WUNRN
Women's Feature Service
By Anjali
Singh
An ASHA -Accredited Social Health Activist - filling out forms during a home visit in Dhanipur block in Aligarh to keep records on the progress of a new born and her mother. (Credit: Narendra\WFS)
Twenty-two-year-old
Rekha’s baby girl, who was born pre-maturely at seven months with a birth
weight of just over a kilo, is also fortunate not to have become part of
The lives of these
two new mothers, Manju and Rekha, have been directly impacted by a new campaign
- the Comprehensive Child Survival Programme (CCSP), in which the ASHAs of
Aligarh are the foot soldiers. And going by the evidence on the ground, this
could well be a movement in the making, epitomising a powerful partnership between
policy makers, UNICEF India and local communities to preserve the country’s
most precious asset: Its children.
The move to use the
formidable force of ASHAs began in 17 districts of Uttar Pradesh (UP) a year
ago. Suman Devi, 41, an ASHA working in Sarmastpur village, explains, “As an
ASHA the work I do gives me immense satisfaction because it is like saving the
future generation. When I used to hear news of young mothers losing their
children or developing health complications because of a lack of awareness, I
used to feel bad. But now, after being trained in the CCSP programme, I feel I
can do my bit to ensure that such deaths are reduced and proper care is
provided to mothers and newborns.”
Through the CCSP,
backed by the expertise of a reputed institution like the Aligarh Muslim
University, the ASHAs of Aligarh have single-handedly managed to address
factors contributing to infant mortality in the district and have ensured
almost 70 per cent institutional deliveries here. But that is not all: They have
been able to usher in real behavioural change on the ground, especially by
helping to dispel traditional myths with regard to breastfeeding and nutrition.
Generally speaking,
for human beings, the chances of dying are highest between 0-28 days post birth.
In
Health experts are
optimistic that the CCSP approach will turn things around. Explains Professor
Noor Mohammed, Chairman and Project Co-ordinator, Sociology and Social Work
Department,
The CCSP programme
involved building a network of care givers. Prior to this module, only 13 per
cent of the 900 ASHAs in the six blocks in the district were performing home
visits for newborns and only seven per cent were following the prescribed
schedule. This has now risen to 92 per cent and 81 per cent, respectively.
There are a total of 2,200 ASHAs in entire district of Aligarh.
According to
Professor Mohammed, there has also been a significant change in traditional
attitudes. “Earlier, newborns were kept hungry for three days as it was believed
that mother’s milk was bad for babies. Instead they were given ‘khada’ (a local
decoction made from honey, jaggery, ‘ghee’ and ‘ajwain’). ASHAs have managed to
change this practice completely by counselling the families of young mothers.
This has led to a 50 per cent rise in breastfeeding within the first hour of
birth,” he says.
The CCSP programme
has now run for a year. It was launched in 17 districts of Uttar Pradesh in its
first phase (2007-08) but because it has had such encouraging outcomes, the
state government plans to implement it across all 71 districts. In addition,
the supportive supervision model evolved in
The impact of the
work of trained ASHAs is there for all to see. Even those who were earlier
hostile to the idea of discarding old practices have had a change of heart. For
example, Radha Devi, 61, now brings her pregnant daughter-in-law, Mamta Devi,
to ASHA group meetings regularly. Says she, “I am a mother of five myself, and
all my children were born at home. How I wish that in my time these ASHAs had
existed to answer the innumerable questions that had bothered me and address
the health complications that come with child birth. I certainly don't want my
daughter-in-law to miss out on the care provided by the ASHA now."
Basically, this is
all about making better use of the institution of the ASHA. Rahul Kulshestra,
Nodal Officer, CCSP Aligarh, puts it this way, “ASHAs, although they were
around, were not being used by the government machinery and were a dormant
workforce. But once the UNICEF and AMU stepped in, the skills of 2,200 ASHAs in
Aligargh have been upgraded. They have now emerged as a powerful mentoring
group reaching even those areas which have poor access to medical and health
support.”
The sense of service
and zeal of the ASHAs is admirable. A single ASHA addresses the maternal and
child health needs of a population of 1,000, for a paltry performance-based
incentive that comes to approximately Rs 3,000 (US$1=Rs 44.3) per month. And
they certainly have the eternal gratitude of young mothers in Aligrah district
now delighting in their little bundles of hope and planning furiously for their
future.