Terms of Reference
NRHM has put in place several community processes, such as the ASHA programme, establishment of Village Health and Sanitation Committee (VHSC), Village Health Planning, provision and management of untied funds to the sub center and VHSC, increasing public spaces for participation in health, Rogi Kalyan Samitis, and Community Monitoring. The ASHA is seen as a key figure in enabling these processes. The past few years has shown that in the absence of support and supervision to ASHA, her role in enabling such community processes remains limited.
Several reviews of the ASHA programme have demonstrated that for effective facilitation of the ASHA scheme, a supportive structure at all levels of programme implementation (State, District, Block, Village level etc.) is required for monitoring, mentoring, and handholding support to the initiative. This document lays out the Terms of Reference for establishing an Asha Resource Center at the state level.
I. Institutional Arrangements in the ASHA Resource Center (ARC)
i. State Level
At the State level, the ASHA Resource Centre will operate under the strategic direction and leadership of Mission Director, NRHM and in close coordination with the State Programme Management unit (SPMU). It will also work in close coordination with Community Processes division of National Health Systems Resource System (NHSRC) for program development.
The ARC team at the state level is expected to have the following staff composition: Team Leader, State ASHA Programme manager, Statistical Assistant, Data assistant, and one office attendant. In addition, given the need to develop state specific communication material, one communications and documentation officer should be appointed at the state level. Given the scale of the programme in the state and the need to also conduct training of the VHSC members, a District Training and Monitoring Consultant, (one per 10 districts) would be recruited. They could be located at state level and travel to the districts or be based in the district but would report. (For description of responsibilities please see Section II)
In each district, the ARC will field a team comprising of one District Mobilizer and one Data Assistant. The District Community Mobilizer will work in close coordination with the DPMU and report to the Programme Manager, ARC, through the DPMU. (For description of responsibilities please see Section II)
At the Block level, the ARC will recruit a Block Community Mobilizer, who will be assisted by the ASHA facilitator. The Block Community Mobilizer will report to the District Community Mobilizer and the Block Medical officer. (For description of responsibilities please see Section II)
II. Roles and Responsibilities of ARC at state, district and block levels.
The role of the State ARC is to provide technical support to the State Programme Management Unit (SPMU) and the State and District Health Societies for strategic planning, implementation, monitoring and coordination of all activities related to the community processes component of NRHM, viz: The ASHA programme, VHSC and Village Health Planning, RKS and community monitoring under NRHM. The ARC will also be responsible for coordinating with the National Health Systems Resource Centre (NHSRC) for facilitation of technical assistance to strengthen programme effectiveness and capacity building on community process on a regular basis.
(A)- The broad responsibilities of the ASHA Resource Center at the state level include:
Planning, Implementation Review and Feedback to State Planning Processes
• To act as the secretariat of ASHA Mentoring Group.
• Develop annual work plans with specific deliverables and measurable outcome s
• Review and assess ongoing community processes and provide feedback to the development of the annual Project Implementation Planning (PIP).
Training and Capacity Building
• Assessment of training needs of VHSC, ASHA, ASHA facilitators, block mobilizers, and district mobilizers.
• Identifying a cadre of trainers at state, district, and block levels with the appropriate skill mix to provide quality training to ASHA
• Ensuring and maintain a stable team of district and block trainers. .
• Designing a training plan for trainers, district and block mobilizers, ASHA facilitators and ASHA.
• Designing state specific training modules and communication material
• Identifying partner NGOs and training sites (for those training components that need competency based training)
• Planning, implementing and monitoring the training programme in consultation with the districts at district, block, and sub block levels.
• Conducting training of trainers in collaboration with NHSRC and the national trainers.
Monitoring and Supervision
• Develop data base to track ASHA and VHSC through the structure at sub block, block, district and state levels to enable tracking of dropouts, payments, and to use as a planning and monitoring tool
• Developing/adapting monitoring formats and registers for ASHA, VHSC, and for the community monitoring process.
• Developing/adapting supervisory protocols and check lists for staff at various levels
• Developing monitoring formats for block, district and state ARC teams
• Develop s schedule of review and monitoring visits at the various levels
• Organizing Monthly review meeting with the Mission Director/SPMU
Coordination and Convergence
• Assist Mission Director for effective coordination among various stakeholders from the government departments and non-government sectors to strengthen community processes.
• Ensure effectiveness in programme monitoring and updating programmatic progress to the Mission Director periodically.
• Identify generic and specific impediments to the programme in districts and enable problem solving at district and state levels.
• Build partnerships with civil society organizations to serve as resources in training and capacity building of ASHA and for other community processes.
• Address issues of convergence with PRI and WCD to strengthen effectiveness of ASHA and other community processes.
Development of IEC/ BCC material, and Documentation
• Develop IEC/BCC/Advocacy related activities contributing to the community processes at the state level and district level.
• Documentation of successful innovations and model community processes, sharing with key stakeholders and develop scaling up strategies.
Specific Functions related to ASHA
• Review and strengthen existing selection processes, in order to recruit the full complement of ASHA required, and plan for recruitment strategy for drop out.
• Ensure role clarity and advocate for an enabling environment to improve ASHA effectiveness.
• Identify state specific issues for inclusion into future rounds of ASHA training and ensure that the requisite 23 days of training for ASHA are held each year.
• Facilitate ASHA training programmes at sub block levels through the district and block level structures.
• Facilitate timely incentive payments through regular reviews and assessments and spot checks of the situation related to payments
• Ensure distribution and refilling of drug kits to ASHA
(B) Responsibilities of the ARC at the District Level
The major responsibilities of District ARC (especially District Community Mobilizer) are;
• Capacity building of Block facilitator and Block Trainer’s Team in coordination with District Trainer’s Team
• Create and maintain district resource database for the health sector and assist in optimal allocation of resources
• Coordinate with other govt. dept. such as; WCD, Water and Sanitary, Education and PRI, at District level for intersectoral coordination, and support Block facilitator for the same at block level.
• Develop measurable performance indicators for the District and Block level ASHA support system/unit.
• Undertake periodic review meetings for ASHA programme and community processes.
• Undertake frequent field visits for supportive supervision to the activities related to community processes implementation..
• Arrange visits/meetings of ASHA Mentoring Groups at District and Block Level.
(C) Responsibilities of the ARC at the Block Level
• Block level mobilizer will assist Block Medical Officer for the effective implementation of ASHA, VHSC and other related community processes activities in the block
• Capacity building of ASHA facilitators and ASHAs (in coordination with Block level trainer’s team), review, implementation and monitoring of ASHA, VHSC and other related community processes activities.
• Coordinate for monthly meeting at PHC to discuss and sort out various issues of ASHAs relating to incentive payment, drug kit replenishment etc.
• Coordinate with other govt. department such as Health, WCD (ICDS official), Water and Sanitation, education etc. at block level for inter-sectoral coordination
• Support/guide ASHA facilitator for various coordination at village level
• Submit reports on the above activities to District ASHA Coordinator
(II) Sub Block Level
At the sub block level, level, one ASHA/Block facilitator for every 10-20 ASHAs to assist Block level organizer as well as to provide continuous handholding support to ASHAs will be engaged. She will be resident in the area. She will support ASHA for/in coordination with ANM, AWW, PRI, VHSC, SHG etc., and will report to Block level organizer. She will support ASHA in organizing monthly meetings, Village Health and Nutrition Day (VHND), VHSC meetings as well as monitor drug kit replenishment. It is expected that she will spend 20 days in the field to provide support ASHA in her area of operation.
Staffing Requirements of the ARC
1. Team Leader
2. ASHA Programme Manager
3. Consultant- Documentation & Communication
4. District Training and Monitoring Consultant, (one per ten districts)
5. Data Assistant
6. Accounts Assistant
7. Statistics Assistant
8. Office Attendant
9. District Community Mobilizers
10. Data Assistant
Block and Sub Block Level
11. Block Community Mobilizers
12. ASHA Facilitators
The funding for the basic staff of ARC at state, district, block and sub block levels is built into the programme. Of the Rs. 10,000 allocated per ASHA, Rs. 3500 has been earmarked for the support mechanism.