A cross sectional study to evaluate the operational skills of asha in randomly selected districts of indore & ujjain division

A cross sectional study to evaluate the operational skills of asha in randomly selected districts of indore & ujjain division Goswami V.P.1*, Rai S.2, Dixit S.3, Mahawar P.4, Jain C.5 DOI: https://doi.org/10.17511/ijphr.2016.i2.01 1* Goswami V.P., Medical Officer, Government of Madhya Pradesh, Indore, Madhya Pradesh, India. 2 Sailesh Rai, Resident, Department of Community Medicine, M.G.M. Medical College, Indore, Madhya Pradesh, India. 3 Sanjay Dixit, Professor & Head, Department of Community Medicine, M.GM Medical College, Indore, Madhya Pradesh, India. 4 Priyanka Mahawar, Assistant Professor, Department of Community Medicine, M.GM Medical College, Indore, Madhya Pradesh, India. 5 Chakresh Jain, Resident, Department of Community Medicine, M.G.M. Medical College, Indore, Madhya Pradesh, India.

The key tasks for the next phase of the NRHM are to equip the ASHA with additional skills to enable an active role for her in not just Reproductive and Child Health but also to undertake action for prevention

Results
The following results were obtained on observation: Among the ASHAs included in the study almost 93% were married and remaining 7 % were unmarried/ widowed. The mean age of ASHAs was 26.5 years with a range of 17 to 58 years in both the divisions.
About 3/4th (72%) of ASHAs had eligible qualification of class 8th and above while the rest (28%) were without eligible qualification, selected as ASHA due to unavailability of qualified candidates. The participants who obtained score more than 7 were considered perfect and who scored less than 7 were considered imperfect or not able to perform skills correctly Hand washing was performed by 93% participants, 67% were table to take proper temperature recording, 57% were able to weight newborns, 87% were able to apply eye ointment, 53% were able to cover the newborn with the blanket and 38% were able to keep the newborn in warm bag.  ASHAs were performing this activity.
Before training less than 9% ASHAs were able to manage sick new born child , but after training more than 47 % of ASHAs were able to manage breast feeding problems identify the danger signs of pneumonia and make referral, and 30% were able to identify the signs of severe dehydration and able to prepare and demonstrate ORS use to caregivers/mothers. Janet Brandling et al 2010 [10] in his evaluation of first aid training of line managers working in public sector also found that there was significant improvement in confidence among participants to deal with the issues pertaining to mental health after undergoing training. Foreman P et al [11] "evaluation of education and training of staff in dementia care in acute setting" 2005 also found increased comfort and confidence after training, in dealing with the patients of cognitive impairment by participants.
Also being poor in newborn-care most ASHAs were weak in organising village level meeting. This had been seen by Bhatt H. et al [12] in Uttrakhand in 2012 in Uttarakhand where ASHAs have indicated that they are unable to motivate the community for Construction of toilets and were not able to organize meeting. After undergoing training at least 30% were able to perform this activity.
Only 8 %, ASHAs were able to maintain their records and registers before undergoing training. After training 33% were able to take proper temperature recording, Garg PK et al [13] (2012) in his found that record keeping practices by ASHAs were satisfactory except birth and death registration records which were relatively deficient in their maintenance and completeness.
While Kansal S et al [14] in his study found that only 23% of registers were complete, 40% were incomplete and 37% were blank. This indicates that ASHAs were poor in maintenance of records and registers. In our study, after undergoing training we found improvement in record and register maintenances, and 80% of ASHAs were competent in this activity.
Incentives Issues of ASHAs: ASHAs were getting incentives for different activities through cheques.
Cash was not given to any ASHA for any activity.
There was no delay in getting incentives except in 11% cases (ASHA But most of these activities are time long processes so ASHAs were less interested in these activities.
Similarly since many ASHAs were not aware of their all roles and responsibilities, they were neither doing it nor getting incentives for that.
None of the ASHAs got incentive for giving health education, counselling and community mobilization. They were also not aware of any incentive regarding home visits for new born care and examination of sick new born child. So they were least interested in these. Due to this the activities of importance like newborn care, urgent referral of children with severe illnesses, DOTS providing , treatment of leprosy cases, malaria slide preparation and treatment of cases get hampered.