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Three women frontline workers - Accredited Social Health Activist (ASHA), Anganwadi Worker (AWW) and Auxiliary Nurse Midwife (ANM) are jointly responsible for delivery of health and nutrition service delivery in India's villages. Each of them has a distinct role - The ASHA mobilises the community to participate in healthcare programs, the AWW is responsible for nutrition and health monitoring of young children and their mothers and the ANM provides basic health diagnosis, treatment or referral. Their roles seem complementary. Yet, cooperation between them has traditionally been minimal. AWWs and ANMs are employed by the Women and Child Development (WCD) and health ministries respectively. In Rajasthan, ASHAs are paid a fixed honorarium and incentives by the WCD and Health Ministries respectively.
There are some fundamental issues:
- There is no map so workers are often unaware of geographical area and population to be served by them
- Frontline workers differ in identification and tracking of beneficiaries
- Tasks are carried out in a linear manner and not as per need
- Workers are ill-equipped to handle community resistance independently
- There are little to no opportunities to learn from each other
The AAA way:
1. Establishing a common database:
AWWs organise people by families, ASHAs use households and ANMs work on a record of eligible couples (married couples in the age group 15-49).
AAA worked together to create a village map, synchronising household and family coverage. On these maps, they numbered houses and affixed coloured bindis to denote various categories of beneficiaries and dynamically track them, prioritising those at highest risk. Now, village health and nutrition information is available at a glance. AAA also involved the community in validating the maps. This raised community's interest in village health issues and the AAA's standing in society.
ASHA workers visit ten houses everyday. Previously, they did it in a linear manner (House one to ten on day one, eleven to twenty on day two and so on). AAA enables them to plan visits based on beneficiary needs using a simple algorithm. This enables them to deliver care when and where it is most required.
One Thursday every month, a Village Health and Nutrition Day is organised in every village. Through the AAA platform, the three workers have a formal meeting. Here, they review each other's work and data, plan for the next month and close with a peer learning session where they educate each other on technical and administrative matters.