State Health Systems Resource Centre - Kerala
Department of Health & Family Welfare, Government of Kerala
0471 2323223

Completed Research Studies

Evaluation of ASHA Component of NRHM in Kerala

The National Rural Health Mission launched in 2005 had the preeminent goal 'to improve the availability of and access to quality health care by people, especially for those residing in rural areas, the poor, women and children' aimed to do so through 'enabling community ownership and demand for services, strengthening public health systems for efficient service delivery, enhancing equity and accountability and promoting decentralization. One of the core strategies to achieve this goal was the introduction of a new cadre of lay women health volunteers called accredited social health activists (ASHA) who will 'act as the interface between the community and the public health system 'and paid a performance based compensation. They were expected to provide information regarding available health care services, on issues such as basic health and sanitation and impress the need timely utilization of health care utilization of the community and ensure community participation to improve the accountability of health care service delivery.

The evaluation broadly sought to seek whether the selection process was adequately done, whether the roles and responsibilities of the ASHAs understood by them and the health services department, to understand the bottlenecks in the day to day functioning and the major causes of concern, identify the on the ground realities of their nature of work, their challenges and suggestions for improvement.

The evaluation study was carried out across seven districts of the state using a mixed methodology employing qualitative and quantitative methods. The quantitative component of the evaluation was designed mainly as a cross sectional survey among ASHA workers, JPHNs and beneficiaries across six districts using a multistage sampling design. In addition key informant interviews with district level officials and focused group discussions with the JPHNs and ASHAs were done in all the selected districts.

State Specific Training Module /Training Material for ASHA Program

The training module primarily aims at enhancing the competencies of ASHA' s in terms of their roles and responsibilities, through equipping trainers /training coordinators to handle sessions/conduct the program more effectively. The task of developing the state-specific training modules was undertaken by Centre for Management Development (CMD) in collaboration with SHSRCK. The thrust of the modules is to develop skills among ASHA's to carry out their roles/tasks more effectively rather than just imparting knowledge on health related topics.

Modules were developed based on stakeholder discussions held with representatives of Department of health, NRHM, SHSRCK, observation of training sessions for ASHA and interaction with participants. Kerala. The training consists of two parts and part one is intended for trainers on how to use the module. This includes lesson plan, check list of materials required, learning objectives and the process of conducting the session. The second part contains a set of reading materials/handouts meant for participants which can as well be used by trainers.

Evaluation of NRHM Fund Utilization in Different Health Facilities in Kerala

National Rural Health mission started in 2005 aimed at strengthening public facilities and increasing access to comprehensive primary health care especially in the rural areas throughout the country. The public spending on health increased considerably after the advent of NRHM. The society route of funding was aimed at hassle free fund transfer to various programs. The changes in terms of infrastructure, human resource medicine supply, quality of care are notable after the NRHM implementation. But the utilization patterns of NRHM funds are limited to annual performance audits done by external audits.

The evaluation study of NRHM fund utilization assesses the extent of utilization, under or better utilization and under lying reasons for these utilization patterns of funds. The study looks at utilization patterns of health care institutions at district, block and panchayat level. It also aims at identifying various barriers of fund utilizations and tries to provide feasible steps to overcome these barriers. Mixed methodology comprising of both qualitative and quantitative techniques were used for the study. A multistage random sampling was devised to select health institutions of various levels from three geographic zones north, central and southern regions.