Annual

ASHA Update
2020-21
ANNUAL ASHA UPDATE 2020 - 21

Table of
Contents
Page No.

Chapter 1 -
INTRODUCTION 5

Chapter 2.
ASHA PROGRAMME UPDATE 7

Chapter 3.
ASHA’s ROLE IN PREVENTION AND MANAGEMENT OF COVID-19 31

Chapter 4.
PROGRAMME UPDATE ON COMMUNITY-BASED INSTITUTIONS 38

Chapter 5.
BEST PRACTICES UNDER COMMUNITY PROCESSES 47

Chapter 6.
KEY HIGHLIGHTS OF THE ANNUAL COMMUNITY PROCESSES STATE 54
NODAL OFFICER WORKSHOP

ASHA INCENTIVES UNDER NATIONAL HEALTH MISSION 58

LIST OF EDITORIAL TEAM 65

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ANNUAL ASHA UPDATE 2020 - 21

CHAPTER
1 Introduction

T
he ASHA programme, a key component of community processes has continuously
evolved over the last decade and a half. Serving as a facilitator, mobilizer and provider
of community level care, ASHA has emerged as the cornerstone of the National Health
Mission. The country currently has 9.83 Lakh ASHAs in position against the target of 10.35 Lakh
across 35 States and UTs (i.e., all except Goa and Chandigarh) making it the world’s largest
community volunteer programme. ASHAs have been widely acknowledged for their substantial
contribution in improving access to care for community in areas ranging from RMNCHA to
Communicable Diseases and more recently to Non communicable diseases. ASHAs are also
critical component of the Community platforms like Village Health and Sanitation Committees
(VHSNC), Mahila Arogya Samiti (MAS) and Community Based Planning and Monitoring under
National Health Mission. ASHAs have been playing a key role in the country’s response
for prevention and management of the COVID-19. In addition to performing tasks related
to COVID-19, ASHAs also continued to support community members for accessing essential
health services.

The programme has evolved in many significant ways since its launch in 2005, responding
to local context and national priorities. Mechanisms built for regular modular training, on
the job mentoring, creation of strong support structures and performance linked monetary
and non-monetary incentives have contributed to the strengthening and sustainability of the
programme.

With the launch of Ayushman Bharat Programme, ASHA in rural and urban areas is now an
integral part of the functional team at the Ayushman Bharat - Health and Wellness Centre (AB-
HWC) while retaining her social activist role. The role of ASHAs has been expanded to provide
Oral care, Eye care, Emergency care, ENT care, MNS care, elderly, and palliative care at the
community level. She is being strengthened to play an active role in health communication and
home and community-based interventions to support the delivery of comprehensive primary
health care, by appropriate training and performance linked incentives. In an interaction,
ASHAs of Nayagarh district in Odisha said “We feel proud that the expansion of the package
of services at the level of the AB-HWC is being done. It helps us render care for all members
of the family. It will enhance our credibility. With incentive for newer packages, our income per
household visit too shall increase. Of course, the competition to get selected as ASHA in the
village will also get tougher”.
This issue of annual ASHA update is first, since the COVID-19 pandemic and is twenty first
in the series of the update. This issue of ASHA update covers status on the ASHA program,
ASHA’s role in prevention and control of COVID-19 pandemic, programme update on
community-based institutions, best practices under community processes, and key highlights
of the annual community processes state nodal officer workshop. One annual issue is being
released covering the financial year April 2020 to March 2021.

ASHA’s role in maternal, newborn and child health has been well documented in number
of publications. More than 15 years of the programme have brought innovations that have

5
 ANNUAL ASHA UPDATE 2020 - 21

been scaled up country wide and encompasses selection, training, payment and to the use of
technology as a job aid/training aid.

Section on ASHA programme update (Chapter 2) provides an overview of trends in the ASHA
program since 2010. Number of ASHAs in position have increased gradually from 6.9 L in 2010
to 9.8 L in 2020. The coverage currently in rural areas is about one ASHA per 979 population,
but with wide variations between and within states. This section also provides comprehensive
overview of the training status for ASHAs across different states. Modular training of ASHAs
have progressed to 96% in Round 1, 92% in Round 2, 89% in Round 3, and 83% in Round 4, in
rural areas. Similarly, NCD & HBYC training completion for rural ASHAs, remained at 55% and
60% respectively. The progress of the training of ASHAs nation-wide is slow in comparison
with the last update. Majority of states have involved ASHAs in COVID-19 related activities
and training activities during the period. The section also provides an overview of the ASHA
certification program in 24 states/UTs. Nation-wide, 36,544 ASHAs have been certified and
accredited in these States/UTs.

Section 3 on ASHA’s role in prevention and management of COVID-19 response, outlines the
role played by ASHAs in containment of the pandemic at the grass root level. Best practices
of the various States/UTs in community mobilization, support extended for both essential and
non-essential services, highlight the varied and dynamic role played by ASHAs in the field.
Overview of state-wise training of ASHAs in wave 1 and wave 2 of the pandemic has been
provided.

Section 4 draws the current scenario of status of constitution and training of community
platforms (VHSNC and MAS). Across India, approximately 5.5 Lakh VHSNCs have been
constituted and 57% of them have been trained on the VHSNC guidelines as per the handbook.
Similarly, 80,238 MAS have been constituted in the urban slum areas and 89% of them have
been trained on MAS guidelines as per the handbook.
In Section 5, we present three best practices that highlight state led innovations in community
processes. Digital Community Engagement Platforms for Improving Family Planning, Maternal
Child Health and Nutrition outcomes by the state of Chhattisgarh, Strengthening Cluster
Meeting as capacity building platform for ASHAs by the state of Uttar Pradesh and an
Innovation Fostering Health service delivery and strengthening ASHA monitoring system by
Madhya Pradesh have been highlighted.
In Section 6, we report key highlights of the annual workshop for state nodal officers for
Community Processes (CP), held online on 4th, 6th, and 9th November 2020. The workshop
focused on identifying trends in the CP programme and planning for collective action for
advancing comprehensive primary Health care services across the country. Eventually,
Section 7 talks about the ASHA incentives under various programs of NHM.
Moving forward, one of the key aspects of the update is to periodically report on progress
related to selection, training, status of support structures and status of community platforms.
As the role of ASHAs has expanded with the roll-out of Ayushman Bharat, in the next update
we intend to capture the progress of training of ASHAs in the expanded package of services.
Additionally, functioning of the community platforms is being prioritized for enhanced ownership
on Ayushman Bharat – Health and Wellness Centres (AB-HWC) and assured support to people
on sociocultural and environmental determinants of health. Au revoir..till we meet again in the
next annual issue.

Dr. (Flt Lt). M.A. Balasubramanya

Advisor, Community Processes and Comprehensive Primary Health Care
National Health Systems Resource Centre (NHSRC)

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ANNUAL ASHA UPDATE 2020 - 21

CHAPTER
2 ASHA
Programme Update
NATIONAL OVERVIEW

T
his section provides information on three major areas related to the ASHA programme
across the country, namely the number of ASHAs in position against the targets, the
status of training (in Modules 6 and 7, NCD and HBYC) and the status of support structures.
The primary source of this information is state/UT reports related to the ASHA and Community
Processes Programmes as of 31st March 2021.

The ASHA program continues to be the centre piece of the community processes covering
all States/UTs (except Goa and Chandigarh) in both urban and rural populations. Ever since
the very first ASHA update in October 2009 to the present date, there has been a steady
progress in terms of ASHA selection, training, and service delivery across most of the states/
UT. Presently a total of 9,83,032 ASHAs are in position in the country, against the target of
10,34,630 (95% in position) under the National Health Mission (NRHM and NUHM) following
the norms of one ASHA for every 1000 population in rural areas and one ASHA covering
2500 population in urban areas. From the first update of 2010 to this update for FY 2020-21,
spanning eleven years, the total ASHA target has increased by approx. 33% (from 7,79,481 to
10,34,630) and in position ASHAs by 42% (6,91,533 to 9,83,032).

The graph below illustrates the overall increase in the number of ASHAs over a decade.
(Figure-1). The increase in target is also on account of the rollout of the ASHA program in urban
areas under NUHM in the year 2013.

FIGURE-1: THE TREND IN ASHA PROGRAM FROM YEAR 2010 TO 2020

(TARGET & IN POSITION)
NUMBER OF ASHAs IN POSITION AGAINST TARGET
1016037

1034630
1022160

1027755
1023254

1021543

1021817
966625

968483

983032
932399

974851
938054
940114
896521

894022
888887

916438
870089
855275
779481

847213
835808
691533

2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Target Position

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 ANNUAL ASHA UPDATE 2020 - 21

SELECTION STATUS OF ASHAs AGAINST THE TARGET

STATUS OF ASHA SELECTION IN RURAL AREAS
Currently, the total number of ASHAs working under NRHM is around 9,14,101 against the
target of 9,56,672 ASHAs. This reflects nearly 96% completion of the selection process across
all states/UTs. Except for Bihar, Rajasthan, Kerala, Telangana, West Bengal, DD&DNH, and
Lakshadweep, all other states/UTs have around 95% or more ASHAs in place against the set
targets of ASHA selection.

 High focus states- Jharkhand has selected 100% ASHAs while Uttarakhand and Odisha
have 98% and 99% ASHAs in place, respectively. The rest of the states in the group
(Chhattisgarh, Madhya Pradesh, Uttar Pradesh), Bihar and Rajasthan have around 95%
ASHAs in position against the targets.
 North-Eastern states, except Nagaland (96%) and Tripura (99%), all other states have
selected 100% ASHAs against the target.
 Non-high focus states, except Kerala, Telangana, and West Bengal, the rest of the states
have reported selection of above 90% ASHAs against the target. Kerala has achieved only
78% ASHA selection while West Bengal and Telangana have completed 89% and 90%
selection respectively.
 Union Territories, except the UTs of Daman, Diu & Dadar Nagar-Haveli and Lakshadweep
where 92% ASHAs are in position against their respective targets, the rest of the UTs
reported more than 96% ASHAs in position.

POPULATION DENSITY PER ASHA

In terms of population for the selection of ASHAs, majority of the states have one ASHA for
1,000 population or less. The National average for population per ASHA under the NRHM
currently is 979 based on the National Commission on Population projection for 2020-21. The
population per ASHA ranges from 153 in the UT of Lakshadweep to 1,241 per ASHA in Bihar.

Presently there are only six states- Bihar, Rajasthan and Uttar Pradesh (among high focus
states) and Maharashtra, Punjab and West Bengal (among the non-high focus states) that have
an average population of more than 1,000 being covered by each ASHA- Average population
covered by an ASHA remains highest in Bihar at 1,241, while Rajasthan, West Bengal, Uttar
Pradesh, Maharashtra and Punjab states come 2nd, 3rd, 4th, 5th and 6th with an average
population per ASHA of 1218, 1164, 1141, 1070 and 1041 respectively.

Since Chhattisgarh has selected ASHAs per habitation, among high focus states, Chhattisgarh
has the lowest population per ASHA at 319. The states of Uttarakhand, Jharkhand, Odisha,
and Madhya Pradesh, have an average of 679, 718, 779 and 945 population, respectively.

Among the non-high focus states, the lowest average population per ASHA remains at 429 in
the state of Kerala, while Himachal Pradesh, Telangana, Andhra Pradesh, Gujarat, and Haryana
states, have an average of 843, 864, 896, 946 and 999 population per ASHA, respectively.

In north- east states, Arunachal Pradesh has the lowest average population per ASHA at
285 and the population to high as 951 per ASHA in Assam. While the other five states in the
northeast are below 600 average population (Tripura- 360, Meghalaya – 397, Mizoram-549,
Manipur –551 and Sikkim- 583). Nagaland has an average of 656 population per ASHA.

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ANNUAL ASHA UPDATE 2020 - 21

Among the Union Territories, except the Lakshadweep where an ASHA covers an average of
153 population, the rest of the UTs, have an average population coverage between 343 to 762
population.

While the population density for the year 2010- 2020 is based on Census 2011 population, that
for the FY 2020-21 is based on the projected population of FY 2020-21. Despite the change
in source, the population density over the last decade has gradually improved in states/UTs,
except in a few states like Bihar, Uttar Pradesh, West Bengal, Punjab and Maharashtra.

FIGURE-2: POPULATION PER ASHA IN RURAL AREAS – THE TREND

POPULATION PER ASHA

1200 1074
979
1000 951 929 931 927
914 910 902 891 879 873
800

600

400

200

0
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021

STATUS OF ASHA SELECTION IN URBAN AREAS

Under National Urban Health Mission (NUHM), a total of 68,931 ASHAs (88%) have been
selected against the target of 77,958 across the country. With the overall completion of
selection currently at 88% under NUHM, states like Bihar, MP, UP, Arunachal Pradesh, Manipur,
Maharashtra, and Telangana have achieved less than the national average and these states
need to expedite the selection process.

In High Focus states, the total number of ASHAs in position is 87% as compared to the target.
All the states except Bihar (60%), Uttar Pradesh (81%), Madhya Pradesh (85%) and Jharkhand
(88%) have above 90% ASHAs in position against their respective targets.

In North-East states, 93% of ASHAs are in position against the target. All states except Arunachal
Pradesh (56%) and Manipur (65%) have over 90% ASHAs in position. Assam, Mizoram, and
Nagaland have achieved 100% selection of ASHAs against the target.

In the Non-High Focus states, except Telangana (72%), Maharashtra (76%), Karnataka and
West Bengal (94%), all states have close to or above over 95% ASHAs in position against the
target.

Amongst the Union Territories, the overall in-position ASHAs is reported to be 96% against
the target. Except for DD&DNH (92%), the rest of all UTs have reported more than 95% ASHA
selection against the target. The table-1 below shows the overall status of ASHA selection
against the target till 31st March 2021.

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10

TABLE-1: STATUS OF ASHAs IN POSITION AGAINST THE TARGET (RURAL AND URBAN ASHAs)

ASHA UNDER NRHM National ASHA UNDER NUHM

NAME OF Commission on DENSITY – PER
Population ASHA
STATES/ UTs Target Selection Selection % Projected Target Selection Selection %
March-21
High Focus States
Bihar 93,687 87,655 94 10,87,78,000 1,241 977 582 60
Chhattisgarh* 70,000 68,277 98 2,17,97,000 319 3,883 3,771 97
Jharkhand 39,964 39,964 100 2,86,99,000 718 1,677 1,475 88
Madhya Pradesh 65,670 64,094 98 6,05,42,000 945 5,335 4,525 85
Odisha 46,652 46,134 99 3,59,28,000 779 1,803 1,700 94
Rajasthan 51,152 48,207 94 5,86,98,000 1,218 4,664 4,269 92
Uttar Pradesh 1,62,885 1,55,070 95 17,68,89,000 1,141 8,603 6,968 81
Uttarakhand 10,813 10,700 99 74,54,000 697 1205 1,205 100
Sub-Total 5,40,823 5,20,101 96 49,87,85,000 959 28,147 24,495 87
North-Eastern States
Assam 31,334 31,334 100 2,97,87,000 951 1,212 1,212 100

ANNUAL ASHA UPDATE 2020 - 21

Arunachal Pradesh 4,040 4,040 100 11,51,000 285 75 42 56
Manipur 3,928 3,928 100 21,63,000 551 186 120 65
Meghalaya 6,589 6,589 100 26,19,000 397 215 195 91
Mizoram 1,012 1,012 100 5,56,000 549 79 79 100
Nagaland 2,000 1,917 96 12,57,000 656 90 90 100
Sikkim 641 641 100 3,74,000 583 35 32 91
Tripura 7,226 7,147 99 25,76,000 360 541 504 93
Sub-Total 56,770 56,608 100 4,04,83,000 715 2,433 2,274 93
 ANNUAL ASHA UPDATE 2020 - 21
ASHA UNDER NRHM National ASHA UNDER NUHM
NAME OF Commission on DENSITY – PER
Population
STATES/ UTs Target Selection Selection % ASHA Target Selection Selection %
Projected
March-21
Non-High Focus States
Andhra Pradesh 39,552 38,216 97 3,42,31,000 896 3,200 3,200 100
Delhi NA NA NA NA NA 6,345 6,036 95
Gujarat 40,293 38,853 96 3,67,60,000 946 4,711 4,478 95
Haryana 18,000 17,557 98 1,75,40,000 999 2,676 2,571 96
Himachal Pradesh 7,964 7,881 99 66,47,000 843 34 33 97
Karnataka 39,195 38,674 99 3,79,42,000 981 3,329 3,125 94
Kerala 30,927 24,079 78 1,03,37,000 429 2,396 2,396 100
Maharashtra 61,215 60,816 99 6,50,52,000 1,070 9,922 7,522 76
Punjab 17,720 17,223 97 1,79,35,000 1,041 2,700 2,569 95
Tamil Nadu** 2,650 2,555 96 NA NA NA NA NA
Telangana 26,028 23,443 90 2,02,57,000 864 5,000 3,597 72
West Bengal 61,008 54,109 89 6,30,05,000 1,164 6,097 5,701 94
Sub-Total 3,44,552 3,23,406 94 34,58,51,000 1,069 46,410 41,228 89
Union Territories
A&NI 412 394 96 2,29,000 581 10 10 100
DD&DNH 370 340 92 2,59,000 762 108 98 91
Jammu & Kashmir 13,010 12,539 96 94,14,000 751 138 136 99
Lakshadweep 110 101 92 15,436 153 NA NA NA
Ladakh 625 612 98 2,10,000 343 371 364 98
Puducherry NA NA NA NA NA 341 326 96
Sub-Total 14,527 13,986 96 98,98,436 708 968 934 96
Total 9,56,672 9,14,101 96 89,50,17,436 979 77,958 68,931 88
*Chhattisgarh has selected ASHAs at the habitation level.
** Tamil Nadu-ASHAs have been selected only in tribal areas
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 ANNUAL ASHA UPDATE 2020 - 21

TRAINING OF ASHAs
This section provides the status of training for ASHAs on Modules 6 and 7, NCDs and HBYC in
both rural and urban areas. Figure-3 presents cumulative training achievement of States and
Union Territories on ASHA Module 6 & 7 up to 31st March 2021.

FIGURE-3 TRAINING OF ASHAs

Round 1 Round 2 Round 3 Round 4 80 83
61
53
41
73 86
24 88 89
62
17
6 54
42 39
1 90 90
84 92
17 80
1 64 67
9 41
0 14
5 78 92 97 93
6 33 63 88 89 96 96
11
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021

TRAINING OF RURAL ASHAs IN MODULE 6 & 7

There has been progress in the training of ASHAs in all four rounds of Module 6 and 7 with an
achievement of 96%, 92%, 89% and 83% in the four rounds respectively under NRHM in the
country. In round 4 training, a significant increase has been reported from 80% in 2020 to 83%
till March 2021.

In the High Focus states group Chhattisgarh, Jharkhand, Odisha, and Uttarakhand reported
97% or more progress in all four rounds of training. While Madhya Pradesh and Rajasthan
have achieved 85%, Uttar Pradesh 84% and Bihar has achieved 47%. There remains a huge
backlog for completion of round 4 training in Bihar where only 47% ASHAs have been trained.

Most of the North-Eastern states reported over 95% in all the four rounds of the ASHA training
in modules 6&7. Owing to a small number in comparison to other states, these states have
shown good training achievements where most of them have completed training for more
than 90-100% ASHAs in all four rounds of Module 6 and 7. Amongst these states, Arunachal
Pradesh has reported the lowest training achievement (75%) in round 4, followed by Nagaland
(83%) and Manipur (85%) respectively.

In the Non-High Focus states, variable progress is observed in respective rounds of Module
6 and 7 training. States of Telangana (48%), Andhra Pradesh (81%), Karnataka (85%) and West
Bengal (89%) have reported below 90% Round 4 training completion status as compared to
the other states. There persists a huge backlog for completion of round 4 training in Telangana
where only 48% ASHAs have been reportedly trained.

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ANNUAL ASHA UPDATE 2020 - 21

Progress has been noted in the training in Union Territories in Module 6 & 7 in Round 1, 2 &
3. Andaman & Nicobar Islands and Lakshadweep have completed 100% training in all four
rounds while Ladakh and Jammu & Kashmir have reported 83% and 87% training completion
respectively. The UT of DD & DNH is yet to start Round 2, 3 and 4 trainings.

TRAINING OF RURAL ASHAs IN UNIVERSAL SCREENING, PREVENTION

AND MANAGEMENT OF NON-COMMUNICABLE DISEASES (NCDs)
With the continued and increased focus on Comprehensive Primary Health Care, states/UTs
have initiated multiskilling of ASHAs in Universal Screening, Prevention and Management of
Non-Communicable Diseases. The scale and quality of population-based screening (PBS) are
determined by the timely training of ASHAs, however, there is tardy progress seen in the
training of ASHA. Around 55% (5,02,817) ASHAs have been trained in NCDs in the country
against the target of 9,14,068 in rural areas.

In the High Focus states group, 82% (4,28,258) ASHAs have been trained in PBS of NCD
training against the target of 5,20,068 ASHAs. With almost 95% of the ASHAs trained,
Chhattisgarh and Odisha have reported the highest percentage of ASHAs trained in the group
while Jharkhand reported the second-highest 82% (32,821) number of ASHAs trained in NCDs.
The states of Uttar Pradesh, Rajasthan, and Uttarakhand have reported much slower progress
of NCD training with just 30% (45,797), 34% (16,590) and 53% (5,703) progress respectively.
There remains a huge backlog for completion of training in Bihar and MP where only 8%
(6,589) ASHAs have been trained in Bihar and 11% (6,793) in Madhya Pradesh.

In North-Eastern states, only 39% (22,337) ASHAs have been trained against the target of
56,608 ASHAs. Except for Mizoram and Sikkim, the slow pace of NCD training was reported
from practically all the states. Meghalaya, Assam, Tripura, and Manipur have reported 32%
(2,088), 38% (11,946), 41% (2,960) and 43% (1,700) of ASHAs trained in NCDs respectively. The
state of Arunachal Pradesh has been able to train only 11% (457) ASHAs against the target till
March 2021.

Among the Non-High Focus states, 77% (2,48,187) ASHAs have been trained in NCD against
the target of 3,23,406. NCD training has progressed well in all non-high focus states except
Gujarat and West Bengal which have reported only 23% and 61% ASHA training against the
target, while Andhra Pradesh and Himachal Pradesh have both reported 76% completion.
The three states of Kerala, Tamil Nadu and Telangana have reported 100% training of ASHA
in NCD.

In Union Territories, the progress of NCD training of ASHAs has been trivial where only 68%
(9,451) training have been completed against the target of 13986 ASHAs. UTs that have majorly
contributed to training progress are Andaman & Nicobar Islands and Lakshadweep with 100%
training reported. Training in other UTs is reported to be slow-paced with Jammu & Kashmir
reporting only 65% training while the UTs of Ladakh and DD&DNH have reported 87% and
92% training against the target.

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 ANNUAL ASHA UPDATE 2020 - 21

TRAINING OF RURAL ASHAs IN HOME BASED CARE FOR YOUNG

CHILD
Despite the outbreak of COVID-19, many states progressed well in HBYC training with an
overall 50% (3,29,249) ASHAs having been trained against the target of 6,60,420 ASHA till
31st March 2021. In High Focus states, against the target of 3,69,332 ASHAs, 1,53,911 (42%)
have been trained in HBYC. Chhattisgarh and Odisha reported the highest progress with
94% and 99% ASHAs trained against the targets respectively. These states were followed by
Uttarakhand (78%), Madhya Pradesh (61%) and Jharkhand (58%). The pace of HBYC training
is reported to be slow from Rajasthan and Bihar, which reported only 11% and 20% ASHAs
trained against the targets. Uttar Pradesh is the only state that has trained only 2% (2645)
ASHAs against the target of 1,55,070 in HBYC.

In North-Eastern states, around 58% ASHAs have been trained on HBYC against the group
target. Almost all states have completed over 85% of training targets except for Nagaland
(18%), Mizoram (53%) and Assam (54%).

In Non-High Focus states, the progress has been sub-optimal. Out of the target of 2,56,010
ASHAs to be trained in HBYC, 59% (73,033) ASHAs have been trained. Tamil Nadu and Kerala
have reported 100% training against the target. This is followed by the state of Karnataka
(85%), Andhra Pradesh (76%), Maharashtra (75%) and Haryana (65%). The progress of training
was reported to be slow in other states with West Bengal training only 45%, Gujarat 32%,
Punjab 31%, Telangana 30% ASHAs. Himachal Pradesh has reported only 21% HBYC training
against the target number of ASHAs.

In Union Territories, overall, 79% ASHAs have been trained against the target, out of which
DD&DNH has reported 98% training of ASHAs; Jammu & Kashmir reported 80% and Ladakh
reported 69% training of ASHAs in HBYC. Andaman & Nicobar Islands and Lakshadweep are
yet to plan ASHAs training in HBYC. The status of training in all rounds of ASHA modules 6&7
till March 2021 can be understood from the table-2 below.

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 TABLE-2: STATUS OF ASHA TRAINING AGAINST THE TARGET

ANNUAL ASHA UPDATE 2020 - 21

ASHA Training in Modules 6&7 PBS Training HBYC Training
Name of
States/ UTs In R-1 % R-2 % R-3 % R-4 % Training % Target Training %
Position
High Focus States
Bihar 87,655 80,531 92 75,769 86 66,532 76 41,272 47 65,89 8 25,079 4,926 20
Chhattisgarh 68,277 66,169 97 66,169 97 66,169 97 66,169 97 64,865 95 66,220 62,561 94
Jharkhand 39,931 39,931 100 39,905 100 39,893 100 39,864 100 32,821 82 39,931 23,320 58
Madhya Pradesh 64,094 63,025 98 62,479 97 55,070 86 54,336 85 6,793 11 12,466 7,606 61
Odisha 46,134 45,377 98 45,167 98 45,097 98 44,804 97 43,684 95 46,134 45,607 99
Rajasthan 48,207 46,796 97 45,650 95 44,051 91 40,767 85 16,590 34 17,758 2,009 11
Uttar Pradesh 15,5070 1,44,090 93 1,40,611 91 1,34,374 87 1,30,410 84 45,797 30 1,55,070 2,645 2
Uttarakhand 10,700 10,700 100 10,700 100 10,636 99 10,636 99 5,703 53 6,674 5,237 78
Sub-Total 5,20,068 4,96,619 95 4,86,450 94 4,61,822 89 4,28,258 82 2,22,842 43 3,69,332 1,53,911 42
North-Eastern States
Assam 31,334 31,334 100 31,334 100 31,334 100 31,334 100 11,946 38 18,044 9,700 54
Arunachal Pradesh 4,040 3,669 91 3,472 86 3,472 86 3,032 75 457 11 429 392 91
Manipur 3,928 3,324 85 3,326 85 3,320 85 3,357 85 1,700 43 354 332 94
Meghalaya 6,589 6,151 93 6,181 94 5,929 90 5,929 90 2,088 32 1,153 1,097 95
Mizoram 1,012 1,012 100 1,012 100 1,012 100 1,012 100 1,012 100 1,012 532 53
Nagaland 1,917 1,576 82 1,570 82 1,624 85 1,593 83 1,533 80 545 100 18
Sikkim 641 630 98 630 98 630 98 629 98 641 100 205 176 86
Tripura 7,147 6,800 95 6,611 93 6,852 96 6,816 95 2,960 41 678 678 100
Sub Total 56,608 54,496 96 54,136 96 54,173 96 53,702 95 22,337 39 22,420 13,007 58
15
16

ASHA Training in Modules 6&7 PBS Training HBYC Training

Name of
States/ UTs In R-1 % R-2 % R-3 % R-4 % Training % Target Training %
Position
Non-High Focus States
Andhra Pradesh 38,216 31,555 83 31,263 82 30,870 81 30,870 81 28,912 76 38,216 29,060 76
Gujarat 38,853 37,101 95 36,817 95 36,071 93 35,543 91 8,840 23 33,512 10,680 32
Haryana 17,557 17,557 100 17,557 100 17,557 100 17,544 100 17,438 99 17,557 11,370 65
Himachal Pradesh 7,881 7,534 96 7,494 95 7,387 94 7,370 94 6,015 76 7,837 1,615 21
Karnataka 38,674 37,045 96 35,402 92 34,133 88 32,981 85 29,589 77 1,984 1,684 85
Kerala 24,079 23,950 99 24,079 100 24,079 24,079 100
Maharashtra 60,816 60,251 99 59,986 99 59,664 98 59,469 98 56,954 94 60,816 45,834 75
Punjab 17,223 17,095 99 17,095 99 17,095 99 17,095 99 17,096 99 17,223 5,393 31
Tamil Nadu 2,555 2,555 100 2,555 100 2,555 100 2,555 100 2,555 100 2,555 2,555 100
Telangana 23,443 23,443 100 23,443 100 23,443 100 11,244 48 23,443 100 23,443 7,119 30
West Bengal 54,109 54,109 100 54,109 100 53,309 99 48,357 89 33,266 61 28,788 12,902 45
Sub-Total 3,23,406 3,12,195 97 2,85,721 88 2,82,084 87 2,63,028 81 2.48,187 77 2,56,010 1,52,291 59
Union Territories

ANNUAL ASHA UPDATE 2020 - 21

A&NI 394 394 100 394 100 394 100 394 100 394 100 0 0 0
DD & DNH 340 255 75 0 0 0 0 0 0 313 92 282 277 98
Jammu & Kashmir 12,539 109,87 88 10,529 84 10,890 87 10,890 87 8,109 65 11,676 9,354 80
Lakshadweep 101 101 100 101 100 101 100 101 100 101 100 110 0 0
Ladakh 612 506 83 506 83 506 83 506 83 534 87 590 409 69
Sub-Total 13,986 12,243 88 11,530 82 11,891 85 11,891 85 9,451 68 12,658 10,040 79
Total 9,14,068 8,75,553 96 8,37,837 92 8,09,970 89 7,56,879 83 5,02,817 55 6,60,420 3,29,249 50
ANNUAL ASHA UPDATE 2020 - 21

TRAINING OF URBAN ASHAs UNDER NATIONAL URBAN HEALTH

MISSION
TRAINING OF URBAN ASHAs IN MODULES 6 & 7
The rollout of training of ASHA in all four rounds of Module 6 & 7 needs to be expedited in
urban areas. A total of 84% ASHAs have been trained in Round 1, 69% in Round 2, 64% in
Round 3 and 50% in Round 4 in ASHA modules 6&7 respectively.

In High Focus states, there has been slow progress in the training of ASHAs in all four rounds
of Module 6 and 7 with an achievement of 82%, 64%, 57% and 54% respectively. All states
except Bihar, Jharkhand and Uttar Pradesh have close to or above 88% ASHAs being trained
in Round 1 and Round 2 of Module 6 and 7. Odisha and Uttarakhand reported 100% ASHAs
trained in all four modules. The state of Jharkhand and Uttar Pradesh are yet to start Round-3
and 4 training of ASHAs in modules 6 & 7. Bihar has not initiated the training in any of the
rounds in modules 6 & 7 for ASHA yet.

In North-Eastern states, the achievement for Module 6 and 7 training is 97%, 96%, 96%, and
89 % respectively for Rounds 1 to 4. Against the target, Arunachal Pradesh, Manipur, Mizoram,
and Nagaland have completed 100% ASHAs training in all four rounds of modules 6 & 7. Slow
pace of ASHAs training has been reported from in Sikkim, where only 53% ASHAs have been
trained in round 4 of module 6 & 7, while the state of Tripura, Assam and Meghalaya have
shown fair progress in all four rounds of module 6 & 7 training.

Amongst the Non-High Focus states, training of ASHAs in modules 6&7 have been progressing
with an achievement of 85%, 72%, 68% and 46% in all four rounds respectively. Against the
target, five states, Delhi, Haryana, Himachal Pradesh, Kerala, and Telangana have trained
100% ASHAs in rounds 1 to 3 in modules 6 & 7 and the progress in Round 4 varies from 0 to
93%. Maharashtra, Karnataka, and Andhra Pradesh have reported slow progress in rounds 1 to
3, where only 42%, 56% and 69% ASHAs have been trained. West Bengal has reported decent
progress in Round 1 (78%) training, but it needs to immediately scale up training from Round
2 onwards. Only Kerala has reported 100% training of ASHA in round 4. There are only two
states Delhi and West Bengal where round 4 training is yet to begin.

In Union Territories, the training of ASHAs in modules 6 & 7 in Round 1 and 2 is 44% and 35%
respectively. Only DD & DNH and Puducherry have initiated Round 1.

TRAINING OF URBAN ASHAs IN UNIVERSAL SCREENING, PREVENTION

AND MANAGEMENT OF NON-COMMUNICABLE DISEASES (NCDs)
About 54% (37082) ASHAs have been trained against the target of 68,931 ASHA in NCD training
to rollout population-based screening of NCDs and their subsequent community follow-up.

In High Focus states, out of 24,495 in position ASHAs, overall, 45% (11,118) ASHAs have
been trained in high focus states. Odisha has reported 100% ASHAs trained, followed by
Chhattisgarh, Uttarakhand and Jharkhand, reported training of 94%, 76% and 66% ASHAs
respectively. The pace of NCD training in the states of Madhya Pradesh and Uttar Pradesh is
slow with only 14% and 48% ASHAs trained against the target. Bihar and Rajasthan are yet to
initiate the NCD training or urban ASHAs.

17
 ANNUAL ASHA UPDATE 2020 - 21

In the North-Eastern States, 89% (2027) ASHAs have been trained against the target. The
four states of Manipur, Mizoram, Nagaland, and Sikkim have already achieved 100% of their
training target while Assam, Tripura and Meghalaya progressed well and reported 86%,
93% and 95% training of ASHAs in NCDs. The NCD training of ASHA has been inadequate in
Arunachal Pradesh, where only 12% ASHAs have been trained.

Among Non-High focus states, 57% (23,572) training achievement is noted against the target of
41,228. Among all of them, four states of Haryana, Himachal Pradesh, Kerala and Telangana
reported 100% of ASHAs trained against the target while Andhra Pradesh, Maharashtra, Delhi,
Punjab and Karnataka have been processing in NCD training and reported 46%54%, 64%, 94%
and 97% achievement against the target. Meanwhile, West Bengal reported minuscule (~1%)
training of ASHAs on NCDs reported in and Gujarat yet initiate the training of urban ASHAs in
NCD.

In Union Territories, Andaman & Nicobar Islands and Puducherry have achieved 100% of their
training against the target, while DD & DNH has reported only 30% achievement. Rest all UTs
have to initiate NCD training of Urban ASHAs.

TRAINING OF URBAN ASHAs IN HOME BASED CARE FOR YOUNG

CHILD
Across the country, 49% (22,991) urban ASHAs have been trained in Home Based Care for
Young Child (HBYC) against the target of 46,764 ASHAs.

In High Focus states, a total of 69% 11,518 (69%) ASHAs have been trained on HBYC against
the target of 16,574. Progress in the HBYC training is reported from Uttarakhand (100%),
Chhattisgarh (98%), and Odisha (91%), while Madhya Pradesh has trained 64% (5,651) ASHAs
against the target of 8,805. The remaining states of Bihar, Jharkhand, Rajasthan, and Uttar
Pradesh initiate HBYC training.

In North-Eastern states, as of now only 187 (22%) ASHAs have been trained against the target
of 854 ASHAs in HBYC. Three states of Manipur, Meghalaya and Sikkim have reported 100%
training of ASHAs against the target, while Mizoram has achieved 19% against the set target.
Assam, Arunachal Pradesh, Nagaland, and Tripura have to initiate HBYC training.

Slow progress was also reported in non-high focus states where overall 11,152 (39%) of ASHAs
were trained in HBYC against the target of 28,774. Among all the states, Andhra Pradesh,
Himachal Pradesh, Karnataka, and Kerala have achieved 100% ASHAs trained in HBYC. Other
states of Gujarat, Delhi, Punjab, Haryana, and Telangana reported inadequate progress in
HBYC training these states. Maharashtra is the only state to which has not initiated the training
of ASHAs yet.

In UTs, a total of 134 ASHAs have been trained on HBYC against the target of 562. Only, DD &
DNH has made decent progress in training with around where 98% ASHAs have been trained
against the target. Jammu and Kashmir have shown slow progress with only 29% of ASHAs
trained against the target. The rest of the UTs have not yet rolled out HBYC training. The status
of training of Urban ASHAs has been shown in the table below-

18
 TABLE-3: STATUS OF URBAN ASHAs TRAINING AGAINST TARGET

ANNUAL ASHA UPDATE 2020 - 21

ASHA Training in Modules 6&7 PBS Training HBYC Training
Name of
States/ UTs In R-1 % R-2 % R-3 % R-4 % Training % Target Training %
Position
High Focus States
Bihar 582 0 0 0 0 0 0 0 0 0 0 0 0 0
Chhattisgarh 3,771 3,682 98 3,682 98 3,682 98 3,682 98 3,530 94 3,771 3,694 98
Jharkhand 1,475 1,475 100 343 23 0 0 0 0 975 66 1677 0 0
Madhay Pradesh 4,525 4,430 98 4,125 91 3,860 85 3,600 80 650 14 8,805 5,651 64
Odisha 1,700 1,700 100 1,700 100 1,700 100 1,700 100 1,700 100 1,614 1,466 91
Rajasthan 4,269 4,076 95 3,744 88 3,558 83 3,107 73 0 0 0 0 0
Uttar Pradesh 6,968 3,492 50 771 11 0 0 0 0 3,342 48 0 0 0
Uttarakhand 1,205 1,205 100 1,205 100 1,205 100 1,205 100 921 76 707 707 100
Sub-Total 24,495 20,060 82 15,570 64 14,005 57 13,294 54 11,118 45 16,574 11,518 69
North-East States
Assam 1,212 1,212 100 1,212 100 1,212 100 1,062 88 1,045 86 0 0 0
Arunachal Pradesh 42 42 100 42 100 42 100 42 100 5 12 42 0 0
Manipur 120 120 100 120 100 120 100 120 100 120 100 120 120 100
Meghalaya 195 189 97 189 97 189 97 189 97 185 95 20 20 100
Mizoram 79 79 100 79 100 79 100 79 100 79 100 79 15 19
Nagaland 90 90 100 90 100 90 100 90 100 90 100 57 0 0
Sikkim 32 17 53 17 53 17 53 17 53 32 100 32 32 100
Tripura 504 466 92 436 87 436 87 436 87 471 93 504 0 0
Sub-Total 2,274 2,215 97 2,185 96 2,185 96 2,035 89 2,027 89 854 187 22
19
20

ASHA Training in Modules 6&7 PBS Training HBYC Training

Name of
States/ UTs In R-1 % R-2 % R-3 % R-4 % Training % Target Training %
Position
Non-High Focus States
Andhra Pradesh 3,200 2,210 69 2,210 69 2,210 69 2,210 69 1,457 46 3,200 3,200 100
Delhi 6,036 6,036 100 6,036 100 6,036 100 3,890 64 2,508 867 35
Gujarat 4,478 4,050 90 4,050 90 4,050 90 4,050 90 0 0 4,281 450 11
Haryana 2,571 2,571 100 2,571 100 2,571 100 2,393 93 2,571 100 2,571 1,129 44
Himachal Pradesh 33 33 100 33 100 33 100 24 73 33 100 33 33 100
Maharashtra 7,522 5,397 72 4,092 54 3,144 42 2,490 33 4,091 54 7,522 0 0
Karnataka 3,125 2,052 66 1,927 62 1,762 56 1,638 52 3,028 97 97 97 100
Kerala 2,396 2,396 100 2,396 100 2,396 100 2,396 100 2,396 100 2,396 2,396 100
Telangana 3,597 3,597 100 3,597 100 3,597 100 1,697 47 3,597 100 3,597 2,080 58
Punjab 2,569 2,248 88 2,248 88 2,248 88 2,248 88 2,414 94 2,569 900 35
West Bengal 5,701 4,431 78 600 11 107 2 0 0 38 1 0 0 0
Sub-Total 41,228 35,021 85 2,9760 72 28,154 68 19,146 46 23,515 57 28,774 11,152 39
Union Territories

ANNUAL ASHA UPDATE 2020 - 21

A&NI 10 0 0 0 0 0 0 0 0 10 100 0 0 0
DD&DNH 98 88 90 0 0 0 0 0 0 29 30 98 94 96
Jammu & Kashmir 136 0 0 0 0 0 0 0 0 0 0 138 40 29
Ladakh 364 0 0 0 0 0 0 0 0 0 0 0 0 0
Puducherry 326 326 100 326 100 0 0 326 100 326 0 0
Sub-Total 934 414 44 326 35 0 0 0 0 365 39 5 62 134 24
Total 68,931 57,717 84 47,841 69 44,344 64 34,475 50 37,025 54 46,764 22,991 49
ANNUAL ASHA UPDATE 2020 - 21

STATUS UPDATE OF ASHA CERTIFICATION

A proposal for certification of ASHAs to enhance competency and professional credibility
of ASHAs by knowledge and skill assessment was approved in December 2013. A tripartite
arrangement between the Ministry of Health and Family Welfare (MOHFW), National Health
Systems Resource Centre (NHSRC) and the National Institute of Open Schooling (NIOS) to
undertake the process accreditation of trainers and training sites and certification for ASHAs
was undertaken. Based on the readiness of the States/UTs on the levels of completion of ASHA
training in Rounds 1 to 4 of Module 6 and 7, the programme has been undergoing in 24 states/
UTs namely Arunachal Pradesh, Assam, Chhattisgarh, Delhi, Gujarat, Haryana, Himachal
Pradesh, Jammu and Kashmir, Jharkhand, Karnataka, Madhya Pradesh, Maharashtra, Manipur,
Meghalaya, Mizoram, Nagaland, Odisha, Punjab, Rajasthan, Sikkim, Telangana, Tripura,
Uttarakhand, and West Bengal.

Presently, 35 state training sites across 21 states/UTs and 132 district training sites across 14
states/UTs have been accredited by NIOS. About the trainers, the National Resource Team
(NRT) of 27 trainers was created by NHSRC to support the refresher training and certification
of state/district trainers, accreditation of state/ district training sites and facilitating certification
of ASHAs and ASHA facilitators. A total of 232 state trainers across 23 states/UTs and 1006
district trainers in 15 States/UTs have been certified by NIOS as of March 2021. In FY 2020-21,
over one year, the certification examination for ASHAs and ASHA Facilitators was conducted
on 28th Feb 2021. The examination of July 2020 could not be held due to the COVID-19
situation in the country.

Till now, a total of six theory examinations have been conducted for ASHAs and ASHA
Facilitators. The details of number of certified ASHAs and AFs (theory and practical) are as
follows-

 31st January 2018– 2,214 certified (theory and practical) out of 2,359 from 9 states-
Arunachal Pradesh, Assam, Delhi, Jharkhand, Karnataka, Madhya Pradesh, Maharashtra,
Sikkim and Tripura.
 22nd July 2018– 3,994 certified (theory and practical) out of 4,593 from 14 states namely
Arunachal Pradesh, Assam, Chhattisgarh, Delhi, Himachal Pradesh, Jharkhand, Karnataka,
Madhya Pradesh, Maharashtra, Odisha, Punjab, Sikkim, Tripura and Uttarakhand.
 20th January 2019– 10,179 certified (theory and practical) from 11,655 from 14 states and
1 UT namely Arunachal Pradesh, Assam, Chhattisgarh, Delhi, Himachal Pradesh, Jammu
and Kashmir, Jharkhand, Karnataka, Madhya Pradesh, Maharashtra, Odisha, Punjab,
Sikkim, Tripura and Uttarakhand.
 10th August 2019– 7,686 certified (theory and practical) from 9,280 from 16 states namely
Arunachal Pradesh, Assam, Chhattisgarh, Delhi, Himachal Pradesh, Jharkhand, Karnataka,
Madhya Pradesh, Maharashtra, Manipur, Mizoram, Nagaland, Odisha, Sikkim, Tripura and
Uttarakhand. ASHAs from Gujarat, a few districts of Karnataka and Maharashtra were
unable to appear in the theory examination due to heavy floods in affected districts and
from Jammu and Kashmir due to the political situation.
 28th January 2020– 12,471 certified from 13,865 from 17 states and 1 UT namely Arunachal
Pradesh, Assam, Delhi, Gujarat, Himachal Pradesh, J&K, Jharkhand, Karnataka, Madhya
Pradesh, Maharashtra, Manipur, Meghalaya, Mizoram, Odisha, Punjab, Sikkim, Tripura,
and Uttarakhand.

21
 ANNUAL ASHA UPDATE 2020 - 21

 25th February 2021– 8,822 certified from 10428 ASHAs appeared from 11 states and 1 UT
namely Arunachal Pradesh, Assam, Chhattisgarh, Himachal Pradesh, Jammu and Kashmir,
Jharkhand, Karnataka, Madhya Pradesh, Maharashtra, Odisha, Sikkim, and Uttarakhand.
 Hitherto, 45,366 (70%) ASHA and ASHA Facilitators have been certified out of 65,029 who
appeared in the examination from January 2018 till February 2021.

TABLE-4: STATUS OF ACCREDITED VOCATIONAL INSTITUTE-AVIs

(STATE & DISTRICT), ASHA TRAINERS (STATE & DISTRICT)
CERTIFICATION OF ASHAs & ASHA FACILITATORS

ASHA and ASHA Facilitators Certified

Total State District State District
State/UTs Jan July Jan- Aug- Jan Certified AVIs AVIs Trainer Trainer
2018 2018 2019 2019 2020
Arunachal 20 80 52 77 31 260 1 2 2 12
Pradesh
Assam 471 220 1,028 537 203 2,459 1 5 5 107
Chhattisgarh 0 90 271 123 0 484 1 0 20 13
Delhi 174 757 719 578 628 2,856 1 11 43 0
Gujarat 0 0 0 0 35 35 2 0 6 15
Haryana 0 0 0 0 0 0 0 0 9 0
Himachal 0 60 233 294 291 878 1 3 12 0
Pradesh
Jammu & 0 0 466 0 2,457 2,923 2 11 21 122
Kashmir
Jharkhand 550 177 1,288 1,859 1,530 5,404 1 20 24 122
Karnataka 301 873 4,114 2,566 4,748 12,602 4 19 3 133
Madhya 114 237 216 233 431 1,231 3 17 13 112
Pradesh
Maharashtra 279 473 957 278 183 2,170 8 0 12 184
Manipur 0 0 0 29 30 59 1 1 8 0
Meghalaya 0 0 0 0 41 41 1 0 6 0
Mizoram 0 0 0 22 44 66 1 0 3 14
Nagaland 0 0 0 49 0 49 1 0 6 0
Odisha 0 347 359 446 945 2,097 1 14 3 55
Punjab 0 233 150 0 149 532 1 2 4 21
Rajasthan 0 0 0 0 0 0 0 0 8 0
Sikkim 25 105 43 79 56 308 1 0 2 11
Telangana 0 0 0 0 0 0 0 0 3 0
Tripura 280 45 71 338 283 1,017 1 2 6 59
Uttarakhand 0 297 212 178 386 1073 1 1 6 26
West Bengal 0 0 0 0 0 0 1 24 7 0
Total 2,214 3,994 10,179 7,686 12,471 36,544 35 132 232 1,006

22
ANNUAL ASHA UPDATE 2020 - 21

STATUS OF SUPPORT STRUCTURES FOR COMMUNITY PROCESSES

STATE ASHA MENTORING GROUP (SAMG)
ASHA Mentoring Groups (AMGs) have been constituted at the state level to act as technical
support groups for assisting the State Governments in the implementation, monitoring, and
review of the ASHA programme. State-level AMGs have been constituted in a total of 25
states/UTs (24 states and 01 UT) in the country. In Chhattisgarh, SAMG is not constituted,
State Health Resource Centre (SHRC) is concerned authority instead of SAMG. Therefore, a
total of four states namely Chhattisgarh, Haryana, Himachal Pradesh, and Tamil Nadu and
five UTs except Jammu and Kashmir have selected ASHAs, but they do not have State ASHA
Mentoring Group (AMGs). Among all States/UTs, Gujarat and Telangana are the only states,
which have reported an AMG meeting in the last year. Telangana reported the last meeting in
June 2020 and Gujarat reported in August 2020.

In the High Focus States, none of the state has reported AMG meetings in the last year. The
last AMG meeting was held in June 2019 for Uttar Pradesh while Rajasthan, Bihar and Odisha
did not have a State AMG meeting since 2010, 2011 and 2012 respectively.

Among all 25 States & 1 UT, Uttarakhand has reported the highest number (27) of AMG
meetings since the constitution of the State AMG in 2009. However, there is no recent update
of the meeting of AMGs in Uttarakhand, with the last AMG meeting held in July 2018.

In the North-Eastern states, all states have constituted State ASHA Mentoring Group (AMG).
However, the frequency of meetings has been irregular across all these states. None of the
States has reported AMG meetings for the last five years. The last AMG meeting was held in
Jan 2016 for Assam while Mizoram, Nagaland, Sikkim, and Tripura have reported their last
AMG meetings in 2013.

In the Non-High Focus States, except Telangana and Gujarat, none of the states have reported
AMG meetings since 2019. Kerala and Maharashtra have reported AMG meetings in 2018,
while Andhra Pradesh reported last AMG meetings in March 2019. Karnataka, Punjab, and
Delhi reported having their last meeting in 2017, 2016 and 2015 respectively. West Bengal did
not have their AMG meeting since December 2011.

In UTs, Jammu & Kashmir reported last AMG meeting in 2018. The status of support structures
across the states largely remains unchanged from the previous ASHA update published in
July 2019.

23
24

TABLE-5: STATUS OF AMGs, STATE ARC AND STATE ASHA TRAINERS

State ASHA Monitoring Group State ARC State Trainers

SHSRC/team
Date of Last

independent
Total No. of

Total No. of

ARC (Regd.

with SPMU
Formation

Members

Meetings

Status of
Meeting
States/ UTs List of

/part of
Year of

body/
AMG

Held
Status of Formation Positions RD1 RD2 RD3 NCD HBYC
filled

High Focus States

SAMG
Bihar constituted and is a registered 2011 10 3 Jun-11 SPMU 2 28 28 28
body
Not Constituted SHRC is
SHRC is concerned
Chhattisgarh 2011 17 19 Apr-20 concerned authority instead 42 42 42
authority instead of SAMG of SAMG
SAMG constituted in 2010 and
Jharkhand 2012 15 10 Oct-17 SPMU 8 9 9 2 6
later reconstituted in 2016
SAMG constituted in 2012 and
Madhya Pradesh 2008 16 4 May-19 7 13 13 13 8 7
later reconstituted in 2013
Odisha SAMG constituted 2009 NA 4 2012 Team within SPMU 6 5 5 5 4
Rajasthan SAMG constituted 2006 21 4 Sep-10 3 26 26 26 2 6
Uttar Pradesh SAMG constituted 2008 29 8 June-19 Team within SPMU 10 109 80 28 15 11
Uttarakhand SAMG constituted 2009 13 27 Jul-18 2 4 4 2 6

ANNUAL ASHA UPDATE 2020 - 21

North-Eastern States
Arunachal Pradesh SAMG constituted 2010 14 9 Aug-15 SPMU 2 4 4 4 4 5
Assam SAMG constituted 2012 12 8 Jan-16 Team within SPMU 2 2 2 2 2 4
Manipur SAMG constituted 2008 11 5 Aug-13 Team within SPMU 3 8 8 8 2 3
Meghalaya SAMG constituted 2009 8 6 Oct-14 SPMU 2 2 2 2 2 5
Mizoram SAMG constituted 2008 30 9 Sep-15 ARC 3 3 3 3 2 6
Nagaland SAMG constituted 2010 11 5 Aug-13 SPMU 3 6 6 6 9 3
SAMG constituted in 2010 and
Sikkim 2016 15 2 Nov-13 SPMU 1 1 1 1 1 4
later reconstituted in 2016
Tripura SAMG constituted 2008 18 7 Nov-13 SARC/DARC/SDARC 7 6 6 6 3 6
 ANNUAL ASHA UPDATE 2020 - 21
State ASHA Monitoring Group State ARC State Trainers

SHSRC/team
(Regd. body/
Date of Last

independent
Total No. of

Total No. of

with SPMU
Formation

Members

Meetings

Status of
Meeting
States/ UTs List of

/part of
Year of

AMG

Held

ARC
Status of Formation Positions RD1 RD2 RD3 NCD HBYC
filled

Andhra Pradesh SAMG constituted 2015 15 2 Mar-19 Team within SPMU 4 5 5 5

Delhi SAMG constituted 2010 8 6 Jan-15 Team within SPMU 4 85 85 85 11 6
Gujarat SAMG constituted 2013 15 10 Aug-20 Team within SPMU 4 29 29 29 29 29
Haryana Not constituted NA NA NA NA Team within SPMU 5 8 8 8 5 6
Himachal Pradesh Not constituted NA NA NA NA 7 12 12 12 12 4
Goa NA NA NA NA NA
Karnataka 2012 and later 2012 NA 1 Apr-17 Team within SPMU 3 3 3 3 7 2
Kerala SAMG constituted 2008 22 8 Jan-18 1
Maharashtra SAMG constituted 2007 16 6 Sep-18 Team within SPMU 4 12 12 12 5 5
Punjab SAMG constituted 2014 11 3 Aug-16 SHSRC and SPMU 5 5 7 4 4 1
Tamil Nadu Not constituted NA NA NA NA Team within SPMU 6 18 18 18 50 22
Telangana SAMG constituted 2015 9 5 June-20 Team within SPMU 6 3 3 3 3 3
Outsourced to CINI
West Bengal SAMG constituted 2010 15 4 Dec-11 10 6 6 6 6 5
(Child in Need Institute)
Union Territories
Andaman & Nicobar Not constituted NA NA NA NA NA Existing Staff 2 2 2 3 0
Dadra & Nagar Haveli Not constituted NA NA NA NA NA Existing Staff 4 0 0 0 0
Daman & Diu Not constituted NA NA NA NA NA Existing Staff 0 0 0 0 0
Puducherry Not constituted NA NA NA NA Team within SPMU Existing Staff 10 10 10 2 0
Ladakh Not constituted NA NA NA NA NA Existing Staff 1 1 1 1 1
Lakshadweep Not constituted NA NA NA NA NA Existing Staff 0 0 0 0 0
Jammu and Kashmir SAMG constituted 2012 10 1 Oct-18 Team within SPMU 4 22 22 22 0 7
Chandigarh NA
25
 ANNUAL ASHA UPDATE 2020 - 21

ASHA SUPPORT STRUCTURE AT STATES/UTs

The support structure at the state level and below has expanded rapidly, especially over the last
five years, as states have increasingly become cognizant of the necessity of a strong support
structure to enhance the community processes component. Presently most of the states have
a well-established support structure for community processes. The ASHA facilitators provide
on the job supervision and mentoring, and one facilitator has been selected for a cluster of 10-
20 ASHAs. Over the last six years, the number of positions sanctioned and filled for support
structures indicates a gradual increase as new positions were created in states of Uttar
Pradesh, Himachal Pradesh, West Bengal, Arunachal Pradesh, Andhra Pradesh, Telangana,
and the UT of Andaman & Nicobar Islands. There are a total of 39,546 ASHA Facilitators
across 20 states in the country.

In high focus States except Odisha other states have support structures at all four levels (State/
District/ Block & Sub-block).

The majority of North-Eastern states have 3 to 4 levels of the support structure, except Sikkim
where support structure has been created at the state and sub- block level only.

Amongst Non-High Focus states, Haryana, Karnataka, and Maharashtra have set up dedicated
support structures at all four levels, while states like Andhra Pradesh, Gujarat, Telangana,
Kerala, Delhi, Himachal Pradesh, Punjab and West Bengal have created a mix of dedicated
and existing support structures setup in SPMU to support the ASHA programme. The support
structure improved in states/UTs and can be understood from the table given below:

TABLE-6: ASHA SUPPORT STRUCTURE AT STATE, DISTRICT, BLOCK

AND SUB-BLOCK LEVEL

States/UTs State Level District Level Block Level Sub-Block Level

High Focus States
4258 positions filled
ARC formed and is a 11 positions filled 438 positions filled (91% against target
Bihar
registered body (against target of 38) (against target of 534) of 4685) 1 AF per 20
ASHAs.
State ARC is not
3452 positions filled
Constituted and SHRC 100% position filled 100% position filled
Chhattisgarh (100% against a target)
is concerned authority against a target of 35 against a target of 292
1 AF per 20 ASHAs.
instead of SAMG
Existing staff- District Block Trainer Team 2290 ASHA Facilita-
Programme Coordinator supports the program tors in place (reaching
Team within SPMU
Jharkhand manages the program at block level. 100% against target of
manages the program
100% positions filled 100% positions filled 2295)- 1 AF for 10- 20
(against target of 582) (against target of 2260) ASHAs
5497 positions filled
Madhya State- ARC not consti- 46 positions filled 259 positions filled (100% against the
Pradesh tuted. (against target of 51) (against target of 313) target) 1 AF per 10 - 15
ASHAs

26
ANNUAL ASHA UPDATE 2020 - 21

States/UTs State Level District Level Block Level Sub-Block Level

717 positions filled
Team within SPMU 52 positions filled Existing staff BPM (100% against the
Odisha
manages the program (against target of 60) supports the program target) 1 AF per 20
ASHAs.
S-ARC has not been 1528 positions filled
constituted. Existing 31 positions filled 174 positions filled (100% against the tar-
Rajasthan
staff manages the (against target of 34), (against target of 249), get) 1 PHC Supervisor
program. at the PHC level
6928 positions filled
71 positions against a 764 positions against a
Team within SPMU (86% against target
Uttar Pradesh target of 75 have been target of 820 have been
manages the program of 8013) 1 AF for 20
filled. filled.
ASHAs.
602 positions filled
The state has 1 Nodal 12 positions against a
100% positions filled (100% against target)
Uttarakhand officer, 1 PM & 2 PCs target of 13 have been
(against target of 101), 1 AF for 20 ASHAs in
place in the SPMU filled.
position
North-Eastern States
354 positions filled
Arunachal Team within SPMU 100% positions filled 100% positions filled
(100% against target)
Pradesh manages the program (against target of 22) (against target of 84)
1 AF for 10-13 ASHAs
ASHA Programme
2661 positions filled
Manager and State 23 positions filled 139 positions filled
Assam (100% against target)
Community Mobilizer (against target of 33) (against target of 153)
1 AF for 20 ASHAs
manage the program
170 positions filled
Team within SPMU 100% positions filled Existing staff - BPM (88% against target
Manipur
manages the program (against target of 9) manage the programme of 194) 1 AF for 20
ASHAs
SAMG constituted State
100% positions filled
ASHA Resource Centre 333 positions filled
100% positions filled (against target of 39)
Meghalaya in place Team within (100% against target)
(against target of 11) Existing staff - BPM
SPMU manages the Selection is at the PHC.
manage the programme
program
The District ASHA
1 SNO (CP), 1 ASHA
Coordinators acts as 97 positions filled
Programme Manager 1
a DCM in the state of No support structure at (100% against target)
Mizoram Assistant Programme
Mizoram (a total of 9 in the block level. The selection level is
Manager manage the
position, one for each SDH/CHC/PHC.
program.
district)
Team within SPMU
Block ASHA Coordi-
manages the program
100% positions filled 66 positions filled nators who provide
Nagaland Senior Program Manag-
(against target of 11) (against target of 72), mentoring support to
er, CP manages all CP
ASHAs
activities.

27
 ANNUAL ASHA UPDATE 2020 - 21

States/UTs State Level District Level Block Level Sub-Block Level

Team within SPMU
71 positions filled
manages the program Existing staff- LHV/
(100% against target)-
ADHS (CP) looks after IEC staff manage the Existing staff - BPM
Sikkim existing ASHAs are
the programme with programme in all 4 manage the programme
playing the dual role
support from SPMU, districts
1 AF for 10 ASHAs.
DOMU and BPMU
4 ASHA Programme
415 positions filled
State ARC is in place Managers and 11
100% positions filled (100% against target)-
Tripura and is registered at Sub-Divisional Pro-
(against target of 11), 1 AF for 20 to 25
SARC/DARC/SDARC gramme Managers
ASHAs in position
support the programme
Non- High Focus States
1385 MPHS- F, 1 per
Team-based in SPMU
Andhra 11 positions filled Existing staff - BPM PHC in place- who
and Directorate manag-
Pradesh (against target of 13) manage the programme provide mentoring
es the program
support to ASHAs
1600 ANMs in place.
1 per 5-7 ASHAs at
Team within SPMU 100% positions filled
Delhi None UPHCs - who provide
manages the program (against target of 11)
mentoring support to
ASHAs
100% positions filled
(against target of 3553 positions filled
Team within SPMU 33) District Program Existing staff - BPMU (95% against target of
Gujarat
manages the program Assistant is in place per manage the programme 3751)- 1 AF for 10
district for monitoring ASHAs
of ASHA Programmes.
573 positions filled
Team within SPMU 100% positions filled 106 positions filled (93% against target
Haryana
manages the program (against target of 22) (against target of 113) of 618)- 1 AF per 20
ASHAs
1679 positions filled
(94% against target
Team within SPMU 28 positions filled 169 positions filled
Karnataka of 2000)- 1 AF per 20
manages the program (against target of 30) (against target of 176)
ASHAs- existing ASHAs
are playing the dual role
S-ARC has not been MPWs at SHCs in
constituted. Existing Existing staff - manage Existing staff - manage place- who provide
Kerala
staff manages the the programme the programme mentoring support to
program. ASHAs
3570 positions filled
(95% against target
33 positions against a 336 positions against a
State ARC has been of 3664)- 1 AF per 10
Maharashtra target of 34 have been target of 355 have been
constituted. ASHAs in tribal areas &
filled. filled.
1 AF per 20 ASHAs in
Non- Tribal areas

28
ANNUAL ASHA UPDATE 2020 - 21

States/UTs State Level District Level Block Level Sub-Block Level

869 positions filled
Team within SHSRC 13 positions against a
100% positions filled (98% against target
Punjab and SPMU manage the target of 22 have been
(against target of 101), of 888)- 1 AF for 20
program. filled.
ASHAs in position.
1663 –Female Health
Workers/MPW at
Himachal 10 positions filled as Existing staff - BPM
None SHCs- 1 MPW per SHC
Pradesh against target of 12 manage the programme
- who provide mentor-
ing support to ASHAs
District Maternal and
Child Health Officer, Community Health
195 Community Health
DMCHO manages the Nurse supports the
Team within SPMU Nurse cadre - who pro-
Tamil Nadu program at the district program at block level.
manages the program vide mentoring support
level. 100% positions 100% positions filled
to ASHAs
filled (against target of (against target of 104)
33)
1552 Multi-Purpose
Health Supervisor
Team within SPMU 6 positions filled (as All position is vacant (MPHS-F) at PHC level
Telangana
manages the program against target of 33) against a target of 81 who provide mentoring
support to ASHAs -
1 MPHS per 20 ASHAs
496 positions against
The program manage-
a target of 682 have
ment has been out-
been filled. On average,
sourced to CINI- Child 22 positions against a
160 ASHAs/ Block and Health Supervisor at
in Need Institute Sr. target of 28 have been
Two (2) Block ASHA Gram Panchayat level-
West Bengal Programme Coordinator filled. The state has one
Facilitators (BAF)/ who provide mentoring
is the Nodal Officer for District ASHA Facilitator
Block norm is followed. support to ASHAs
ASHA and is support- per district
Around 80 ASHAs are
ed by CINI supported
supported by 1 (one)
manpower
BAF.
Union Territories
State- ARC not consti- Existing DPMU staff
Andaman Existing PHC staff -
tuted Existing staff at supports the pro- Existing staff - BPM
& Nicobar who provide mentoring
the state level manages gramme at the district manage the programme
Islands support to ASHAs
the program. level.
State- ARC not consti- Existing DPMU staff
tuted Existing staff at supports the pro- Existing staff - BPM Existing staff manages
Lakshadweep
the state level manages gramme at the district manage the programme the programme
the program. level.
UT- ARC not constitut- Existing DPMU staff
Existing PHC staff -
ed Existing staff at the supports the pro- Existing staff manages
DD & DNH who provide mentoring
state level manages the gramme at the district the programme
support to ASHAs
program. level.

29
 ANNUAL ASHA UPDATE 2020 - 21

States/UTs State Level District Level Block Level Sub-Block Level

Existing DPMU staff 52 MPWs - who pro-
supports the pro- Existing staff - BPM vide mentoring support
Team within SPMU gramme at the district manage the programme to ASHAs - 1 MPW per
Ladakh
manages the program level. 100% positions 100% positions filled 20 ASHAs in Non-HTR
filled against a target against a target of 12. and 1 per MPW for 10
of 2. ASHAs in HTR
The existing CHO/
Existing staff - 816 MPWs - who pro-
Health Educator has
Project Officer ASHA block-level CHO/ Health vide mentoring support
been designated as
Jammu & manages the program Educators are selected to ASHAs 1 MPW per
District ASHA Coordi-
Kashmir 100% positions filled as Block ASHA Coor- 20 ASHAs in Non-HTR
nator (DAC) manage
against a target of 1 dinator (BAC) manage and 1 per MPW for 10
the programme in all 20
the programme ASHAs in HTR
districts
Existing DPMU staff
Team within SPMU supports the pro- Existing staff - BPM Existing ASHAs are
Puducherry
manages the program gramme at the district manage the programme playing a dual role
level.

30
ANNUAL ASHA UPDATE 2020 - 21

ASHA’s Role in
CHAPTER
3 Prevention and
Management of Covid-19

D
uring the pandemic, ASHAs emerged as one of the key pillars of the health system’s
response for COVID-19 prevention and management. The engagement of ASHAs in
COVID-19 related activities such as line listing and contact tracing began as soon as
the first few cases were notified in some states like Kerala and Rajasthan, from February
2020 onwards as per local requirements. Subsequently, the guidelines on measures for
containment of COVID-19 at the community and outreach level were issued in March 2020 to
outline the broad roles and responsibilities of the ASHAs.
As has been the practice in the programme, these new tasks were accompanied by the training/
skill building of ASHAs and ASHA facilitators and were linked with new incentives for ASHAs
and ASHA facilitators. Brochure– “Role of Frontline Workers in Prevention and Management of
Corona Virus” was developed by NHSRC in English and Hindi languages and was shared with
all states/UTs for translation in regional languages. The main objective of the brochure was to
– introduce COVID-19 with details of high-risk groups, key preventive measures to curtail the
spread of infection and myth vs facts, roles of ASHAs and measures to be followed by ASHAs
for self-care and continuation of other tasks.

BROCHURE– “ROLE OF FRONTLINE WORKERS IN PREVENTION AND

MANAGEMENT OF CORONA

31
 ANNUAL ASHA UPDATE 2020 - 21

Nearly 7.3 lakh (80%) Rural ASHAs and 0.61 lakh (89%) Urban ASHAs were trained within two
months in the first wave of COVID pandemic in April and May 2020 and 8.67 lakh (95%) rural
and 0.45 lakh urban ASHAs were trained in the second wave of COVID pandemic in March
2021 against the target. Because of the travel restrictions and physical distancing norms,
most states conducted the training in small batches at the PHC level. Use of digital platforms
like zoom, Webex by Cisco and ECHO facilitated the fast-paced rollout of training as the live
sessions by state/district teams were attended by ASHAs and AFs in small batches at PHC
level or using their smart phones as per the local context of access to internet connectivity
and local travel restrictions. An additional incentive of Rs. 1000 per month for ASHAs and Rs.
500 per month for ASHA facilitators were introduced for these new COVID-19 related tasks.
In addition, all ASHAs and ASHA Facilitators were covered under the ‘Pradhan Mantri Garib
Kalyan Package’, for an insurance amount of up to Rs.50 lakh as part of the health care
workforce working for COVID-19.

During the pandemic, ASHAs continued to play an important role in enabling access to
other essential health care services such as immunization, ANC, safe delivery, availability of
medicines for chronic non-communicable and communicable diseases as per the guidelines
issued for Enabling Delivery of Essential Health Services.

KEY TASKS UNDERTAKEN BY ASHAs ACROSS THE STATES/UTs

 Community-level Surveillance– Listing of all houses with a recent travel history and contact
tracing for all individuals who had contact with positive/ suspected COVID-19 cases was
done to facilitate early detection and timely referral of suspected cases.
 Counselling– Creating awareness on COVID-19 by sharing information about COVID-19
appropriate behaviour for prevention and about services for testing, quarantine and
treatment made available by the government.
 Follow up– Home visits were undertaken for COVID-19 patients advised staying under
isolation and individuals who were advised to follow home quarantine to ensure adherence
to protocols and monitoring of health status.
 High-Risk Group Identification– Listing of elderly and patients with comorbidities like
diabetes, hypertension, heart disease and /or respiratory illness who were more prone to
develop severe complications due to COVID-19 was done for focussed counselling and
regular follow-ups.
 Provision of essential services– Follow up was done with individuals requiring other
essential health care services to enable access to services like ANC, institutional delivery,
immunization, continued treatment for chronic illnesses like TB, Diabetes, Hypertension.
 Recording and reporting– As ASHAs are positioned at the village/ward level, ASHAs also
played a key role in collecting, compiling and reporting the information that was important
for the public health system to respond to the pandemic.

BEST PRACTICES REPORTED FROM STATES/UTs

 Community Mobilization– ASHAs were included as core members of committees formed at
the village /ward level to take preventive measures including active surveillance in many
states like– DD & DNH, Karnataka, Meghalaya, Mizoram, Nagaland and Uttar Pradesh.
ASHAs also led the community level action by working closely with VHSNCs and MAS in

32
ANNUAL ASHA UPDATE 2020 - 21

the states of Mizoram, Chhattisgarh, Odisha and Tripura. In Chhattisgarh and Odisha, walls
created by VHSNCs were used for health promotion to disseminate important preventive
messages. ASHAs also worked closely with local teams of volunteers for community-level
activities in Andhra Pradesh and Kerala.
 Supporting the Marginalized– Across states, ASHAs played a critical role in supporting
the individuals/families from vulnerable groups who had limited access to social and
health services. This was particularly noted in the case of migrant returnees, where ASHAs
performed several tasks to support them viz, line listing, counselling, facilitating home
and institution-based quarantine and enabling access to other health services. Special
efforts were reported in this regard from states of Jharkhand, Madhya Pradesh, Odisha
and Uttar Pradesh. (One such example is tracking of 30.44 lakh migrants in UP by ASHAs
in two phases). On the other hand, ASHAs in Delhi and Kerala provided local support to
migrant workers during lockdown by working closely with primary health care teams and
Corona control room respectively. COVID-19 related services –ASHAs supported setting
up and smooth functioning of quarantine centres in Nagaland, Odisha and Uttar Pradesh.
They were also actively involved in the distribution of home care kits and close monitoring
of COVID-19 patients during home isolation in Bihar, Delhi, Gujarat and Telangana while
in Sikkim, ASHAs were engaged in mitigating stigma associated with the patients who
returned home after recovery from COVID-19. During the early phase of the pandemic,
reports of ASHAs stitching and distributing cloth masks emerged from states of Mizoram,
Nagaland, Odisha, Rajasthan and Uttarakhand. Some states like Uttarakhand, West
Bengal and Mizoram deputed ASHAs along with other primary health care team members
at state/ district borders for screening.
 Essential non-COVID-19 services– To assure continued access to medicines, door step
delivery of medicines was conducted through ASHAs for patients with chronic illnesses
in Bihar, Chhattisgarh, Madhya Pradesh, Odisha, Meghalaya, Punjab, Telangana (for TB
patients) and in Jharkhand, Assam, J&K, Madhya Pradesh, Manipur, Meghalaya, Mizoram,
Andhra Pradesh, Kerala, Telangana and Puducherry (for elderly and hypertensive and
diabetes patients)
 IT system– State-specific IT applications were designed for ASHAs by a few states to
address the urgent need for real-time tracking for planning and follow up by a few states.
These examples include – launch of the Corona Access app in Delhi, updating of the
IDSP module in the TECHO+ app in Gujarat, updating of PLA application in Jharkhand
and development of an application for ASHAs surveillance in Punjab. However, the actual
usage of these applications needs to be further studied.
 As the programme progresses in the current paradigm of comprehensive primary health
care while simultaneously adapting to the ‘new normal’ imposed by the pandemic, the
next phase of the programme must be designed to resolve a few systemic challenges and
promote local innovations for improved sustainability.

TRAINING OF ASHAs IN PREVENTION AND MANAGEMENT OF

COVID-19
The status of training for the Rural and Urban ASHAs during the first and second wave of
COVID-19 pandemic is given in table 7 and 8 below.

33
34

TABLE-7: TRAINING OF ASHAs IN PREVENTION AND MANAGEMENT OF COVID-19

Rural ASHAs Urban ASHAs

Training First wave Second wave First wave Second wave
Status No. of No. of No. of No. of State/
States Names States Names States Names States Names
State/ UTs States/ UTs State/ UTs UTs
Bihar, Jharkhand, MP, Jharkhand, Odisha, Rajas-
Bihar, Rajasthan, Rajasthan, Uttarakhand, Assam,
Rajasthan, Arunachal than, Uttarakhand, Arunachal
Assam, Nagaland, Manipur, Mizoram, Andhra
Pradesh, Assam, Mizoram, Pradesh, Mizoram, Andhra
Sikkim, HP, Delhi, Pradesh, Gujarat, Haryana.
100% 19 Sikkim, Tripura, Gujarat 15 Pradesh, Gujarat, Haryana, 11 15
Gujarat, Kerala, Karnataka, Kerala, Maharashtra,
HP, Kerala, Maharashtra, Karnataka, Kerala, Maharash-
Maharashtra, Telangana, DD & DNH, J & K,
Punjab, Telangana, A&NI, tra, Tamil Nadu, Telangana,
Telangana Puducherry
J&K, Lakshadweep, Ladakh DD & DNH
Chhattisgarh, Odisha, Chhattisgarh,
Manipur, Meghalaya, Chhattisgarh, Madhya Odisha, Arunachal Chhattisgarh, Jharkhand, MP,
90-99% 10 Nagaland, Andhra Pradesh, 5 Pradesh, Uttar Pradesh, Naga- 7 Pradesh, Andhra 7 Arunachal Pradesh, Meghalaya,
Haryana, Karnataka, Tamil land, Tripura Pradesh, Haryana, Delhi, West Bengal
Nadu, West Bengal Karnataka, Punjab
Tripura,
75-89% 1 Uttar Pradesh 2 Assam, Ladakh 2 2 UP, Tripura

ANNUAL ASHA UPDATE 2020 - 21

Puducherry
< 75% 0 None 3 Bihar, Himachal Pradesh, J&K 2 Manipur, Mizoram, 1 HP
Jharkhand, MP,
UP, Uttarakhand,
Manipur, Meghalaya, Sikkim,
Meghalaya, West Bihar, Odisha, Nagaland,
0% 2 Uttarakhand, DD&DNH 7 Punjab, West Bengal, A&NI, 10 7
Bengal, DD&D- Sikkim, Punjab, A&NI, Ladakh
Lakshadweep
NH, A&NI, J&K,
Ladakh
Total 32* 32* 32* 32*
*Tamil Nadu has only Rural ASHAs, and Puducherry and Delhi have only urban ASHAs
 TABLE-8: STATUS OF ASHA TRAINING IN PREVENTION AND MANAGEMENT OF COVID-19

ANNUAL ASHA UPDATE 2020 - 21

Rural ASHAs Urban ASHAs
Name of First Wave Second Wave First Wave Second Wave
State/ UT
In In
Trained % Target Trained % Trained % Target Trained %
Position Position
Bihar 87,655 25,000 29 85,272 85,272 100 582 0 0 550 550 100
Chhattisgarh 68,277 67,512 99 68,277 67,805 99 3,771 3,729 99 3,771 3,721 99
Jharkhand 39,931 39,807 100 39,931 39,964 100 1,475 1,475 100 1,677 0 0
Madhya Pradesh 64,094 62,350 97 63,183 62,511 99 4,525 4,235 94 4,525 0 0
Odisha 46,134 45,934 100 45,941 45,941 100 1,700 0 0 1,614 1,522 94
Rajasthan 48,207 48,207 100 47,924 47,886 100 4,269 4,269 100 4,298 4,298 100
Uttar Pradesh 1,550,70 1,39,592 90 1,56,632 1,32,811 85 6,968 5,666 81 6,968 0 0
Uttarakhand 10,700 10,700 100 10,418 0 0 1,205 1,205 100 1,205 0 0
Sub-Total 5,20,068 4,39,102 84 5,17,578 4,82,190 93 24,495 20,579 84 24,608 10,091 41
North-Eastern States
Assam 31,334 25,000 80 31,334 31,334 100 1,212 1,212 100 1,212 1,212 100
Arunachal Pradesh 4,040 2,753 68 2,753 2,753 100 42 40 95 42 40 95
Manipur 3,928 0 0 3,928 3,819 97 120 120 100 120 81 68
Meghalaya 6,589 0 0 6,589 6,426 98 195 184 94 195 0 0
Mizoram 1,012 1,012 100 1,012 1,012 100 79 79 100 79 15 19
Nagaland 1,917 1,845 96 1,917 1,845 96 90 0 0 90 90 100
Sikkim 641 0 0 641 641 100 32 0 0 35 35 100
Tripura 7,147 7,147 100 7,158 7,158 100 504 398 79 504 427 85
Sub-Total 56,608 37,757 67 55,332 54,988 99 2,274 2,033 89 2,277 1,900 83
35
36

Rural ASHAs Urban ASHAs

Name of First Wave Second Wave First Wave Second Wave
State/ UT
In In
Position Trained % Target Trained % Position Trained % Target Trained %
Non-High Focus States
Andhra Pradesh 38,216 38,216 100 38,216 35,015 92 3,200 3,200 100 2,609 2,509 96
Delhi NA 6,036 5,926 98 5,982 5,982 100
Gujarat 38,853 38,853 100 38,391 38,391 100 4,478 4,478 100 4,281 4,281 100
Haryana 17,557 17,557 100 18,000 17,699 98 2,571 2,571 100 2,676 2,593 97
Himachal Pradesh 7,881 2,116 27 7,881 7,881 100 33 33 100 33 33 100
Karnataka 38,674 38,674 100 38,407 37,790 98 3,125 3,125 100 3,091 2,900 94
Kerala 24,079 24,079 100 24,079 24,079 100 2,396 2,396 100 2,396 2,396 100
Maharashtra 60,816 60,816 100 60,862 60,862 100 7,522 7,522 100 6,001 6,001 100
Punjab 17,223 0 0 17,144 17,111 100 2,569 0 0 2,532 2,479 98
Tamil Nadu 2,555 2,555 100 2,650 2,520 95 NA
Telangana 23,443 23,443 100 23,111 23,111 100 3,597 3,597 100 3,929 3,929 100
West Bengal 54,109 0 0 53,077 52,252 98 5,701 5,337 94 5,487 0 0
Sub-Total 3,23,406 2,46,309 76 3,21,818 3,16,711 98 41,228 38,185 93 39,017 33,103 85

ANNUAL ASHA UPDATE 2020 - 21

Union Territories
A & NI 394 0 0 412 412 100 10 0 0 10 0 0
DD & DNH 340 282 83 351 0 0 98 98 100 98 0 0
Jammu & Kashmir 12,539 4,791 38 11,640 11,640 100 136 136 100 136 0 0
Lakshadweep 101 0 0 104 104 100 NA
Ladakh 612 513 84 534 534 100 364 0 0 0 0 0
Puducherry NA 326 326 100 341 304 89
Sub-Total 13,986 5,586 40 13,041 12,690 97 934 560 60 585 304 52
Total 9,14,068 7,28,754 80 9,07,769 8,66,579 95 68,931 61,357 89 66,487 45,398 68
ANNUAL ASHA UPDATE 2020 - 21

SOME FIELD LEVEL ACTIVITIES PERFORMED

BY ASHAs AND ASHA FACILITATORS

37
 ANNUAL ASHA UPDATE 2020 - 21

Programme Update on
CHAPTER
4 Community-Based
Institutions

VILLAGE HEALTH SANITATION AND NUTRITION COMMITTEES AND

MAHILA AROGYA SAMITIS

C
ommunitization is one of the key strategies under the National Health Mission. Various
community participation platforms have been created to enable active participation
of the community and its representatives, especially the elected representatives of
Panchayat Raj Institutions (PRIs) and the Urban Local Bodies (ULBs), in Health Promotion and
Action on Social Determinants of Health. They also play a supportive and oversight role to the
Health System in both delivery of services and greater utilization of the public health facilities.
Village Health Sanitation Committees (VHSNCs), at the village level, Jan Arogya Samitis at
AB-HWCs and Rogi Kalyan Samiti (RKS) in a higher-level health facility (DH/SDH, CHC) are
the institutional platforms created for facilitating this participation of the community. With the
launch of the National Urban Health Mission (NUHM), Mahila Arogya Samiti (MAS) was created
at the community level in urban areas. To strengthen the ‘local level action’ of the VHSNCs, a
community-level campaign VISHWAS - Village-based Initiative for Synergising Health Water
and Sanitation with guidance for VHSNC members and community representatives was
launched in 2017.
In this update we report on the status of the constitution, training, operations of bank accounts
and role played by ASHAs in the platform of VHSNC and MAS in different states including the
status of VISHWAS training.

FIGURE-4: VILLAGE HEALTH SANITATION AND NUTRITION COMMITTEES

TARGET VS CONSTITUTION AND TRAINING

VHSNC Target vs Constituted 2017-21 VHSNC Constituted vs trained 2019-21

580000 570311
600000 553866
567320 536903
560000 500000
548655 553866
536903 400000
540000 522232
324194
300000 250868
520000
200000
500000 100000
480000 0
2017 2019 2021 2019 2021
Target Achievement Target Achievement

38
ANNUAL ASHA UPDATE 2020 - 21

FORMATION OF VILLAGE HEALTH SANITATION AND NUTRITION

COMMITTEES
At the National level 5,53,866 (97%) VHSNCs have been constituted against total target of
5,70,311 for the country.
In the High Focus states 2,84,235 (97%) VHSNCs have been formed against the target of
2,91,852. All states except Chhattisgarh, Madhya Pradesh and Uttar Pradesh have formed
100% VHSNCs against the state-specific target. While Uttar Pradesh, Chhattisgarh and
Madhya Pradesh have only 5%, 4% and 2% VHSNCs to be constituted respectively, Bihar
needs to complete the formation of a significant 16% VHSNCs for complete saturation. In all of
these states, VHSNCs have been formed at the revenue village level except in Bihar, where
VHSNCs have been formed at the level of Gram Panchayats. The majority of states reported
15-20 participants per VHSNC except for the state of Bihar where there are 5 members in the
committee followed by Jharkhand that reported an average of 11 members.

Non-High Focus states also show good progress in the formation of VHSNCs and 2,17,053
(96%) have been formed against the total target of 2,25,007. The Non-High Focus states has
reported 100% constitution from all the states except Himachal Pradesh (98%), Karnataka (97%),
West Bengal (99%) and Telangana (62%). In this group of states, VHSNCs have been formed
at the level of revenue village except in Andhra Pradesh, Tamil Nadu (at GP level) and West
Bengal at Gram Samsad level which is the booth/ward area of Gram Panchayat. The number
of committee members also ranged from 15-17 in all the states. Segregating state-wise.

In Union Territories, 6,928 (99%) VHSNCs were reported formed against a target of 6, 973.
Most of the UTs reported the level of formation of VHSNCs to be at revenue village/village.

CONVERGENCE OF ASHA AND VILLAGE HEALTH SANITATION AND

NUTRITION COMMITTEES
As per the Operational Guidelines for VHSNC, ASHA is expected to serve as the member
secretary of the committee and be a joint account holder with the chairperson who is a
representative of the panchayat. This is to promote better community-level ownership,
participation of marginalized, actual need-based village health planning. Across India, ASHA
is serving as member secretary in about 3.7 Lakh VHSNC formed (67%). States and UTs where
ASHA is not a Member Secretary include- Bihar (ANM), Odisha (AWW), Tripura (Partially CHOs),
Haryana (AWW), Kerala (ANM), Tamil Nadu (VHN), Telangana (ANM), West Bengal (ANM),
DDNH & D & D (ANM), and Puducherry (ANM). Overall, 545887 (99%) of constituted VHSNCs
had a bank account.

CAPACITY BUILDING OF VILLAGE HEALTH SANITATION AND

NUTRITION COMMITTEES
To institutionalize the capacity building of VHSNC members, MoHFW introduced a Handbook
for Training of VHSNCs members in 2013 through a two-day programme. At the National level,
3.24 Lakh (59%) of total constituted VHSNCs and 19,37,978 VHSNC members have been trained
on the VHSNC handbook. In High focus States, 1,42,314 (50%) of total constituted VHSNCs and
8,23,481 VHSNC members have been trained on the VHSNC handbook. Only Odisha and

39
 ANNUAL ASHA UPDATE 2020 - 21

Chhattisgarh have completed 100% of the training, whereas other states are required to scale
up the training activity. Progress of training in the North-eastern states has been 40,269(88%)
with Manipur, Mizoram, Nagaland, and Sikkim completing the 100% of training. Similarly, in
Non-high focus states 141336(65%) committees and 10,28,421 members have been trained
on the VHSNC handbook. In UTs progress of the training is very low at 4% and an immediate
scale-up is required.
In addition to the training on the VHSNC handbook, few states have initiated other training
for VHSNC members. Some of those training topics include Climate change (Chhattisgarh),
COVID-19 management (Jharkhand), PLA (Madhya Pradesh), Monitoring of SC-HWC (Assam),
Community action for health (Karnataka), Vector-borne diseases (West Bengal) etc.
The VISHWAS campaign launched in 2017, is expected to strengthen the institutional capacity
of VHSNCs for effective and sustained community action on health, and states have initiated
the training on VISHWAS. Overall, 2,98,187 (54%) (36%) committee and 7,11,463 committee
members have been trained on VISHWAS.

40
 TABLE-9: STATUS OF VILLAGE HEALTH SANITATION AND NUTRITION COMMITTEE

ANNUAL ASHA UPDATE 2020 - 21

Status update for Village Health Sanitation Nutrition Committee Training on VHSNC Handbook Training in VISHWAS Module

No. of Bank
Constituted
Panchayat/

per VHSNC

as per GOI
Guidelines

No. of DTs
Formation

Secretary

members

members
Revenue

Member

Member

VHSNCs
Level of

Village)
States/UTs

VHSNC

VHSNC
trained

trained

trained

trained
(Gram

Target

No. of

No. of

No. of

No. of
2013

A/C
%

%
High Focus States
Bihar Gram Panchayat 5 10,051 8,406 84 ANM 8,406 1,173 4,559 12 0 0 0
Chhattisgarh Revenue Village 15-17 20,000 19,180 96 ASHA 19,180 19,180 2,49,340 96 57,686 19,180 40
Jharkhand Revenue Village 11 30,012 30,012 100 ASHA 29,635 18,236 42,832 61 55,656 20,276 42
Panchayat
Madhya Pradesh Revenue Village 12-20 50,567 49,567 98 49,567 14,930 10,4515 30 2,346 782 87
Secretary
Odisha Revenue Village 10-12 46,102 46,102 100 AWW 46,102 46,102 1,35,000 100 1,79,250 32,300 124
Rajasthan Revenue Village 15 43,440 43,440 100 ASHA 40,698 19,020 1,14,120 44 1,14,120 19,020 1,565
Uttar Pradesh Revenue Village 17 77,032 72,880 95 ASHA 72,880 16,746 1,39,318 22 13,821 3,770 20
Uttarakhand Revenue Village 15 14,648 14,648 100 ASHA 14,648 6,927 33,797 47 20,310 1,01,550 0
Sub-Total 2,91,852 2,84,235 97 1,42,314 8,23,481 49 4,40,843 1,96,878
North-Eastern States
Arunachal Pradesh Village 6-10 3,772 3,318 88 ASHAs 3,318 2,152 4,304 57 39 2,152 39
Assam Village 10-15 28,149 28,149 100 ASHAs 28,149 27,673 55,346 98 11,370 2,274 191
Manipur Village 8-15 3,878 3,878 100 ASHAs 3,878 3,878 7,756 100 0 0 50
Meghalaya Village 7-10 6,685 6,310 94 ASHAs 6,310 3,073 4,250 46 3,954 1,318 100
Mizoram Village 15 830 830 100 ASHAs 830 830 1,660 100 1,660 830 18
Nagaland Village 15 1,346 1,346 100 ASHAs 1,346 1,346 3,444 100 0 0 0
Sikkim Village 10 641 641 100 ASHAs 641 641 6,410 100 0 0 0
Tripura Gram Panchayat 10-15 1,178 1,178 100 CHO, MPW, ASHA 1,178 676 2,356 57 120 58 49
Sub-Total 46,479 45,650 98 40,269 85,526 87 17,143 6,632
Non-High Focus states
Andhra Pradesh Gram Panchayat 15 13,065 13,065 100 ASHA 13,065 0 0 0 1,30,630 13,065 2,723
41
42

Status update for Village Health Sanitation Nutrition Committee Training on VHSNC Handbook Training in VISHWAS Module

No. of Bank
Constituted
Panchayat/

per VHSNC

as per GOI
Guidelines

No. of DTs
Formation

Secretary

members

members
Revenue

Member

Member

VHSNCs
Level of

Village)
States/UTs

VHSNC

VHSNC
trained

trained

trained

trained
(Gram

Target

No. of

No. of

No. of

No. of
2013

A/C
%

%
Gujarat Revenue Villages 11 17,676 17,672 100 ASHA 17,672 10,506 52,530 59 0 0 0
Haryana Revenue Villages 12-15 6,049 6,049 100 AWW 6,049 6,049 30,245 100 6,049 30,245 370
Himachal Pradesh Revenue Villages 15 7,930 7,787 98 ASHA 7,787 7,295 19,654 92 19,654 7,295 44
Goa Gram Panchayat 10-12 204 201 99 MPW 202 261 1,979 128 1,291 119 90
Karnataka Revenue Village 10-15 26,866 26,084 97 ASHA 26,084 7,614 7,406 28 9,108 4,554 36
Kerala Ward 15-20 19,523 19,523 100 MPW 19,523 19,523 2,34,276 100 0 0 0
Maharashtra Revenue village 15-17 39,770 39,770 100 ASHA 39,770 7,954 16,010 20 7,954 16,010 467
Punjab Revenue Village 15 12,982 12,982 100 ASHA 12,982 12,452 73,546 96 77,736 12,956 110
Tamil Nadu Gram Panchayat 5 15,015 15,015 100 VHN 15,015 15,015 16,994 100 0 0 0
Gram Panchayat
Telangana & Revenue Village 15-19 16,876 10,433 62 ANM 8,830 10,433 1,56,495 62 1,56,495 10,433 124
Gram Samsad,
West Bengal which is Booth/ 15 49,051 48,472 99 ANM 45,261 44,234 5,75,781 90 0 0 0
Ward area of GP
Sub-Total 2,25,007 2,17,053 96 1,41,336 10,28,421 63 2,52,422 94,677

ANNUAL ASHA UPDATE 2020 - 21

Union Territories
A & NI Village 6 275 275 100 ASHA 275 275 550 100 0 0 0
DD & DNH Village 8 98 89 91 ANM 89 0 0 0 0 0
Puducherry Revenue Village 7 99 99 100 ANM 99 0 0 0 0 0 0
Ladakh Revenue village 12 259 259 100 ANM, ASHA 256 0 0 0 0 0
Lakshadweep NA
Jammu & Kashmir Revenue village 8-10 6,242 6,206 99 ASHA 6,162 0 0 0 0 0 0
Chandigarh NA
Sub-Total 6,973 6,928 99 275 550 4 0 0 0
Total 5,70,311 5,53,866 97 3,24,194 19,37,978 57 0 2,98,187 0
ANNUAL ASHA UPDATE 2020 - 21

MAHILA AROGYA SAMITIS (MAS)

FORMATION OF MAHILA AROGYA SAMITIS (MAS)
Total 80,238 (87%) MAS have been constituted against the target of 92,111 MAS in 1105 cities
across India. On average there are 10-15 MAS members reported in the majority of MAS across
states/UTs except for Puducherry which has an average of 50 members in each MAS.

High focus states like Jharkhand, Odisha, Rajasthan have constituted 100% MAS against the
state-specific targets and over 95% formed MAS have bank accounts. This is followed by
Chhattisgarh which reported the constitution of 98% MAS and bank accounts of MAS. The
remaining states have formation ranging between 72-88 %. The number of MAS with bank
accounts is reported lowest from Uttarakhand with only 32% of constituted MAS reported
having bank accounts.

In North-eastern states, around 87% MAS was constituted against the state-specific targets in
35 cities. 100% formation was reported from Assam, Meghalaya, Mizoram, Sikkim, and Tripura
followed by Arunachal Pradesh (98%). Manipur and Nagaland with 68% and 66% constitution
respectively.

In Non-High focus states, 54669 (86%) MAS have been constituted against the target across
604 cities. 100% constitution was reported from Andhra Pradesh, Karnataka, Maharashtra,
Punjab, and Telangana. The lowest constitution was reported from Himachal Pradesh (15%)
followed by Tamil Nadu (31%). 95% of MAS constituted have reported having a bank account.
The average number of MAS members is raging from 8 to 12.

Similarly, in UTs 93% MAS have been constituted across 87 cities and 71% MAS have a bank
account. States of Rajasthan, Uttarakhand and Himachal Pradesh also reported support from
NGOs in the implementation.

FIGURE-5: MAHILA AROGYA SAMITIS TARGET VS CONSTITUTION AND TRAINING

MAS Target vs Constituted 2017-21 MAS Constituted vs trained 2017-21

150000 100000
77003 80238
80000 70574
98619 89446 77003 92111 80238
100000
65165 60000 49481

40000
50000
20000
0 0
2017 2019 2021 2019 2021
Target Achievement Target Achievement

TRAINING OF MAHILA AROGYA SAMITIS

Nationally, 70574 (88%) against the constituted MAS and 4,13,881 MAS members have been
trained on the MAS handbook. On average across all states, training was conducted for 2
days.

In High focus states, a total of 21,958 (91%) of MAS and 2,21,159 MAS members have been
trained on the MAS handbook. States of Chhattisgarh, Odisha, and Rajasthan have completed

43
 ANNUAL ASHA UPDATE 2020 - 21

100% training, whereas other states reported training in the range of 86-92%. The lowest
training against the constitution has been reported from the state of Bihar (16%) which requires
massive efforts to scale up. On Average, the duration of training days were 1-2 days except for
Chhattisgarh where training was done for 18 days (each round 3 days of training).

North-eastern states reported training of 1,401 (84%) of MAS and 4,787 MAS members on the
MAS handbook. 100% training completion was reported from Assam, Nagaland, and Mizoram.
Arunachal Pradesh, Manipur, and Meghalaya reported 71%, 67% and 94% MAS training
respectively. Sikkim is yet to initiate the training of MAS. On average the duration of training
for MAS was reported to be 1-2 days.

In Non-high focus states, 31,746 (87%) of MAS and 3,12,235 total members have been trained
on the MAS handbook. The majority of states have completed 100% of training. On average
the duration of training was 1-2 days except for Tamil Nadu where training spanned over 16
days.

In UTs 45% of MAS constituted have been trained on MAS handbook and the training duration
was the average of 2 days.

In addition to the training on the MAS handbook, states took initiatives depending on the local
context like COVID prevention (Jharkhand, Rajasthan, Andhra Pradesh), Handwashing and
RNTCP (Odisha) and RMNCHA+ (Puducherry).

44
 TABLE-10: STATUS OF MAHILA AROGYA SAMITIES

ANNUAL ASHA UPDATE 2020 - 21

Status update for Mahila Arogya Samities (MAS) Training for MAS in Handbook
States/UTs No. of No. of members No. of Bank No. of Members Training
Cities with Target formed % Target Trained %
per MAS A/C trained duration
MAS
High Focus States
Bihar 25 843 734 87 10-12 675 734 116 16 1,395 1
Chhattisgarh 19 3,771 3,698 98 20 3,622 3,698 3,698 100 1,19,771 3
Jharkhand 22 918 918 100 11 876 918 793 86 1,905 2
Madhya Pradesh 66 5,335 3,825 72 11-19 3,645 3,825 3,283 86 26,264 1
Odisha 36 3,132 3,132 100 11-15 3,132 3,132 3,132 100 12,528 2
Rajasthan 61 4,718 4,718 100 10-12 4,718 4,718 4,718 100 45,180 1
Uttar Pradesh 131 7,036 6,171 88 10-20 5,127 6171 5,658 92 11,316 2
Uttarakhand 10 760 620 82 5-10 200 620 560 90 2,800 1
Sub-Total 370 26,513 23,816 90 21,995 23,816 21,958 92 2,21,159
North- Eastern States
Arunachal Pradesh 2 92 90 98 5-10 65 90 30 33 90 2
Assam 14 658 658 100 10 658 658 658 100 3,340 2
Manipur 3 604 409 68 5-8 409 409 409 100 818 1
Meghalaya 4 110 110 100 10-15 110 110 104 95 NA 3
Mizoram 3 50 50 100 10-20 50 50 50 100 50 1
Nagaland 5 113 75 66 15 75 75 70 93 265 2
Sikkim 1 35 35 100 15 15 35 0 0 0 0
Tripura 3 96 96 100 10-15 96 96 80 83 224 2
Sub-Total 35 1,758 1,523 87 1,478 1,523 1,401 92 4,787
45
46

Status update for Mahila Arogya Samities (MAS) Training for MAS in Handbook
States/UTs No. of No. of members No. of Bank No. of Members Training
Cities with Target formed % Target Trained %
per MAS A/C trained duration
MAS
Non-High Focus states
Andhra Pradesh 110 10,440 10,440 100 8-10 10,440 10,440 10,440 100 92,008 2
Delhi 11 110 91 83 10-15 86 91 91 100 1,039 1
Gujarat 71 7,171 6,843 95 10-12 6,829 6,843 4,773 70 31,411 3
Haryana 1 50 48 96 5-10 48 48 48 100 270 1
Himachal Pradesh 4 34 5 15 11-15 5 5 5 100 18 1
Goa 8 10 10 100 116 8 10 8 80 116 2
Karnataka 80 4,071 4,071 100 8-12 4,003 4,071 4,071 100 19,622 2
Kerala 50 2,560 1,596 62 8-12 683 1,596 723 45 12,768 3
Maharashtra 95 5,557 5,557 100 10 5,557 5,557 1,493 27 14,000 1
Punjab 40 7,475 7475 100 12 7,475 7,475 7,193 96 20,327 2
Tamil Nadu 11 3,324 1,025 31 10-12 - 1,025 1,025 100 10,250 16
Telangana 41 11,000 7,750 70 10 7,750 7,750 7,750 100 7,750 3
West Bengal 90 11,792 9,758 83 8-12 9,274 9,758 9,483 97 1,02,772 3

ANNUAL ASHA UPDATE 2020 - 21

Sub-Total 612 63,594 54,669 86 34,750 54,669 47,103 86 1,87,605
Union Territories
A&NI 1 25 25 100 6 25 25 0 0 0 0
Puducherry 1 108 25 23 50 Nil 25 0 0 0 0
Ladakh NA
Jammu & Kashmir 85 113 180 159 8-15 138 180 112 62 330 2
Chandigarh NA
Sub-Total 87 246 230 93 163 230 112 49 330
Total 1,105 92,111 80,238 87 58,386 80,238 70,574 88 4,13,881
ANNUAL ASHA UPDATE 2020 - 21

CHAPTER
5 Best Practices Under
Community Processes

V
arious best practices have been piloted and upon encouraging outcomes have been
scaled up across states. In this section, we summarize a few of these best practices
about the thematic area of Community Processes-

 Digital Community Engagement Platforms for Improving Family Planning, Maternal Child
Health and Nutrition outcomes
 Strengthening Cluster Meeting as a capacity building platform for ASHAs
 An Innovation Fostering Health service delivery and strengthening ASHA monitoring
system- Madhya Pradesh

5.1 DIGITAL COMMUNITY ENGAGEMENT PLATFORMS FOR

IMPROVING FAMILY PLANNING, MATERNAL CHILD HEALTH AND
NUTRITION OUTCOMES
Social and behavioral change in multicultural countries like India calls for a solution that
is modern yet adaptive and scalable. To bring about social and behavioral change around
health, Digital Green in partnership with the Chhattisgarh government piloted a video-based
approach that empowers local communities to generate and share knowledge about maternal
and child health and adopt practices that improve nutrition and family planning outcomes
through community videos. This peer video-based learning approach aimed to increase
the knowledge of health care providers and subsequently improve the outcome of health
indicators.

PROCESS OF IMPLEMENTATION
Digital green implemented the training program for frontline workers in a phased manner from
2018 as mentioned in table 11.1. As the implementation scale increased, there was a noted
increase in the knowledge and perceptions of both frontline workers as well as community
members. Frontline workers have been using several community platforms like VHND, AWC,
VHSNC etc. to disseminate the information and skills through digital platforms. Participatory
video making was enabled through the training of Mitanin (ASHA) trainers and SHRC staff.
Several videos have been made in the local language with the help of local producers as
mentioned in table 11.2. So far, cumulatively pico bases dissemination have been reached to
104252 men & women with tailored messages around maternal and child health, nutrition,
and family planning as mentioned. Mitanin Trainers leveraged multiple community platforms
like Village Health, Sanitation and Nutrition Committee (VHSNC) meetings, Village Health and
Nutrition Days (VHNDs), hamlet meetings etc. to screen videos on ANC, IFA, complementary
feeding, family planning etc. among the community members.

47
 ANNUAL ASHA UPDATE 2020 - 21

TABLE-11.1: PHASE WISE IMPLEMENTATION

No. of MTs trained on
District No. of Blocks No. of villages video- dissemination skills
Phase- I (March 2018)
Rajnandgaon 5 389 50
Phase- II (August 2019)
Rajnandgaon 9 641 70
Kabirdham 4 521 51
June 2019 Onwards
Kabirdham 1 24 6
Total 13 1575 177

TABLE-11.2: VIDEOS PRODUCED THROUGH LOCAL PARTNERS

Sl. Video Title Language

No.
1. Garbhvati ke Liye Aayrangolikamahtv Chhattisgarhi
2. Complementary feeding Chhattisgarhi
3. Dast Chhattisgarhi
4. Kangaroo mother care Chhattisgarhi
5. Malaria Chhattisgarhi
6. Garbhvati ke parivar se charcha final Chhattisgarhi
7. Family Planning Chhattisgarhi
8. Home-based care for Common Cold and Cough Chhattisgarhi
9. Blood pressure Chhattisgarhi

OUTCOME
Biannual surveys were conducted in 2018 and 2019 to address the effectiveness of the
intervention and comparative outcome is outlined in the graphical presentation. Anecdotally,
Government partners observed increasing attendance in Village Health and Nutrition Days
(VHNDs), immunization days which were commonly used for video dissemination. Frontline
workers have reported standardized messaging, ease of work, high effectiveness and
increased trust and respect in them as key motivators for using this approach at the community
level. Community members have shared that the videos are easy to understand, relatable and
target the right messages in a locally appropriate manner. The following data is presented in
figure-6 from both rounds in a comparable format.

48
ANNUAL ASHA UPDATE 2020 - 21

FIGURE-6: COMPARATIVE OUTCOME OF BIANNUAL SURVEYS

CONDUCTED IN 2018 AND 2019

5.2 STRENGTHENING CLUSTER MEETING AS CAPACITY BUILDING

PLATFORMS FOR ASHAs
It has been a well-established fact that regular capacity building sessions are essential
to encourage ASHA to perform her dedicated role. Uttar Pradesh has taken a step in
strengthening capacity building activities at the monthly cluster meetings of ASHA and ASHA
facilitators. This novel capacity-building intervention is aimed at improving knowledge, skills,
and competencies of ASHAs around critical RMNCH+A indicators and addresses the barriers
faced by ASHAs or ASHA facilitators in the achievement of the desirable outcome.

IMPLEMENTATION OF THE PROCESS

Efforts were made to identify gaps in the knowledge, attitudes and practices amongst ASHA
and their facilitators were done through a Needs Assessment Consultation Meeting. This
was followed by phased implementation between FY 2018-19 (61 blocks and 16 HPDs) and
FY 2019-20 (127 blocks and 28 districts), and later to all the blocks. Operational guidelines
were issued to CMOs and DCPMs highlighting the financial implications of the intervention.
Training and facilitation modules were prepared followed by implementation of training in the
cascade manner from state trainers to district and block community process officials. BCPM
were provided with the responsibility of ensuring the reorientation and practice session for
ASHA Sanginis in their monthly meeting on scheduled sessions for the cluster meetings. The
process of the rollout of implementation and training calendar is mentioned below in figure 7
and Table 12 respectively.

49
 ANNUAL ASHA UPDATE 2020 - 21

FIGURE-7: INTERVENTION ROLL-OUT PROCESS

PROCESS TO ROLL OUT THE INTERVENTION

Consultation with ASHA & Sangini

done for need assessment workshop

Based on finding 12 key focus areas

derived for capacity building of ASHAs

Facilitator guide cum module

development for session facilitation

Feedback of NHSRC also incorported &

module field testing done

Operational guideline released and

shared with all CMOs and DPMs

State level training of trainers (RM &

DCPM, ZCS and DCS)

DDistrict level 5 days (3+2) training for

ASHA sanginis and BCPMs

ASHA Sangini’s re-orientation in AS

monthly review meeting by BCPM

Scheduled Session facilitation by

ASHA Sangini in Cluster meeting

TABLE-12: CAPACITY BUILDING CALENDAR

Month wise - Cluster Meeting Capacity Building Calendar

April May June July
Diarrhoea Prevention & Exclusive breastfeeding, Birth Preparedness, ID & 48 Danger sign identification in
Treatment LBW, Management hours’ stay and FP newborn
August
October
Early Identification & Reg- September November
HRP identification and
istration of PW and VHIR ANC & IFA Supplementation VHND and Immunization
referral
updating
January
December February March
Pneumonia prevention &
Newborn care and HBNC Non-communicable disease VHSNC
treatment

Community-Based Tracking Survey (CBTS), which is a household survey conducted by UPTSU

since 2014, indicated an incremental trend in MNCH community-level indicators between
Round 3 (2016) to Round 6 (2018) which depicted ASHAs' enhanced performance, skills, and
competencies in providing optimum care and services to pregnant woman, mothers, and new-
born mentioned below in figure 8. Improvement of knowledge and skills among ASHA and
ASHA facilitators enabled them to perform well in their working area.

50
 ANNUAL ASHA UPDATE 2020 - 21

FIGURE-8: COMPARATIVE CBTS HIGHLIGHTING THE KEY MNCH INDICATORS

PERFORMANCE IN 2016 AND 2018

88 CBTS–3 (2016) CBTS–6 (2018)

79 78 75
71
69
61 61 60 63
53 55
45 48
40
36 34
27
14
11

% of PW contacted % of PW who % of PW % of PW % of PW % of PW had % of newborn not % of newborn with % not bathed for the % not newborn
by ASHA during received any ANC received 3+ registered in received any institutional delivery given prelacteal no application on first 3 days identified as LBW
pregnancy during her last ANC services first trimester ANC in 3rd trimester cord stump
pregnancy

5.3 AN INNOVATION FOSTERING HEALTH SERVICE DELIVERY AND

STRENGTHENING ASHA MONITORING SYSTEM- MADHYA PRADESH
ASHA SANGINI KNOWLEDGE LEVEL
Over a decade, ASHA has played a critical role in the reduction of maternal and newborn
mortality. However, in difficult and remote geographies the progress of outcome indicators was
slow. The data available with ASHAs can be used for effective planning and prioritization of
home visits. This can also provide a benchmark for supportive supervision by ASHA Sahyogis
(Facilitators) who can guide and motivate ASHAs to track the beneficiary’s health progress.
Therefore, to intensify the efforts of ASHAs, the state of Madhya Pradesh implemented pilot
innovations fostering mapping of village health indicators by frontline workers. This innovation
is intended to establish an effective service delivery and efficient review mechanism for ASHA.

FIGURE-9: ASSESSMENT OF KNOWLEDGE AMONGST ASHA FACILITATORS

ASHA Sangini Knowledge Level (2019-2020)
N = 1056 ASHA Sanginis
87
74 75 75 73
70 73
65
51 50 49
45 41
41 41
38

ANC Institutional delivery HBNC Danger sign Danger sign Aware about Program Supportive
identification in identification in guideline implementation supervision &
mother newborn Mentoring

STRENGTHENING ASHA MONITORING SYSTEM

Tracking of Maternal and child health indicators was done by posting an ASHA report card
tracker on the walls of Aanganwadi Centre as shown in picture 10.1. Plotting of indicators with
red pins enabled ASHA and ASHA facilitators in planning for focus areas for improving health
outcomes. A similar tool was posted at the house of every pregnant and lactating mother and
red pin plotting was done in case of missed service delivery by ASHAs. Validation of service
delivery provided by ASHAs was done by ASHA facilitators and BCMs to ensure the last mile
of and outcome. A sample of tracking report cards filled by ASHAs is depicted in Figure 10.2.

51
 ANNUAL ASHA UPDATE 2020 - 21

FIGURE-10.1: SAMPLE OF ASHA FIGURE-10.2: OVERVIEW OF

REPORT CARD BASED TRACKING ASHA REPORT CARD

ASHA report card (to be filled by ASHA)

ASHA report card (to be filled by ASHA)

ASHA Report card (Maintained by ASHA Worker)

(Place: Posted At AWC) Block level
Block level
Indicators tracked: LMP, EDD, ANC, Early registration,
High risk status, immunization, HBNC, HBYC etc.
Visual tool: Color pins on paper pasted on
thermocol sheet Cluster level
Cluster level Red colour pins: Poor status/High factor/
unachieved targets.
Benefits: Easy tracking of health status, help
ASHA supervisors to access the overall situation
of the village. Village level
Village level
Note: More the red pins indicates poor performing ASha

FIGURE-10.3: INDICATOR WISE VILLAGE MAP

Use of village map-indicator wise (to be filled by ASHA)

Block level
Four A4 size village maps posted at AWC
(Place: Posted At AWC)
Indicators tracked by each map ANC, Immunization, HBNC, HBYC
Cluster level Visual tool: Colour pins on paper pasted on
thermocol sheet
Red colour pins: Poor status/High factor/
unachieved targets.
Village level Benefits: Easy tracking of health status, help
ASHA supervisors to access the overall situation
of the village.

Furthermore, to understand the overall picture of the health status ‘Village map’ was pasted
on the walls of AWCs (Figure 10.3). ANC, Immunization, HBNC and SAM/MAM were plotted
on the village map through different colour-coded pins (Red, yellow, and green) (Figure 10.4).
Red colour coding implies missed delivery of respective services. The column under each
of the four indicators was designated for ASHA Facilitators to plot the work of ASHAs. This
comprehensive tool provided firsthand information about the specific hamlets and areas which
requires extra efforts for the desired improvement.

The performance-based tracking of ASHAs was done through the counting of colour-coded
pins by ASHA facilitators. This also enabled planning and prioritizing of village visits by ASHA
facilitators. Compilation of data at the block level by BCM helped them to identify and address
loopholes in the program implementation.

Strengthening the ASHA monitoring system model of Madhya Pradesh proved useful in
devising a work plan based on prioritization. This also aided supervisors to provide support to
improve work efficiency and output. Furthermore, as the data was visualized at a single place
the need to refer to the register was reduced.

52
ANNUAL ASHA UPDATE 2020 - 21

FIGURE-10.4: DATA COMPILATION AT CLUSTER LEVEL AND

PERFORMANCE-BASED MONITORING

Block level

Cluster level

Village level
Ø ASHA Sahyogis compile the formates of ASHAs in their cluster.
Ø Review of ASHAs is done based on the number of red pins per ASHA
Ø ASHA sahyogi plan visit to villages where ASHA needs more guidance

53
 ANNUAL ASHA UPDATE 2020 - 21

Key Highlights of the

Annual Community
CHAPTER
6 Processes State
Nodal Officer Workshop

T
he annual workshop for state nodal officers for Community Processes (CP), held online on
4th, 6th, and 9th November 2020, was envisaged to identify trends in the CP programme
and gather plans for collective action with the advancing comprehensive primary
Health care services across the country. The workshop focused on gathering suggestive
recommendations on – Strengthening the support structures to mentor ASHAs, improving
working conditions of ASHAs and AFs, redesigning of ASHA programme in urban and peri-
urban areas, up-gradation of capacity building framework for ASHAs, engagement of ASHAs
in rural areas, convergence, and community engagement. About 82 participants from 27
states and 5 UTs attended the workshop.
The initial day of the workshop focused on the trends in the evolution of the ASHA program
since its inception and the subsequent achievements. Highlights outlined the critical role
of ASHAs in controlling the unforeseen COVID-19 pandemic, alongside the uninterrupted
delivery of the existing essential RMNCH+A services. However, the need to strengthen the
ASHA program was reinforced through -Training of ASHAs, strengthening of existing support
structures, streamlining payment of incentives, expediting ASHA Certification, and devising
mechanisms to motivate uptake of IT applications.
Group discussions were organized to facilitate deliberations among state programme
managers to generate ideas about the future of the ASHA programme and suggest possible
solutions to the emerging challenges faced by the programme. States were divided into six
groups based on the thematic areas- Strengthening the support structures to mentor ASHAs,
improving working conditions of ASHAs and AFs, redesigning of ASHA programme in urban
and peri-urban areas, up-gradation of capacity building framework for ASHAs, engagement
of ASHAs in rural areas, convergence, and community engagement. Group Discussions were
followed by a plenary discussion where each group presented the key recommendations
of the group, which were consolidated and presented to the Additional Secretary & Mission
Director, MoHFW in the concluding session.

KEY DISCUSSION POINTS FROM GROUP 1: STRENGTHENING THE

SUPPORT STRUCTURES TO MENTOR ASHAs IN DELIVERING AN
EXPANDED RANGE OF SERVICE AT THE COMMUNITY LEVEL
 With the implementation of the Expanded package of services under Ayushman Bharat-
Health and Wellness Centres, suggestions emerged on transitioning the role of ASHAs
from a volunteer/community health worker and a community mobilizer to HWC team
member for engagement in surveys and reporting.

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ANNUAL ASHA UPDATE 2020 - 21

 As ASHAs are required to work in constant coordination with the HWC team it is required
that the capacities of ASHAs should also be enhanced to equip them with organizational
and digital literacy skills. Recommendations also came for joint training of ASHAs and
MPW-F on newer packages for better role clarity and teambuilding. Similarly, it was also
insisted to organize a periodic training session for support structures of ASHAs at all levels.
 Revision of salary structures for Block and District Nodal Officers was insisted to increase
motivation and reduce turnover. The group stressed on the need to redefine the role of
ASHA facilitators with an increase in working days and more focus on community-level
activities.
 The group also suggested the revision of the ASHA Kit in accordance with the current
context of the expanded package of services. The members also presented the idea of
creating a National ASHA portal with provision for state-specific modules. The need for
streamlining payments linked with Public Financial Management System (PFMS) to assure
regular payments was also emphasized.

KEY DISCUSSION POINTS FROM GROUP 2: IMPROVING WORKING

CONDITIONS OF ASHAs AND ASHA FACILITATORS
 With respect to ASHA restrooms, the need was identified for the mandatory establishment
of restrooms under IPHS norms for District Hospitals under Rogi Kalyan Samities. At sub-
district level or below facilities, the mandatory provision should be linked with minimum
caseload under IPHS. To strengthen the upkeep and management of the restroom RKS
should take necessary actions and accountability should be held by leveraging it with the
NQAS certification.
 The group also suggested the provision of mobility allowances to ASHAs in the form of the
monthly travel allowance.
 For safeguarding the positions of ASHAs and AFs efforts are required to organize periodic
sensitization on gender-based violence and legal provisions of programme management,
service delivery staff and frontline workers. National level commitment and guidance to
states are required for ‘zero-tolerance against the discrimination or assault of frontline
workers. Removal of ASHAs should be based on performance and existing norms and not
by the influence of local authorities. Group also suggested the formation of a ‘State-level
committee’ to address gender-based violence, harassment and discrimination faced by
ASHAs.
 To fortify the existing Grievance Redressal mechanisms for ASHAs, a Toll-Free helpline
should be created to address the grievances faced by frontline workers and take necessary
steps to address them.
 With regards to social security, the group recommended the introduction of Maternity
Benefit Schemes for ASHAs and AFs. Also, alongside the existing schemes, ASHAs and AFs
should be provided access to the state and central health insurance schemes regardless
of their socio-economic status.
 A need was identified for providing states with the guidance on creating enabling
environment for ASHAs and AFs for pursuing higher opportunities which may include
continuation of existing mechanisms of enrolment in ANM/nursing courses, provision of

55
 ANNUAL ASHA UPDATE 2020 - 21

weightage for experience as an ASHA/ AF and age relaxation for positions under health
department if other criteria are met.
 With the evolving technology, it was addressed to identify solutions for providing
smartphones to ASHAs and AFs. Also, the development process of the ASHA application
should be undertaken for the smooth recording of data.

KEY DISCUSSION POINTS FROM GROUP 3: CAPACITY BUILDING

FRAMEWORK TO ADDRESS THE NEED FOR REGULAR REFRESHER
TRAINING FOR COMPLEX TASKS AND VARIED LEVELS OF LITERACY
AMONG ASHAs
 Appraising the success of the cascade training model, the group suggested the creation of
a district training hub with the empanelment of agencies/NGOs. The group urged for better
coordination between programme divisions and ASHA resource centres for planning and
conducting training on new packages. Revision of existing training norms especially for
difficult terrains was also proposed.
 2. Suggestions were provided on the revision of ASHA certification guidelines in terms
of duration, adjusting requisites for accreditation examinations and discontinuation of
component of accreditation of state and district training sites were presented. The group
further added that ASHA Certification through State University could add more value to
ASHAs for career progression compared to the current process through NIOS.
 Given the expanded tasks of ASHAs, the group insisted on the revision of educational level
requirements for selection to the 10th standard.

KEY DISCUSSION POINTS FROM GROUP 4: TERMS OF ENGAGEMENT

OF ASHAs IN RURAL AREAS IN THE NEXT PHASE OF THE NHM
 With regard to incentives, the group felt that the same rates (as rural areas) of incentives
should be applicable in urban areas for all common activities between rural and urban
ASHAs. However, the need was felt to revise the incentive amount of the routine activity
packages.
 Because of the expanded tasks of ASHAs, the group insisted on the revision of educational
level requirement for selection to the 10th standard. Involvement of ASHAs in unlawful
activity should be subjected to removal alongside the norms suggested in the guidelines.
 Revision of existing performance-based indicators as per the expanded package of services
was desired for the identification of both non-functional and well-performing ASHAs.
 The concept of Second specialist ASHA was proposed at the AB-HWC level to cater for the
demands of the expanded package of services under Comprehensive primary health care.
Specialist ASHA can be skilled in mental health/palliative care/other expanded services
and additional incentives on identified indicators were recommended.
 In terms of work time allocation, the group suggested new evidence on the time use of
ASHAs in the context of CPHC and allocated in the follow-up for bilateral programs.
 Another key recommendation of the group was to create pool wise incentive package –
RCH, NCD, CD by identification of routine activities under each service area and creating
routine activities under each pool, designing incentives based on coverage indicators

56
ANNUAL ASHA UPDATE 2020 - 21

rather than being linked with the number of home visits made and increasing number of
case-based incentives which require long- term follow- up.

KEY DISCUSSION POINTS FROM GROUP 5: CONVERGENCE AND

COMMUNITY ENGAGEMENT
 To strengthen the health of the village residents, it was suggested to regularize meetings
of VHSNC/MAS, the inclusion of village health review in VHSNC meetings, quarterly review
by Gram Panchayat and improving ownership of PRIs & ULBs over VHSNC/ MAS.
 Strengthening the role of ASHAs in VHSNC / Village level health planning was also shared
as a strategy to improve community engagement. The group opined that provision of
guidelines with role clarity of different frontline workers and mechanisms of coordination,
collaborative training (e.g. VISHWAS Campaign), state-specific modules (PLA Trainings),
capacity building of ASHA support structures on convergence and strong IEC on inter-
sectoral coordination can contribute to the strengthening of community-level engagement.

57
 ANNUAL ASHA UPDATE 2020 - 21

ASHA Incentives
Under National Health Mission
PART-1 UPDATED LIST OF ASHA INCENTIVES UNDER NATIONAL
HEALTH PROGRAMS
SOURCE OF FUND
SN ACTIVITIES AMOUNT IN RS./CASE & FUND DOCUMENTED IN
LINKAGES
I Incentive for Routine Recurrent Activities
Mobilizing and attending Village
1 Health and Nutrition Days or Urban Rs.200/session
Health and Nutrition Days
Conveying and guiding monthly
2 Rs. 150
meeting of VHSNC/MAS
Attending monthly meetings at Block
3 Rs. 150 Order on revised rate of
PHC/UPHC
ASHA incentives- D. O. No.
a. Line listing of households done P17018/14/13-NRHM-1V
4 at beginning of the year and updated Rs. 300
every six months
NHM- Flexi Pool
b. Maintaining village health register
and supporting universal registration
Rs. 300
of births and deaths to be updated
on the monthly basis
c. Preparation of duelist of children
Rs. 300
to be immunized monthly
d. Preparation of list of ANC benefi- Order no. F No7 (84)/2018
Rs. 300
ciaries to be updated monthly NHM-1- 28th Sept- 18
e. Preparation of list of eligible
Rs. 300
couple monthly
II Maternal Health
JSY financial package
a. For ensuring antenatal care for the Rs.300 for Rural areas and MOHFW Order No. Z
woman Rs. 200 for Urban areas Maternal Health- 14018/1/2012/-JSY
1 NRHM-RCH Flexi JSY-section Ministry of Health
b. For facilitating institutional Rs. 300 for Rural areas and pool and Family Welfare
delivery Rs. 200 for Urban areas -6th. February-2013
Reporting Death of women (15-49 Rs. 200 for reporting within MoHFW OM-120151/
HSC/ U-PHC- Un-
2 years age group) by ASHA to PHC 24 hours of the occurrence 148/2011/MCH; Maternal
tied Fund
Medical Officer1 of death by phone Health Division, 14th Feb-2013

1. Under SUMAN Guidelines 2019, any person who first reports a Maternal Death in the community shall be entitled of incentive @
RS. 1000/- including ASHAs, however the mode of reporting shall only be through 104 call center and no other mode of
reporting except specified by the State Govt. shall be included and palpable after the death to be certified by the designated
block team.

58
ANNUAL ASHA UPDATE 2020 - 21

SOURCE OF FUND
SN ACTIVITIES AMOUNT IN RS./CASE & FUND DOCUMENTED IN
LINKAGES
III Child Health
Home Visit for the Newborn and
Post-Partum mother2 -Six Visits in
Case of Institutional Delivery (Days Child Health- NHM- HBNC Guidelines –
1 Rs. 250
3, 7, 14, 21, 28 & 42) -Seven visits RCH Flexi pool August-2014
in case of Home Deliveries (Days 1,
3, 7, 14, 21, 28 & 42)
Home Visits of Young Child for
Strengthening of Health & Nutrition Rs. 50/visit with total Rs.
D.O. No. Z-28020/
2 of the young child through Home Vis- 250/per child for making 05
177/2017-CH 3rd May-2018
its-(recommended schedule- 3, 6, 9, visits
12 and 15 months) -(Rs.50X5visits)
For follow up visits to a child dis-
Rs. 150 only after MUAC Order on revised rate of
charged from facility or Severe Acute
3 is equal to nor-more than ASHA incentives-D.O. No.
Malnutrition (SAM) management
125mm P17018/14/13-NRHM-IV
centre
Order on revised rate of
Ensuring quarterly follow up of low-
ASHA incentives-D.O-
birth-weight babies and newborns Rs. 50/ Quarter-from the 3rd
4 Z.28020/187/2012-CH,
discharged after treatment from month until 1 year of age
MoHFW- Would be subsumed
Specialized Newborn Care Units 3
with HBYC incentive
Child Death Review for reporting
Operational Guidelines for Child
5 child death of children under 5 years Rs. 50
Death Review- 2014
of age
For mobilizing and ensuring every el-
igible child (1-19 years out-of-school OGs for National Deworming
6 Rs. 100/ ASHA/Bi-Annual
and non-enrolled) is administered Day January-2016
Albendazole.
Week-1-ASHA incentive for prophy-
Rs. 1 per ORS packet for
7 lactic distribution of ORS to families
100 under-five children
with under-five children
Week-2- ASHA incentive for facilitat- OGs for Intensified Diarrhoea
ing growth monitoring of all children Control Fortnight – June-2015
Rs. 100 per ASHA for
in village; screening and referral of
8 completing at least 80% of
undernourished children to Health
household
centre; IYCF counselling to under-five
children household
MAA (Mother’s Absolute Affection)
Rs. 100/ASHA/ Quarterly OGs for Promotion of Breast-
9 Programme Promotion of Breastfeed-
meeting feeding-MAA -2016
ing- Quarterly mother meeting
IV Immunization
Order on Revised Norms under
Full immunization for a child under
1 Rs. 100 UIP-T.13011i01/2077-CC-
one year
May-12
Complete immunization per child Routine Immuniza-
up to two years age (all vaccination tion Pool
Order no – T.13011/01/2012/-
2 received between 1st & IInd year of Rs. 75 4
CC& V
age after completing full immuniza-
tion after one year
2 This incentive is provided only on completion of 45 days after birth of the child and should meet the following criteria-birth
registration, weight-record in the MCP Card, immunization with BCG, first dose of OPV and DPT complete with due entries in
the MCP card and both mother and new born are safe until 42nd of delivery.
3 This incentive will be subsumed with the HBYC incentive subsequently
4 Revised from Rs. 50 to Rs, 75

59
 ANNUAL ASHA UPDATE 2020 - 21

SOURCE OF FUND
SN ACTIVITIES AMOUNT IN RS./CASE & FUND DOCUMENTED IN
LINKAGES
Order on revised rate of
Mobilizing children for OPV immuni-
3 Rs. 100/day 5 IPPI funds ASHA incentives-D.O. No.
zation under Pulse polio Programme
P17018/14/13-NRHM-IV
Order no-T.13011/01/2012/
4 DPT Booster at 5-6years of age Rs.50
CCV
V Family Planning
ENSURING SPACING OF 2 YEARS
1 Rs. 500 Family planning– Order No- D.O – N-
AFTER MARRIAGE 6
NHM RCH Flexi 11012/11/2012 – FP, May-
ENSURING SPACING OF 3 YEARS Pool 2012
2 Rs. 500
AFTER THE BIRTH OF 1ST CHILD 5
Ensuring a couple to opt for perma-
3 Rs. 1000
nent limiting method after 2 children7
Rs. 200 in 11 states with
high fertility rates (UP, Bihar,
MP, Rajasthan, Chhattisgarh,
Counselling, motivating and follow Jharkhand, Odisha,
4
up of the cases for Tubectomy Uttarakhand, Assam,
Haryana and Gujarat)
Rs.300 in 146 MPV districts
Rs. 150 in remaining states
Rs. 300 in 11 states with
high fertility rates (UP, Bihar,
MP, Rajasthan, Chhattisgarh,
Jharkhand, Odisha,
Counselling, motivating and follow
5 Uttarakhand, Assam,
up of the cases for Vasectomy/ NSV
Haryana and Gujarat) and
400 in 146 MPV districts
and
Rs. 200 in remaining states
Rs. 300 in 11 states with
high fertility rates (UP, Bihar,
MP, Rajasthan, Chhattisgarh,
6 Female Postpartum sterilization Jharkhand, Odisha, Uttara-
khand, Assam, Haryana,
Gujarat) & 400 in 146 MPV
districts
Rs. 1 for a pack of 03
Guidelines on home delivery
Social marketing of contraceptives- condoms, Rs. 1 for a cycle
7 of contraceptives by ASHAs-
as home delivery through ASHAs of OCP, Rs. 2 for a pack of
Aug-2011-N 11012/3/2012-FP
ECPs
Escorting or facilitating beneficiary Order on revised rate of
8 to the health facility for the PPIUCD Rs. 150/per case ASHA incentives-D.O. No.
insertion P17018/14/13-NRHM-IV
Escorting or facilitating beneficiary
Order on revised rate of ASHA
9 to the health facility for the PAIUCD Rs. 150/case
Incentives -2016
insertion

5 Revised from Rs 75/day to Rs 100/day

6 Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttar Pradesh, Uttarakhand, Arunachal Pradesh,
Assam, Manipur, Meghalaya, Mizoram, Nagaland, Sikkim, Tripura, Gujarat, Haryana, Karnataka, Maharashtra, Andhra
Pradesh, Telangana, West Bengal & DD&DNH
7 Bihar, Chhattisgarh, Jharkhand, Maddhya, Pradesh, Odisha, Rajasthan, Uttar Pradesh, Uttarakhand, Arunachal Pradesh,
Assam, Manipur, Meghalaya, Mizoram, Nagaland, Sikkim, Tripura, Gujarat, Harayana and Dadar & Nagar Haveli.

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ANNUAL ASHA UPDATE 2020 - 21

SOURCE OF FUND
SN ACTIVITIES AMOUNT IN RS./CASE & FUND DOCUMENTED IN
LINKAGES
Mission Parivar Vikas- In selected 146 districts in six states-
(57 in UP, 37 in Bihar, 14 RJS, 9 in Jharkhand, 02 in Chhattisgarh and 2 in Assam)
Injectable Contraceptive MPA (Antara
Program) and a non-hormonal
10 Rs. 100 per dose
weekly Centchroman pill (Chhaya) -
Incentive to ASHA
Mission Parivar Vikas Campaigns
Block level activities- ASHA to be
oriented on eligible couple survey for
11 Rs. 150/ ASHA/round
estimation of beneficiaries and will
be expected to conduct eligible cou- Family plan-
ple survey- maximum four rounds ning-RCH- NHM D.O.No.N. 110023/2/2016-FP
Flexi Pool
Nayi Pahel- an FP kit for newly-
weds- an FP kit would be given to
Rs. 100/ASHA/Nayi Pahel
12 the newlywed couple by ASHA (In
kit distribution
initial phase ASHA may be given 2
kits/ ASHA)
Saas Bahu Sammelan- mobilize Saas
13 Bahu for the Sammelan- maximum Rs. 100/ per meeting
four rounds
Updating of EC survey before each
MPV campaign-
Note-updating of EC survey register
14
incentive is already part of the rou-
tine and recurring incentive

VI Adolescent Health
Menstrual hygiene
Distributing sanitary napkins to Rs. 1/ pack of 6 sanitary
1 Scheme–RCH –
adolescent girls napkins Operational guidelines on
NHM Flexi pool
Scheme for Promotion of Men-
Organizing monthly meetings with strual Hygiene August-2010
2 adolescent girls pertaining to Men- Rs. 50/meeting VHSNC Funds
strual Hygiene
The incentive for support to Peer
3 Educator (for facilitating selection Rs. 100/ Per PE Operational framework for
process of peer educators) RKSK- NHM Flexi
Rashtriya Kishor Swasthya
pool
The incentive for mobilizing adoles- Karyakram – January-2014
4 Rs. 200/ Per AHD
cents for Adolescent Health Day
Participatory Learning and Action- (In selected 10 states that have low RMNCH+A indicators – Assam,
VII
Bihar, Chhattisgarh, Jharkhand, MP, Meghalaya, Odisha, Rajasthan, Uttarakhand and UP)
Conducting PLA meetings- 2
meetings per month- D.O. No. Z.15015/56/2015-
Rs. 100/ASHA/per meeting
1 Note-Incentive is also applicable for NHM-1 (Part)- Dated 4th
for 02 meetings in a month
AFs @Rs.100/- per meeting for 10 January-2016
meetings in a month

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 ANNUAL ASHA UPDATE 2020 - 21

SOURCE OF FUND
SN ACTIVITIES AMOUNT IN RS./CASE & FUND DOCUMENTED IN
LINKAGES
VIII Revised National Tuberculosis Control Programme 8
Honorarium and counselling charges
for being a DOTS provider
Rs. 1000 for 42 contacts
For Category I of TB patients (New
1 over six or seven months of
cases of Tuberculosis)
treatment
Rs. 1500 for 57 contacts
over eight to nine months of Order on revised rate of
For Category II of TB patients (previ-
2 treatment including 24-36 ASHA incentives-D.O. No.
ously treated TB cases)
injections in the intensive P17018/14/13-NRHM-IV
phase RNTCP Funds
Rs. 5000 for a completed
course of treatment (Rs.
For treatment and support to 2000 should be given at the
3
drug-resistant TB patients end of the intensive phase
and Rs. 3000 at the end of
the consolidation phase
For notification, if the suspect re- Revised National Tuberculosis
4 ferred is diagnosed to be a TB patient Rs.100 Control Program-Guidelines for
by MO/Lab 9 partnership- The year 2014
IX National Leprosy Eradication Programme 10
Referral and ensuring compliance
Rs. 250 (for facilitating diag-
for complete treatment in pauci- Order on revised rate of
nosis of leprosy case) +
1 bacillary cases of Leprosy - for 33 NLEP Funds ASHA incentives-D.O. No.
Rs. 400 (for follow upon
states (except Goa, Chandigarh & P17018/14/13-NRHM-IV
completion of treatment)
Puducherry).
Referral and ensuring compliance
Rs. 250 (for facilitating
for complete treatment in multi-bac-
diagnosis of leprosy case)
2 illary cases of Leprosy- for 33
+ Rs. 600 (for follow upon
states (except Goa, Chandigarh &
completion of treatment)
Puducherry).
X National Vector Borne Disease Control Programme
A) Malaria 11

Preparing blood slides or testing

1 Rs. 15/slide or test
through RDT
Providing complete treatment for
2 Order on revised rate of
RDT positive PF cases
NVBDCP Funds for ASHA incentives-D.O. No.
Providing complete radical treatment Rs. 75/- per positive cases Malaria control P17018/14/13-NRHM-IV
3 to positive PF and PV case detected
by blood slide, as per drug regime
For referring a case and ensuring Rs. 300 (not in their updated
4
complete treatment list)

8 Initially ASHAs were eligible to an incentive of Rs 250 for being DOTS provider to both new and previously treated TB cases.
Incentive to ASHA for providing treatment and support Drug resistant TB patients have now been revised from Rs 2500 to Rs
5000 for completed course of treatment
9 Provision for Rs 100 notification incentive for all care providers including ASHA/Urban ASHA /AWW/ unqualified practitioners
etc if suspect referred is diagnosed to be TB patient by MO/Lab
10 Incentives under NLEP for facilitating diagnosis and follow up for completion of treatment for pauci bacillary cases was Rs
300 before and has now been revised to-Rs 250 and Rs 400 now.
For facilitating diagnosis and follow up for completion of treatment for multi-bacillary cases were Rs 500 incentive was given
to ASHA before and has now been revised to Rs 250 and Rs 600.
11 Incentive for slide preparation was Rs 5 and has been revised to Rs 15. Incentive for providing treatment for RDT positive Pf
cases was Rs 20 before and has been revised to Rs 75. Incentive for providing complete radical treatment to positive PF and
PV case detected by blood slide, as per drug regimen was Rs 50 before. Similarly incentive for referring a case of malaria
and ensuring complete treatment was Rs 200/case and has been revised to Rs 300 now.

62
ANNUAL ASHA UPDATE 2020 - 21

SOURCE OF FUND
SN ACTIVITIES AMOUNT IN RS./CASE & FUND DOCUMENTED IN
LINKAGES
B) Lymphatic Filariasis
For one timeline listing of lymph-
oedema and hydrocele cases in all
1 Rs. 200
areas of non-endemic and endemic NVBDCP funds for Order on revised rate of
districts control of Lym- ASHA incentives-D.O. No.
Rs. 200/day for a maximum phatic Filariasis P17018/14/13-NRHM-IV
For annual Mass Drug Administration
2 of three days to cover 50
for cases of Lymphatic Filariasis 12
houses and 250 persons
C) Acute Encephalitis Syndrome/Japanese Encephalitis
Order on revised rate of
Referral of AES/JE cases to the
1 Rs. 300 per case NVBDCP funds ASHA incentives-D.O. No.
nearest CHC/DH/Medical College
P17018/14/13-NRHM-IV
D) Kala Azar elimination
Involvement of ASHAs during the Rs. 100/- per round during
spray rounds (IRS) for sensitizing Indoor Residual Spray i.e., Minutes Mission Steering
1 NVBDCP funds
the community to accept indoor Rs 200 in total for two Group meeting- February-2015
spraying 13 rounds
ASHA Incentive for referring a sus-
Minutes Mission Steering
2 pected case and ensuring complete Rs. 500/per notified case NVBDCP funds
Group meeting- February-2018
treatment.
E) Dengue and Chikungunya
The incentive for source reduction
Rs. 200/- (1 Rupee /House
& IEC activities for prevention and
for maximum 200 houses
control of Dengue and Chikungunya The updated list of NVBDCP
PM for 05 months- during
in 12 High endemic States (Andhra incentives shared by MoHFW-
1 peak transmission season). NVBDCP funds
Pradesh, Assam, Gujarat, Karnataka, NVBDCP Division – Dated-16th
The incentive should not be
Kerala, Maharashtra, Odisha, Punjab, August-2018
exceeded Rs. 1000/ASHA/
Rajasthan, Tamil Nadu, Telangana
Year
and West Bengal)
F) National Iodine Deficiency Disorders Control Programme
Rs.25 a month for testing National Iodine Deficiency Dis-
1 ASHA incentive for salt testing NIDDCP Funds
50 salt samples orders Control Program-Oct-06
XI Incentives under Comprehensive Primary Health Care (CPHC) and Universal NCDs Screening
Maintaining data validation and
collection of additional information-
1 Rs. 5/form/family
per completed form/family for NHPM
–under Ayushman Bharat
Filling up of CBAC forms of every
individual –onetime activity for Rs. 10/perform per form/
D.O.No.7 (30)/2018-NHM-I
2 enumeration of all individuals, filling per individual as a one-time NHM funds
Dated 16th April-2018
CBAC for all individuals 30 or > 30 incentive
years of age
Follow up of patients diagnosed with
Hypertension/Diabetes and three
3 Rs. 50/per case/Bi-Annual
common cancers for ignition of treat-
ment and ensuring compliance

12 Incentive has been revised from Rs 100 to Rs 200 per day for maximum three days to cover 50 houses or 250 persons
13 In order to ensure vector control, the role of the ASHA is to mobilize the family for IRS. She does not carry out the DDT spray.
During the spray rounds her involvement would be for sensitizing the community to accept indoor spraying and cover 100%
houses and help Kala Azar elimination. She may be incentivized of total Rs 200/- (Rs.100 for each round) for the two rounds
of insecticide spray in the affected districts of Uttar Pradesh, Bihar, Jharkhand and West Bengal.

63
 ANNUAL ASHA UPDATE 2020 - 21

SOURCE OF FUND
SN ACTIVITIES AMOUNT IN RS./CASE & FUND DOCUMENTED IN
LINKAGES
Delivery of new service packages Rs.1000/ASHA/PM (linked D.O.No.Z-1505/11/2017-
4 NHM funds
under CPHC component with activities) NHM-I-Dated 30th May-2018
XII Drinking water and sanitation
Order No. Jt.D.O.No.W-
Motivating Households to construct 11042/7/2007-CRSP-part-
1 Rs. 75 per household
toilets and promote the use of toilets. Ministry of Drinking Water and
Ministry of Drinking Sanitation - 18th May-12
Water and Sani-
tation Order No. -11042/31/2012
Motivating Households to take indi- -Water II Ministry of Drinking
2 Rs. 75 per household
vidual tap connections Water and Sanitation – Feb-
2013
XII Incentives to the ASHA and ASHA Facilitators during Covid-19 pandemic (applicable till September 2021)
Provision of additional incentives on
1 Rs. 1000/month/ASHA
account of COVID-19 related work D.O No: Z-28015/58/2019-
ECRP fund
Provision of additional incentives on Rs. 500/month/ASHA NRHM-I 4th May-2021
2
account of COVID-19 related work Facilitators

PART-2 STATE-SPECIFIC INCENTIVES FOR ASHAS FROM STATE FUNDS

SN Name of States State Specific Incentives for ASHAs from State Funds

1 Andhra Pradesh Provides balance amount to match the total incentive of Rs.10, 000/month

2 Arunachal Pradesh Provides 100% top-up

3 Bihar Rs.1000/PM/ASHA linked with functionality of five specified 06 activities (started in FY 2019-20)

75% of matching amount of incentives over the above incentives earned by an ASHA as a top-up on
4 Chhattisgarh
an annual

5 Delhi Rs.3000/month for functional ASHA (against the 12 core activities performed by ASHA)

6 Gujarat Provides 50% top-up

7 Haryana Rs. 4000/month from June-2018 and 50% top-up

8 Himachal Pradesh Rs. 2000/month

9 Kerala Rs.5000/month in FY 2020-21

10 Karnataka Rs.4000/month – recently introduced replacing the top-up incentive

11 Odisha Rs.1000 /month from state fund launched on April 1st, 2018

12 Rajasthan Rs. 2700/month through ICDS

13 Sikkim Rs. 6000/month

14 Tripura Provides 100% top-up against 08 specified activities and 33% top-up based on other activities.

15 Telangana Provides balance amount to match the total incentive of Rs. 7500/month

16 Uttarakhand Rs.5000/year and Rs. 2000/month.

Rs.750/- per ASHA per month linked with the functionality of five specified activities
17 Uttar Pradesh
(started from March 2019)

18 West Bengal Rs.3000/month

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Editorial Team

National Health Systems Resource Centre (NHSRC)

1. Maj Gen (Prof ) Atul Kotwal- Executive Director

2. Dr. (Flt Lt) M.A. Balasubramanya- Advisor, Community Processes - Comprehensive

Primary Health Care

3. Dr. Neha Singhal- Senior Consultant, Community Processes - Comprehensive Primary

Health Care

4. Mr. Syed Mohd. Abbas- Consultant, Community Processes - Comprehensive Primary

Health Care

5. Dr. Anwar Mirza- Consultant, Community Processes - Comprehensive Primary Health

Care

Special thanks to :

 Nodal Officers, ASHAs and ASHA Facilitators in all States’/Union Territories

 Senior Consultants and Consultants, Community Processes and Comprehensive

Primary Health Care, in National Health Systems Resource Centre & North East
Regional Resource Centre (NE-RRC).

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NOTES

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