Scheme Primer
Health & Nutrition
ngo-practitioners
NHM and the ASHA Programme — India's Last-Mile Health Architecture
Last verified: May 2026 · 8 min read · JaBaSu Knowledge Commons
At a Glance
| Parameter |
Detail |
| Full Name |
National Health Mission (NHM) — ASHA Component |
| NHM Launched |
2013 (subsuming NRHM 2005 and NUHM 2013) |
| ASHA Launched |
2005 (under NRHM) |
| Nodal Ministry |
Ministry of Health and Family Welfare |
| Status |
Active — India's largest community health programme |
| ASHA Scale |
Over 10.4 lakh (1.04 million) ASHAs nationwide |
| Odisha |
~45,000 ASHAs; NHM Odisha headed by Mission Director Dr. Brundha D, IAS |
| Community structure (Odisha) |
~45,000 Gaon Kalyan Samitis (GKS) — Odisha's equivalent of VHSNC |
| ASHA fixed incentive |
Rs. 1,000–Rs. 2,000/month (state-supplemented; minimum Rs. 2,000 in most EAG states) |
| ASHA variable incentives |
Performance-based; cumulative average varies but can reach Rs. 4,000-6,000/month for active ASHAs |
| Official portal |
nhm.gov.in; nhmodisha.gov.in |
| Helpline (NHM) |
104 (health helpline); 102 (ambulance) |
What Is NHM?
The National Health Mission (NHM) is India's overarching framework for strengthening the public health system and delivering universal health coverage — with particular focus on rural, tribal, and marginalised communities. Launched in 2005 as the National Rural Health Mission (NRHM) and expanded in 2013 to include the National Urban Health Mission (NUHM) under an overarching NHM, it is the financial and institutional vehicle through which nearly all primary and secondary health investments at the public level are channelled.
NHM does not deliver a single scheme to individual beneficiaries in the way that PM-KISAN or Subhadra Yojana do. Instead, it builds and funds the health system infrastructure — health centres, health workers, medicines, diagnostics, institutional delivery incentives, disease surveillance, maternal and child health programmes — through which all health benefits are delivered.
For NGOs, NHM is most immediately relevant through three components: the ASHA programme (India's community health volunteer army); the JSSK maternal and infant entitlements (Janani Shishu Suraksha Karyakram); and the Village Health, Sanitation, and Nutrition Committees (VHSNCs — called Gaon Kalyan Samitis in Odisha). All three are documented in this primer.
The ASHA — Accredited Social Health Activist
The ASHA is the most consequential community health innovation in modern Indian public health. One ASHA per 1,000 rural population — a local woman, resident of the village, selected by and accountable to her community — who serves as the primary link between the community and the health system.
The ASHA's role spans prevention, promotion, facilitation, and referral:
Maternal health: Registers pregnancies within the first trimester; facilitates 4 antenatal check-ups at the PHC; accompanies women to the health facility for institutional delivery; conducts 7 Home Based Newborn Care (HBNC) visits after birth; facilitates immunisation of the newborn.
Immunisation: Maintains a vaccination due list for all children under 5 in her village; mobilises families for Routine Immunisation sessions and Intensified Mission Indradhanush drives; follows up on missed children.
Disease management: Facilitates diagnosis and treatment adherence for TB patients under NTEP; malaria surveillance (blood slide collection and RDT in malaria-endemic areas including Odisha's tribal districts); leprosy case detection and treatment support.
NCD screening: In districts implementing AAM NCD screening, supports the CHO's household-level screening of hypertension, diabetes, and common cancers by mobilising community members and maintaining registers.
Family planning: Counsels eligible couples on family planning options; distributes contraceptive pills, condoms, and sanitary napkins; facilitates sterilisation services.
Nutrition: Supports AWW in POSHAN 2.0 activities; conducts HBNC visits that include weighing and nutrition counselling for new mothers; identifies SAM children for AWC referral.
ASHA Incentives — How ASHAs Are Paid
ASHAs are not employees of the government. They are community health volunteers who receive performance-based incentives for specific activities. The incentive structure has evolved significantly since 2005 and now has two components:
Fixed Monthly Incentive: Rs. 1,000-Rs. 2,000 per month (varies by state; Odisha provides a fixed component linked to activity completion targets). The NHM national circular of July 2025 updated the incentive schedule.
Variable Incentives (task-based): Paid for specific completed activities. Key examples:
- Rs. 600 for facilitating institutional delivery (EAG states including Odisha)
- Rs. 300 for completing 7 HBNC visits post-delivery
- Rs. 500 per SAM child referred and treated
- Rs. 500 for TB patient referral and treatment initiation
- Rs. 75 per household motivated to take a JJM tap connection
- Rs. 150/round for motivating eligible couples for family planning
- Rs. 200 for transportation support to women seeking safe abortion
A highly active ASHA in a rural Odisha block can earn Rs. 4,000-6,000/month in combined fixed and variable incentives — but this requires diligent activity completion, accurate record-keeping, and timely submission. Payment delays are chronic in many states.
JSSK — Janani Shishu Suraksha Karyakram — What Pregnant Women Are Entitled To
JSSK, launched under NHM in 2011, provides absolutely free services to all pregnant women and sick newborns at government health facilities — with no conditionality, no income criterion:
- Free normal and caesarean delivery at government facilities
- Free drugs, sutures, and consumables
- Free diagnostics (blood tests, ultrasound)
- Free diet for inpatient stay (Rs. 100/day for 3 days for normal delivery; 7 days for C-section)
- Free transport from home to facility, and return after delivery
- Free treatment of sick newborns up to 30 days after birth
- Zero out-of-pocket expenditure at any government facility
In Odisha, which is an EAG (Empowered Action Group) Low Performing State for institutional delivery, JSSK entitlements are enhanced — and the ASHA's incentive for institutional delivery facilitation is also higher than in High Performing States.
Gaon Kalyan Samiti — Odisha's Village Health Governance Body
Every revenue village in Odisha has a Gaon Kalyan Samiti (GKS) — Odisha's equivalent of the national Village Health, Sanitation, and Nutrition Committee (VHSNC). There are approximately 45,000 GKS across Odisha.
The GKS structure: Ward Member (as President), Anganwadi Worker (as Convener), and ASHA (as Facilitator). The GKS receives an annual untied fund of Rs. 10,000 from NHM to take local action on health-related issues — purchasing medicines, supporting a health camp, arranging sanitation materials, or any other locally prioritised health need.
The GKS is theoretically the community health planning and accountability body — a gram sabha-adjacent institution with health-specific authority. In practice, GKS functionality is highly variable. NGOs with community institution-building experience can help GKS committees hold regular meetings, utilise their Rs. 10,000 annual funds purposively, and link with the local AAM (Ayushman Arogya Mandir) CHO for joint health planning.
What NGOs Need to Know — the Practical Reality
1
ASHA payment delays are the system's most damaging dysfunction. Across India — and in Odisha — ASHA incentive payments are routinely delayed by 2-4 months. An ASHA who has conducted 30 household visits, 5 deliveries, and 15 immunisation sessions in a month waits for payment while managing her household on whatever her family's other income provides. Payment delays cause activity reduction, low morale, and ASHA dropout. NGOs can specifically document and formally escalate systematic payment delays to the BMO and NHM District Programme Manager.
2
Tribal ASHAs face the hardest conditions and the lowest documentation support. ASHAs in PVTG habitations and remote tribal blocks — who often work in the most difficult terrain, serve the highest-risk communities, and cover the largest geographic areas — are the most likely to face documentation problems that reduce their incentive payments. NGOs can train tribal ASHAs in incentive documentation, help them maintain activity registers, and facilitate monthly verification at PHC level.
3
The ASHA-CHO-ANM coordination is the health system's critical joint. Effective primary health care at the village level requires the ASHA (community volunteer), ANM (Auxiliary Nurse Midwife, at sub-centre), and CHO (Community Health Officer, at AAM) to work as a coordinated team. In practice, these three roles sometimes duplicate effort, sometimes create gaps, and rarely have structured coordination meetings. NGOs can facilitate joint village-level health planning sessions that use GKS meetings as the coordination platform.
4
Odisha is an EAG state — both burden and opportunity. Odisha's designation as a Low Performing State for maternal and child health indicators means it receives additional NHM funding, enhanced JSSK provisions, and higher ASHA incentives for institutional deliveries. This creates a funding environment where NGO health programmes can leverage NHM resources more substantially than in High Performing States.
5
NHM funds the ecosystem — but cannot reach everywhere. The most remote tribal habitations — PVTG areas in Malkangiri's interior, forest-adjacent villages in Nabarangpur, island habitations — often have ASHA positions that are vacant or filled by under-supported women who cannot access the training, supply, and supervision that makes ASHA work effective. NGOs with field presence in these areas are the only institutional support available.
How JaBaSu Helps NGOs Connect Their Communities
ASHA payment escalation
JaBaSu formally escalates chronic ASHA payment delays in partner NGO areas to the NHM District Programme Manager and the CDMO — using documented data from partner NGO field teams.
GKS activation support
JaBaSu provides partner NGOs with GKS meeting facilitation tools, Rs. 10,000 fund utilisation guidelines, and coordination frameworks with AAM CHOs — helping transform nominal GKS structures into functional health governance bodies.
NHM convergence mapping
JaBaSu helps partner NGOs map which NHM-funded services are operational in their areas (JSSK, Janani Express ambulance, institutional delivery incentives, immunisation schedule) and which are gaps — creating a community health entitlement register.
Block Medical Officer interface
JaBaSu's Government Interface team maintains relationships with Block Medical Officers (BMOs) in Odisha's tribal districts — facilitating partner NGO coordination with the health system for specific community health programme integration.