Abstract

One of the core strategies of NRHM was to promote access to improved health care at household level through ASHA. A community based research study was conducted to assess the knowledge and functioning of ASHA with respect to three selected districts of Kerala and to analyze the problems faced by them in the delivery of Primary Health Care Services at the village level. A survey approach with selective employment of qualitative method was used.A descriptive cross sectional survey design was used. To represent the entire state of Kerala one district each from Northern (Wayanad, Central (Kottayam), and Southern (Thiruvananthapuram) region of Kerala was randomly selected. The Sample consists of 405 ASHAs and 73 JPHNs and they were selected using cluster sampling technique. Data collection instruments were structured knowledge questionnaire, self administered rating scale,focus group interview guidelines, in-depth interview guidelines and opinionnaire. Quantitative analysis revealed thatalmost half (42.3%) of the ASHAs from Thiruvananthapuram belongs to the category of good knowledge level, Thiruvananthapuram (good- 36.3%) has better functioning than Kottayam and Wayanad and Significant association was found between knowledge scores and educational status and level of satisfaction of ASHA workers (P>0.05). Themes derived from qualitative analysis are problems related to Maternal Child Health services, adoption of Family planning services, Communicable and Non communicable Disease monitoring, work load, Lack of transportation facilities, Inadequate payment structure, inappropriate Government health infrastructure ,lack of recognition by the Panchayat, lack of medicine kit, lack of follow up after initial training, inadequate knowledge and communication skill, lack of supervision and lack of co-operation from the families. Majority (49.3%) of the JPHNs have only average opinion regarding the functioning of ASHAs in the community. Only 16 (21.9%) had good opinion about the services rendered by the ASHAs in the community.

Keywords: ASHA; JPHN; Knowledge; Functioning; Primary Health Care Services