHAs) are equipped with necessary knowledge and skills and the adequacy of support they get from supervisors to carry out their assigned tasks in a rural district in Karnataka, (South) India. A cross-sectional descriptive study was carried out among 225 ASHAs between June - July 2011. Quantitative and qualitative data were collected using pre-tested semi-structured interview schedule. The data were analyzed using SPSS version 17. Chi-square test was used to determine associations between categorical variables. The response rate was 207(92%). In terms of knowledge of all key danger signs (Complication Readiness), 2(1%), 10(4.8%), and 15(7.2%) ASHAs were aware of key danger signs for labor and child birth, postpartum period and pregnancy period, respectively. Knowledge of key danger signs was associated with repeated, recent and practical training (p <0.05). A majority (71%) scored 4-7 of the maximum score out of 8 for knowledge regarding Birth Preparedness. ASHAs in rural Karnataka, India, are poorly equipped to identify obstetric complications and to help expectant mothers prepare a birth preparedness plan. There is critical need for the implementation of appropriate training and follow-up supervision of ASHAs within a supportive, functioning and responsive health care system.
Highlights
India has made some progress towards achieving the Millennium Development Goals (MDGs), especially in the rural areas
The shortage of skilled health workers in remote rural areas of the country remains a key challenge to achieving the goals related to maternal and child health as laid out in MDGs 4 and 5
Community HealthWorkers (CHWs)[1] do not replace the need for health workers with greater training, they certainly play an important role in increasing access to and utilization of health care services
Summary
India has made some progress towards achieving the Millennium Development Goals (MDGs), especially in the rural areas. The shortage of skilled health workers in remote rural areas of the country remains a key challenge to achieving the goals related to maternal and child health as laid out in MDGs 4 and 5. ASHAs play important roles such as counseling women on issues such as birth preparedness and importance of safe delivery, arranging escort services to accompany pregnant women, mobilizing funds, arranging transport and blood donor, all of which would ensure better outcomes of pregnancy and child birth.[2] “Birth Preparedness and Complication Readiness” (BPCR) is a strategy which promotes timely use of skilled maternal and neonatal care especially during child birth, based on theory that preparing for child birth and being ready for any complication reduces delays in obtaining this care.[3]. All ASHAs are required to have a birth preparedness plan and be aware of danger signs of complications to initiate appropriate and timely referral to obstetric care
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