Tridibesh Tripathy, Umakant Prusty, Chintamani Nayak, Rakesh Dwivedi, Mohini Gautam
When ASHAs were introduced in NRHM in 2005, their primary aim was to visit homes of newborns as the first program in UP operated through the ASHAs was the Comprehensive Child Survival Program in 2008. Since then, tracking of all deliveries and all the newborns are an integral part of the work of ASHAs in all the primary health care programs operated by the NHM in UP (GOI, 2005, GOUP, 2013). Evaluation studies on the performance of ASHAs was done since 2011 as by then ASHAs had actually worked in the field for a minimum period of 5 years. It is to be noted that National Rural Health Mission was rolled out in April 2005 but it took about one to two years for the states to hire ASHAs and put things in place right from the state to the village level (GOUP, 2013). The current study explores some of the crucial variables on the performance of ASHAs & grading of their performance based upon the perception of the Recently Delivered Women in the state of UP. The mothers responded about the performance based upon their experience in Janani Surakya Yojana (JSY), New Born Care (NBC) & Routine Immunization (RI) as these were the frontline programs for the states. The responses of these mothers or Recently Delivered Women (RDW) (as named for the current study) had a 3 to 6 months old child during the time of survey. They were selected as respondents as they were in a position to recollect the health care events of their children. The relevance of the study assumes significance as data on the perception details followed by grading of the health personnel’s performance is usually not collected. Such responses on perception & performance grading by community are not the focus in very large-scale health surveys. It is important to note that social audit is an integral part of the National Health Mission document but it is not prioritized. Usually, the responses, knowledge of trained health personnel are assessed in many studies while neglecting the response & perception of the community members. Here in this article, the same mothers talk about their perception on ASHAs & also grade them as per their performance. Here also it is seen that usually, the trained personnel become the respondents as part of evaluation of their timely actions in many other studies. The uniqueness of the current study is that the mothers become the pivot around which all the modalities move. A total of four districts of Uttar Pradesh were selected purposively for the study and the data collection was conducted among the RDWs in the villages of the respective districts with the help of a pre-tested structured interview schedule with both close-ended and open-ended questions. These in-depth interviews were conducted amongst the RDWs and a total 500 respondents participated in the study. The results reflected that majority of the RDWs across the 4 districts believed that the ASHA did not know about her work totally. Further, the RDWs also responded that ASHA needed to communicate the messages with respect and dignity while visiting RDWs at their homes. Regarding grading, very few RDWs across the four districts graded the ASHA’s performance as poor while only 1% of RDWs in Banda district graded the performance of the ASHAs as very poor.