Nandan Deoki
Indian Public Health Association.
Indian J Public Health. 2005 Jul-Sep;49(3):168-70.
National Rural Health Mission (NRHM) launched by Government of India holds great hopes and promises to serve the deprived and underserved communities of rural areas. The backbone of the programme is Accredited Social Health Activist (ASHA), which will play major role in the implementation of the programme. The invariable existence of socio-cultural clusters in the community has always been a major challenge to the health care efforts made by the government. Though ASHA is a novel concept to melt the ice in the culture of silence among the various cluster community groups, it is important to emphasize that inter-cluster communication may still pose a problem, which ASHA may be unable to address. Considering the constraints of ASHA and success of cluster community approach in Unicef supported community based Maternal Child Health & Nutrition (MCHN) Project, it is quite reasonable to state that inclusion of community mobilisers (Bal Parivar Mitra) from within the cluster community group might well be an asset to the programme, who may actually bring about the task of spreading the spirit of NRHM. These set of functionaries may work in coordination to bring about the desired behaviour changes and decrease the social delays responsible for maternal and childhood mortality. It will also bring about the feeling of community participation and ownership. The programme is in its initial phase but has years ahead of it to bring visible changes at community level to make it a reality.
印度政府发起的国家农村卫生使命(NRHM)承载着为农村地区贫困和服务不足社区提供服务的巨大希望和承诺。该计划的核心是经认证的社会健康活动家(ASHA),其将在计划实施中发挥主要作用。社区中社会文化群体的始终存在一直是政府医疗保健工作的重大挑战。虽然ASHA是打破各群体社区间沉默文化的一个新概念,但必须强调的是,群体间的沟通可能仍然是个问题,ASHA可能无法解决。考虑到ASHA的局限性以及联合国儿童基金会支持的社区母婴健康与营养(MCHN)项目中群体社区方法的成功,可以合理地说,从群体社区群体中纳入社区动员者(儿童家庭之友)可能对该计划是一项资产,他们实际上可以承担起传播国家农村卫生使命精神的任务。这群工作人员可以协同工作,带来期望的行为改变,并减少导致孕产妇和儿童死亡的社会延误。这也将带来社区参与感和主人翁意识。该计划尚处于初始阶段,但未来还有数年时间才能在社区层面带来明显变化,使其成为现实。