Can ASHA be the ray of hope for providing MCH services in Odisha, India? Exploring through a qualitative study

摘要

Odisha registers very high Infant mortality rate (57 per 1000 live births) and Maternal Mortality Ratio (258 per 100,000 live births). The national rural health mission (NRHM) introduced the Accredited Social Health Activist (ASHA) for improving maternal and child health (MCH) of rural India. In-depth interviews of ASHA (N=9) and focus group discussion with mothers (N=24) demonstrated their adequate knowledge and skills in meeting the MCH needs in selected rural setting. The ASHAs outlined problems encountered in dispensing duties into categories, such as, economic (no fixed economic incentives), logistical (lack of transportation) and workload (serving large population). Despite facing problems, ASHAs developed logistical (contact list of auto rickshaws) and economic (loaning money during emergency) strategies to address these hurdles. ASHAs strongly favored stable economic incentive through regular monthly salary to combat livelihood difficulties and introduction of ambulance services at Public Health Centre to combat transportation challenges.