Completed ASHA Diaries Help Reach More of Agra’s Eligible Couples with Family Planning Services

Apr 29, 2019

Contributors: Parul Saxena, Deepak Kumar Tiwari and Nitin Kumar Dwivedi

When The Challenge Initiative for Healthy Cities (TCIHC) began implementing in June 2018 in Agra – a city in Uttar Pradesh (UP), India – TCIHC’s experienced city manager quickly noticed a problem. It appeared that the Accredited Social Health Activists, or ASHAs, were not maintaining their diaries, a registry tool essential for tracking eligible couples for family planning services and their community mobilization work.

The UP government provides all ASHAs with these diaries – also known as the Urban Health Index Registers (UHIRs) –to maintain health records on the women, men and children in theirs catchment areas. The diary covers records for immunizations, antenatal and prenatal care, institutional delivery, family planning and other health service areas. Systematically maintaining this data is crucial for ensuring those with various health needs in the community are counseled by the ASHAS and provided information and referrals to services. This is especially important for family planning because ASHAs are supposed to identify currently married women of reproductive age and counsel them on available services based on their need and choice.

In addition, ASHAs help with mobilizing women of reproductive age in the community to attend Fixed Day Static (FDS) services– a proven TCIHC high-impact approach that are special family planning days organized at urban primary health centers (UPHCs), district hospitals, accredited private facilities, and Urban Health and Nutrition Days and Outreach Camps.

Santosh with her diary.

“It is so difficult to find and prioritize eligible couples for family planning services. There is an abundance of scattered data, so I don’t know where to start,” said Santosh, a 40-year old ASHA working in Agra since September 2016. “It’s a painstaking process to identify them…. I had received my UHIR, but I was unable to use it. Hence, I have kept it in my storeroom and had totally forgotten about it.”

With TCIHC’s support, senior government officials in Agra assessed the situation and found 85% of the 585 ASHAs serving the city’s slum population of 1,275,000 had received their diaries, but they were incomplete or blank.

The ASHAs had not received any orientation or training in how to complete the diary, so did not understand the usefulness of it. Agra’s Urban Nodal Officer designed an orientation plan and engaged TCIHC’s Field Program Associates (FPAs) and Field Program Coordinators (FPCs) to help implement it since they already coach and mentor ASHAs in family planning counseling. In September 2018, a half-day orientation session was held for FPCs and FPAs on how to correctly complete and use the UHIR. The FPAs and FPCs then began step-down trainings with the ASHAs who had received their diaries. The ASHAs were trained during their daily household visits so they could practice completing the diary in real-life situations.

The training initiative has already shown positive results. Within four months, 81% of the ASHAs in Agra had completed their diary’s family planning section, which resulted in them making more contact with eligible family planning couples. In September 2018, 2,867 contacts were made by ASHAs but this increased 21% to 3,475 contacts in December 2018. The ASHAs also increased their contact with couples under the age of 25 – from 41% in September 2018 to 98% in January 2019. This simple fix also made as impact on family planning services uptake. IUCD uptake at UPHCs increased 46% and oral contraceptive pills uptake rose 131% from October 2018 to March 2019.

“Learning how to properly fill my diary has helped me to maintain client records in a systematic manner and now I can easily and quickly extract specific information like first-time parent and adolescent couple details for family planning,” said Santosh.