Visiting the Communities, Part 5: ASHA Monthly Meeting + Summary of Research – Blog Post #8

Continuing to post my blogs 🙂

Saturday, July 2nd

Continuing on with the description of my second week in the communities:

Saturday – ASHA Monthly Meetings: I was able to observe Prabha and Ravi conduct a monthly meeting with the ASHAs and their facilitators. This really gave me some insight into what an ASHA’s responsibilities are as well as why ASHAs seem to be ineffective when it comes to improving SRH outcomes and general health outcomes for the Mahadalit community. The issues discussed were:

  1. No Mahadalits in the ASHA’s community – Only after the BPCs started traveling into some of the target communities did they find that their were no Mahadalits and that the ASHA that was working in that community was therefore, not working with any Mahadalits. Each ASHA is usually responsible for about 1000 people and this group of 1000 can consist of people belonging to various castes. However, Pathfinder specifically isolated ASHAs that are working with Mahadalits because a Mahadalit can best relate to and relay information to another Mahadalit.
  2. Poorly done home visits – The BPCs found out after talking with Mahadalit members from various villages that ASHAs sometimes rush the home visits or don’t show up at all. They come to the women’s homes, sit for 5 minutes, and take off, which makes it very difficult to relay any of the SRH/HTSP information to the community women. The BPCs revisited the primary components of a proper home visit during the monthly meeting to help the ASHAs review, emphasizing who their audience should be when they do the visit, how to establish trust, and how to use their flipbook.
  3. Poor distribution of contraceptives – The BPCs also found out after talking with Mahadalit members from various villages that some community members had requested for a particular contraceptive from an ASHA, but hadn’t received their supply in 6 months! This is too long of a waiting period. It makes it, overall, very difficult for the ASHA program and Sashakt to function if the primary objectives of increasing and meeting contraceptive demand and demand for SRH/HTSP information are not being met.
  4. Fake or blank ASHA reports – Every month, ASHAs are required to submit a report, which they use to record information from their home visits. The report has boxes that allow the ASHA to indicate things like how many contraceptives of each type are being requested by how many women, how many contraceptives of each type were distributed, and how many contraceptives of each type remain in their stock. The BPCs collect these reports at the end of each month, however, upon reviewing the reports, they have found that the numbers some ASHAs are recording don’t make sense or that some ASHAs are leaving parts of the reports completely blank. This issue was especially emphasized.

Summary of Research: 

This summer was truly eye-opening. Since my freshman year at W&M, I had been reading several articles on early marriage and community-based participatory research, but I was finally able to see and hear about the on-ground realities for the first time. Sashakt is a wonderful project that is really making headway and I hope that Pathfinder continues to receive funding to scale it up. Nonetheless, based on my observations and interviews with members of Pathfinder’s staff (my co-researchers) and community members, I feel that several aspects of the project need to be improved in order to establish greater trust with and fully involve the Mahadalit community and better meet their needs and concerns. However, that simultaneously requires improving the system, in some cases, given that their partnership with the government brings up systemic issues. For examples, ASHAs work under India’s health system and Pathfinder is incorporating them into Sashakt to relay SRH/HTSP information. I believe that ASHAs can be ineffective in this context, and they are not to be blamed, give that they must juggle both their family responsibilities and responsibilities as an ASHA without being paid a salary. And, given that ASHAs’ benefits fall under the jurisdiction of the government, I believe that Pathfinder has limited control over this. Nonetheless, the focus can be moved to how Pathfinder trains the adolescents, ASHAs, and Vikas Mitras, through the 3-day life education sessions, 1-day orientations sessions, and the 2-day training sessions, respectively. The adolescents’ sessions do not provide them with enough time to retain the SRH/HTSP information (especially given that their is no reinforcement at home) and the ASHAs’ and Vikas Mitras’ sessions do not provide enough time for them to retain the necessary information and obtain the necessary practice needed to properly conduct home visits and group discussions. For the ASHAs specifically, they are taught during the 1-day orientation how to be more culturally sensitive as well. However, again, I feel that this is too short of a time period to learn about how to interact with the Mahadalit community. To specifically further involve community members, Pathfinder should work with community members to design the different components of Sashakt, especially if they receive funding for next year (by which they will have reevaluated this year and can make adjustments). Although they are trying to do this, according to their proposal, with peer educators, for example, more emphasis should be made on this aspect.

I hope to make this a long-term project. I would really like to return to Bihar next summer and choose one Mahadalit community out of all the communities I traveled to to partner with. I hope to again work on the issue of early marriage and consequences for SRH, however, based on my interviews with community members this summer and possibly next summer, they may be more interested in improving their quality of life with regards to a different issue (e.g. sanitation, education). Furthermore, I will need to think about other organizations besides Pathfinder that will be able to provide me with some guidance while I am there, given that there is no certainty in Pathfinder receiving funding for the following year and given that they may not be able to accommodate me next summer.