Fearing forgery in ASHA records, the public health department will issue incentives for ASHA workers with the approval of new mothers. ASHA or the Accredited Social Health Activists is a group of trained community health workers. The group aimed at generating awareness on post-delivery mother and child health. In 2012-2013, Rajasthan government hired the ASHA workers for the HBNC (Home-Based Newborn Care) program to control infant mortality. Nevertheless, the escalating neonatal mortality rate or the unexpected death of infants within a month of their birth continued to plague the state.
Under the HBNC program, it is mandatory for ASHA workers to visit the expecting mothers and their newborns on the following dates—
- 1st, 3rd, 7th, 14th, 21st, 28th and 42nd day in case of delivery in home and
- 3rd, 7th, 14th, 21st, 28th and 42nd day in case of delivery in the hospital.
The workers would ensure health and safety of mothers and their infants. In return, the workers received fixed incentives per visit. Despite an effective action plan, the program failed to make an impact on the NMR (neonatal mortality rate) as the SRS or Sample Registration System recorded 35 deaths per live births in 2012. The numbers declined in subsequent years: 32 in 2013-2014 and 30 in 2015, but the problem was still existent.
The health department officers suspect workers of making fake registries to receive incentives for their job. Lack of awareness and disinterest of people are secondary reasons for its failure. The government plans to issue HBNC voucher under the National Health Mission (NHM) to monitor the activities of ASHA workers. ASHA workers will get the money only when mothers sign the HBNC voucher issued by Rajasthan government.
The new system will implement on a pilot basis by July end or August first week in Rajasthan’s Rajsamand and Dungarpur districts. These districts have the highest rate of institutional delivery (84.7% in Rajsamand and 86.4% in Rajsamand). Public health officers will ensure that activists visit the mothers on a regular basis.
The ANM will dispatch the vouchers to mothers after their delivery. The recipients have to sign the voucher before sending it to the ASHA for verification. The department will examine the health of mothers and newborns during the counseling session before they approve payments for the workers.
With these modifications, the officers will attempt to control forge register entry and increasing NMR in Rajasthan.
