Identify and hire trainers with extensive experience in FP to train ASHAs. During FP training, invite gender experts, male engagement programmers and gender champions (city and facility level) to facilitate a session on gender to orient and sensitize ASHAs so that they can integrate gender components into their FP activities.

(Refer to the List of master trainers to be sourced at the time of planning of training from states and ensure that trainer have gender perspective and sensitive towards issues.)

In general, when ASHAs are recruited they undergo initial training which include only one session on family planning. However, detailed and in¬depth training is required for them to provide quality information and services to the community. Thus, a two-day training, especially on family planning and informed choice counseling is necessary for ASHAs and this should include the following:

Update population register

Coach ASHA to map and list all households including the most vulnerable population (Refer to TCI India’s mapping & listing tool) and on updating her survey record or population register, specifically section-2 of UHIR (ASHA diary), termed as ‘slum/gram survey’ periodically. An updated survey reveals the total number of population to be served by an ASHA

In-Depth knowledge of modern contraceptive methods

ASHAs must be coached on the effectiveness, advantages, working mechanisms and side effects of each contraceptive They must be coached on providing informed choices to eligible couples, using FP job aids, promoting spousal communication and increasing male participation in family planning by supporting their spouse in FP decisions or by adopting a FP method. The training must integrate gender components, like use of gender-sensitive language, non-discriminatory practices in all interactions, addressing cultural and social norms that impact gender equality, use of simulation games on gender sensitization such as white and black marble game to change the mind-set of son preference, Kranti Bhranti an interactive game of Rashtriya Kishore Swasthya Karyakram (RKSK), and creating awareness on Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT), etc. ASHA must also be coached on conducting Mahila Arogya Samitis (MAS) meetings.

Periodically a refresher training is to be conducted by MOICs on contraceptive methods by leveraging ASHA and ANM meeting platform.

Family planning job-aids

Each ASHA must be provided with FP job aids such as basket of choice, flyers on various FP methods, simulation games on gender on gender sensitization, flyers on various government schemes like Ensuring Spacing at Birth (ESB) and frequently asked questions with answers related to FP methods. Ensure FP job aids content should be gender sensitive.  This will help ASHAs to provide more effective FP interpersonal counseling and create gender awareness  during home visits.

Develop a due-list of eligible couples

Once the ASHA updates her UHIR, she then updates/completes section 9 of the UHIR, which is an aggregation of all eligible couples in the community. From this section, the ASHA can extract the eligible couples in the population she serves. Further, segregation of lists of eligible women based on age and user/non-user helps frame a duelist for counseling. Coach ASHA on the 2BY2 matrix tool developed by TCI India which helps them to segregate and prioritize eligible FP clients list based on parity and age (Refer to 2BY2 matrix tool).

Prioritize visits to eligible clients and integration into routine contact plan

When an ASHA extracts the due list from her UHIR, it gives her a clear picture of potential couples  who are in high need of FP services. ASHA can take support of community health workers such as MAS and Anganwadi workers by sharing the duelist with them for better coordination. ASHAs precedence to this list during household visits. Also, the list is categorized into users and non-users; the ASHA is encouraged to devise a plan with her supervisor to meet non-users first and refer them to Fixed day static service (FDS)/Antral diwas, Khushhal Privar diwas, UHND and outreach camps. As for users, she must provide continuation support including both reassurance couple counseling to promote shared decision-making and support for contraceptive use In addition to that she also resupply of commodities such as condoms, Chhaya, and OCPs.

Training on Family Planning Logistic Management Information System (FPLMIS)

To strengthen supply chain and door step delivery of FP commodities Government of India (GoI) has devised a FPLMIS mobile software. The FPLMIS Manager must map the names of the current ASHAs and ensure their correct details are added at the backend of FPLMIS software. Every six months’ update FPLMIS portal by deleting the names of ASHAs who left job and adding the names of new ASHAs. The FPLMIS manager must coach both ANMs and ASHAs on the online indenting process and reorient them at least once every year. A poster/flex describing indenting process pictorially can be placed at each UPHC for easy reference.

Orientation on the benefits of government schemes related to their work

The FP incentive and ESB are government schemes to promote family planning and spacing between births. It is important that an ASHA feels motivated to work for FP. Hence, it is important to coach ASHA on the schemes, specifically on how to fill out the forms, when to claim, what are the criteria on which the incentives are given and where these should be submitted (Refer FP incentive and ASHA incentive scheme (Form 1 for payment of incentive amount to urban ASHA). 

Family planning information dissemination and follow-up

ASHA must provide information and counseling on FP to motivate new users, and encourage regular usage and switching of methods, if necessary (Refer to Training module on Inter-Personal Communication; and method-specific training PPTs). During the home visits, Arogya Mela, Saas Bahu Beta Sammelan (SBBS), and UHND platforms, ASHA must conduct couple counselling, and encourage inter-spousal communication. ASHA should also encourage male partners to promote shared decision-making and support contraceptive use. ASHAs must identifying FP and gender champions from different NGOs, community, facilities and male engagement programs to build enabling environment. With the support of them, during SBBS and MAS meetings street plays (Nukkad Natak) can be used as a medium to spread the messages on FP and gender across community.

To ensure retention of the adopted method by the client, ASHAs must follow up with clients in the proposed interval and track the continuation of the FP method and track drop-outs. They should discuss with contraceptive users how the method has worked as well as any issues or difficulties that might have come up. ASHAs to ensure referral for management of any side-effect or complications.

Preparedness for emergencies

UHC/CCPM, MOICs should coach ASHAs on inclusion of FP under essential services and that they should regularly provide FP information and supplies during any emergency like the COVID-19 pandemic.

Continuous on-the-job mentoring and supervision is required to help the ASHA translate her training into practice. Guidance on mentoring and supervision of ASHAs is provided in the handbook for ASHA facilitators, and includes a field-visit-checklist for supervisor and a checklist for feedback (Refer to : Guidelines for ASHA facilitators). Community Process Manager at the state level should be oriented on coaching CCPM on establishing the importance of building the capacities of urban ASHAs and ANMs on family planning. ANMs must be coached on the following:

1. Providing handhold support to their ASHAs by initially accompanying them during a few household visits and later when ASHA face any challenges like counseling gatekeepers and decision-makers of the family. Review the eligible couple list and support in identifying non-users in the catchment area of ASHAs.
2. Demonstrate the use of job aid and providing informed choice.
3. Coaching ASHAs on availing benefits of the government schemes like ESB scheme and support in documentation
4. Work related to UHIR, vouchers, ANMs can deploy a tactic of pairing up one good performing ASHA with other ASHAs to coach them on reports and voucher filling, completing and updating UHIR.

ANMs must take all the above steps when a new ASHA joins.

ASHA and ANM meeting platform lead by MOICs should be used to review, motivate and regularly coach ASHAs and ANMs, check UHIR and documentation work, and support low performing ASHAs. ASHAs should be encouraged to share positive experiences and challenges during ASHA and ANM review meetings. UHC/CCPM should also participate in ASHA and ANM meeting.

Recognizing and rewarding ASHAs who perform well, contributes to maintaining motivation of ASHAs and helps prevent drop-outs.