Evaluation of accredited social health activists in Anand District of Gujarat.

BACKGROUND: Accredited social health activist (ASHA) has the pivotal role to play in the whole design and strategy of national rural health mission (NRHM). The performance of ASHA is, therefore, critical for the success of NRHM and hence of the health improvement strategy of the government of India. OBJECTIVES: (1) To evaluate the knowledge and performance of ASHA. (2) To assess the factors affecting these two attributes of ASHA. METHODS: Ten ASHAs were randomly selected from each of the eight administrative blocks of Anand District. Thus, a total of 80 ASHAs participated in the study. Knowledge of ASHAs was assessed by computing knowledge score which included 15 questions, while the performance was assessed through performance score which included 17 indicators. Each ASHA was ranked "Poor," "Average," and "Good" based on the performance score. RESULTS: Out of 80 ASHAs, 49 (61%) were in the age group of 30-40 years. Majority of ASHAs(68%) belonged to other backward class (OBC). 73 (91%) ASHAs had education up to at least secondary level. 65 (81%) ASHAs were working for more than 4 years. About 84% of ASHAs had knowledge score between 12 and 15. Nearly 51% of ASHAs ranked average in performance, while 49% ranked poor. None of the ASHAs ranked good. Knowledge score and performance ranks were not associated with age, caste, education, and duration of service of ASHAs. Performance ranks were found to be significantly associated only with time lapse since the last training received. CONCLUSION: To strengthen the grass root cader of ASHAs, their evaluation should be conducted regularly. Additional refresher training should be provided to ASHAs with low knowledge and performance scores so that the engagement of rural community with the health system can be improved.