A Cross-sectional Study to Assess the Performance of Accredited Social Health Activists (ASHAs) Functioning under a Select Community Health Centre in a Rural Block from Kerala

Abstract

Background: ASHAs are the cornerstone of community-level service delivery under the National Health Mission(NHM). Their performance is crucial to programme success, yet quantitative evaluations of ASHA performance in Kerala remain scarce.Objective: To assess the job performance of ASHAs functioning under a select Community Health Centre(CHC) in a rural block of Kannur district, Kerala, using both self-reported data and beneficiary responses. Methods: A cross-sectional descriptive study was conducted during 2019–2020 among 110 ASHAs selected by simple random sampling functioning under the CHC, and 450 beneficiaries (mothers with infants). Data was collected using pre-tested, semi-structured questionnaires administered in Malayalam, supplemented by review of ASHA records and monthly reports. Performance in core maternal and child health(MCH) indicators over the preceding official year was categorized with reference to programme norms and crude birth rate. Results: The mean age of ASHAs was 45.9 ± 4.4 years, and 98.2% had 9–10 years of service. The mean population covered(1,424 ± 304) exceeded the recommended norm. Performance was high in pregnancy registration(98.2%), completion of six postnatal visits(97.3%) and ensuring complete immunization of infants(95.5%), with ≥50% of expected targets achieved; however, only 45.5% achieved this level for Janani Suraksha Yojana(JSY) promotion. Family planning services, escort services, and drug kit availability showed notable gaps. Beneficiary responses corroborated high functionality in antenatal and immunization services but revealed discrepancies in postnatal visit coverage.  Conclusion: ASHAs were largely functional and effective in delivering key MCH services. Addressing the ageing workforce, workload, underperforming domains such as JSY and family planning, and incentive-related concerns is essential to further strengthen the programme.