As the National Government of India’s Ministry of Health and Family Welfare (MoHFW) strives to improve the health infrastructure of underserved rural areas in line with the National Rural Health Mission (NRHM), the Accredited social health activists (ASHA) program has become a cornerstone of the Indian health system. With the goal of training an ASHA (Village Health Worker) in every village across India, this program has grown to be one of the largest health worker initiatives in the world since its inception in 2005.
Given that “Asha” is the Sanskrit word for hope, it is fitting that this program has come to represent the ambition and aspiration of the Indian health system in ensuring that rural populations have access to high quality health education and services.
ASHAs are female residents of a village who are trained to work as an interface between the community and the public health system. Each ASHA serves up to 5,000 people and is responsible for providing first-contact health care, advocating for health services and mobilizing the community towards local health planning. Although they are considered to be volunteers, ASHAs receive performance-based incentives for promoting universal immunization, providing referrals for health services and constructing household toilets.
“I am proud to serve my community as an ASHA. In this role, I am responsible for providing front-line care and health education. The training I have received allows me to provide a very high quality of service and to improve the lives of everyone in my village" - Ms. P. Rani, ASHA, Warangal District.
Each ASHA receives extensive health education through a “train-the-trainer” model, by which national and state agencies deliver training to ASHA District Trainers, who in turn provide trainings to the ASHAs. Mr. P.Ch.Basaveswara Rao, Joint Director of Information, Education and Communication at the Telangana State AIDS Control Society, noted that "the program is very efficient. By investing heavily in the training of one person, high-quality training reaches ASHAs in dozens of villages. Each ASHA has a personal, respectful relationship with the District Trainer in their area, so the barriers to learning from an outsider are removed We replicate this at scale to reach hundreds of thousands of ASHAs across Telangana and India".
In several recent sessions, ASHA District Trainers in the Telangana districts of Warangal and Hyderabad received training on HIV/AIDS, coordinated by Dr. Valleri Sowmya, UNICEF Consultant for Prevention of Parent-to-Child Transmission for the Andhra Pradesh and Telangana state AIDS control societies. During the sessions, ASHA District Trainers viewed the Telugu version of the TeachAIDS HIV education software and had the opportunity to ask medical doctors questions about HIV and AIDS. Dr. Sowmya explains that “each set of district trainers receive ten days of intense training on topics such as family planning and maternal and child health. The TeachAIDS materials are used across each of the training sessions to contextualize issues around HIV and AIDS. The trainers are also given the TeachAIDS materials on physical media which are then taken and shared at the village level”.
Dr. Rama Devi, Professor of Public Health at the Indian Institute of Health & Family Welfare has generously extended her support to this program, and will coordinate trainings for ASHA District Trainers in the remaining eight districts of Telangana. In discussing why the TeachAIDS materials were selected for integration into the program, she notes that “the TeachAIDS materials are informative, very simple, and can be easily understood. All these factors are imperative given that many of the ASHAs and their clients have limited literacy, so pictorial materials are far better understood and absorbed rather than a mere lecture method”.
Over the coming months, ASHA District Trainers throughout the 13 districts of Andhra Pradesh will receive HIV education training, using the TeachAIDS software. The Telangana State AIDS Control Society and the Andhra Pradesh State AIDS Control Society also plan to integrate the TeachAIDS materials onto electronic tablets that will be provided to ASHAs across each of these states in order to allow them to effectively deliver HIV education to the villagers they serve.
TeachAIDS applauds the ASHA program as well as the State AIDS Control Societies of Telangana and Andhra Pradesh for their commitment to ensuring that high quality HIV education is available to rural populations throughout these states. The partnership will combine efforts to tackle the notoriously difficult “last mile” in healthcare and also empower the populations of these states to protect themselves from HIV and AIDS.