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Asha Template -Form Fill
Interviewer Information
Q01
Name of District
Q02
Interview No.
Q03
Date of Interview
Q04
Time of Interview
Q05
Interviewer Name
Q06
Consent for Audio Recording Given
Yes
No
Demographic Information
A01
Respondent Name
A02
Name of District
A03
Name of Block
A04
Name of Village
A05
Age
A06
Education
A07
How long have you been working as ASHA?
A08
Approximate households in the catchment areas
A09
Population of Catchment areas
In this section, I would like to know about your roles and responsibilities under COVID response, in addition to your routine duties. This would involve discussion about the awareness and screening activities under COVID response.
B01
Are you presently, carrying out any of these routine activities?
Beneficiary mobilization – VHND
Beneficiary Mobilization – Institutional delivery
Beneficiary mobilization – ANC
Beneficiary mobilization – PNC
Routine Immunization
Tracking of HRPs
Referrals – HRPs, LBW etc.
HBNC
Follow-up
Counselling on FP services
Distribution of contraceptives (oral contraceptives and condoms)
Any other (please specify)
B02
During lockdown, were you carrying out any of the routine activities?
Beneficiary mobilization – VHND
Beneficiary Mobilization – Institutional delivery
Beneficiary mobilization – ANC
Beneficiary mobilization – PNC
Routine Immunization
Tracking of HRPs
Referrals – HRPs, LBW etc.
HBNC
Follow-up
Counselling on FP services
Distribution of contraceptives (oral contraceptives and condoms)
Any other (please specify)
B03
When did you start performing the discontinued activity?
B03_1
Beneficiary mobilization – VHND
B03_2
Beneficiary Mobilization – Institutional delivery
B03_3
Beneficiary mobilization – ANC
B03_4
Beneficiary mobilization – PNC
B03_5
Routine Immunization
B03_6
Tracking of HRPs
B03_7
Referrals – HRPs, LBW etc.
B03_8
HBNC
B03_9
Follow-up
B03_10
Counselling on FP services
B03_11
Distribution of contraceptives (oral contraceptives and condoms)
B04
If you were not performing certain routine activities, what were the reasons for not doing those routine activities during lockdown?
B05
Did you face any difficulties availing payment during/after the lockdown period? What were they? What led to these difficulties?
B06
In terms of COVID response, what are the activities being carried out by you currently?
Counselling on Signs and symptoms of COVID
Counseling on home quarantine
Counseling on social distancing and use of masks
Demonstrating Steps of handwashing
Awareness about COVID facilities in your area
Line-listing of households & tracking of migrants (travel history)
Active Surveillance using S form (symptom history)
PCM distribution on symptoms
Referral - on appearance of symptoms
Accompany beneficiaries to COVID facility
Any other (please specify)
B06A
How are these activities being carried out currently?
Home visits for individual counseling
Group counselling
Individual counseling for resistant families (myth mitigation)
Using IEC material
Telephonically/messaging
Whatsapp or other online platform
Any other (please specify)
B07
In terms of COVID response, what are the activities being carried out by during lockdown?
Counselling on Signs and symptoms of COVID
Counseling on home quarantine
Counseling on social distancing and use of masks
Demonstrating Steps of handwashing
Awareness about COVID facilities in your area
Line-listing of households & tracking of migrants (travel history)
Active Surveillance using S form (symptom history)
PCM distribution on symptoms
Referral - on appearance of symptoms
Accompany beneficiaries to COVID facility
Any other (please specify)
B07A
How are these activities being carried during lockdown?
Home visits for individual counseling
Group counselling
Individual counseling for resistant families (myth mitigation)
Using IEC material
Telephonically/messaging
Whatsapp or other online platform
Any other (please specify)
B08
Has the added responsibilities for COVID related work affected you in carrying out your regular work/routine activities? If yes, then in what ways?
B09
Are you getting any incentives in context of added or changed responsibilities due to COVID?
Yes
No
Communication
C01
Do you have any interactions with other FLWs – ANM and AWW?
Yes
No
C02
In context of COVID response, what is the frequency of your interaction with other FLWs?
Yes, with increased frequency
Yes, with same frequency
Yes, with reduced frequency
None
C03
What are the platforms used for the interaction?
In-person
Telephonic
Online platform
Any other (please, specify)
C04
In context of COVID response, what is the role AWW or What is the work they are doing?
C05
Do you have any interactions with your supervisors?
Yes
No
C06
In context of COVID response, what is the frequency of your interaction with supervisor?
Yes, with increased frequency
Yes, with same frequency
Yes, with reduced frequency
None
C07
What are the platforms used for interaction?
In-person
Telephonic
Online platform
Any other (please, specify)
C08
What is the purpose of your interaction?
For routine activities
For activities related to COVID response
Challenges in community outreach
Receipt of Incentives
Any other (please, specify)
C09
Have you received any handholding/mentoring support from your supervisor on activities under COVID response?
Yes
No
C10
During the lockdown, have there been any monitoring visits made by your supervisor?
Yes
No
C11
Has there been any additional supervisor/ reporting authority pertaining to your activities for COVID response?
Yes
No
C12
How has your interaction with supervisor changed during the COVID situation?
Capacity Building
D01
Were you provided any training to carry out activities under COVID response?
Yes
No
D02
What were the areas of training?
Personal protection
Signs and symptoms of COVID
Incubation period
Mode of spread of COVID
Social distancing
Role of FLWs in prevention of COVID
Hand washing technique
Interventions required home quarantine
Reporting
Performing routine activities during lockdown
Any other (please specify)
D03
Can you give us the following details about the trainings you attended?
D03_1
Who gave the training?
GoUP (State)
GoUP (district)
GoUP (block)
Any other partner
D03_2
When was the training given?
One week ago
2 weeks ago
1 month ago
More than a month ago
Don’t know
D03_3
How long was the training?
D03_4
Mode of training
In-person
Telephonic
Online platform
D03_5
Did the training cover all the activities you are currently doing in response to COVID?
Yes
No
D04
Were you provided any of these job aid resources to perform your responsibility for COVID response?
Guidelines
Protective gears
Reporting formats
Fliers/Posters
Any video aid – short films etc.
Modules
SMS
None
Any others
D05
Can you give us the following details about the resources you were provided
D05A
Provided by
D05A_1
Guidelines
GoUP
NGO
Local Leaders / institutions
Any other partners
D05A_2
Protective gears
GoUP
NGO
Local Leaders / institutions
Any other partners
D05A_3
Reporting formats
GoUP
NGO
Local Leaders / institutions
Any other partners
D05A_4
Fliers/Posters
GoUP
NGO
Local Leaders / institutions
Any other partners
D05A_5
Any video aid – short films etc.
GoUP
NGO
Local Leaders / institutions
Any other partners
D05A_6
Modules
GoUP
NGO
Local Leaders / institutions
Any other partners
D05A_7
SMS
GoUP
NGO
Local Leaders / institutions
Any other partners
D05B
When was it provided?
D05B_1
Guidelines
D05B_2
Protective gears
D05B_3
Reporting formats
D05B_4
Fliers/Posters
D05B_5
Any video aid – short films etc.
D05B_6
Modules
D05B_7
SMS
D05C
Were they adequate?
D05C_1
Guidelines
Yes
No
D05C_2
Protective gears
Yes
No
D05C_3
Reporting formats
Yes
No
D05C_4
Fliers/Posters
Yes
No
D05C_5
Any video aid – short films etc.
Yes
No
D05C_6
Modules
Yes
No
D05C_7
SMS
Yes
No
Community Response
E01
Has community been supportive in activities pertaining to COVID response?
Yes
No
E02
Has community been supportive pertaining to performing alternative mechanisms of your routine activities?
Yes
No
E03
What are the challenges` you have faced in performing your routine/alternative mechanism of routine activities or activities pertaining to COVID response in lockdown?
E04
Did people from community reach out to you for seeking any of the health services during the lockdown?
ANC
PNC
Delivery
Immunization
IFA and other supplements
ORS and other medicine
Other medical emergencies
COVID related services
None
E05
How did you respond to the people reaching out to you for certain services during lockdown?
E06
Do you think there will be changes in health seeking behavior and/or health outcomes, due to lockdown situation? If yes, in what ways?
E07
Do you have any concerns while carrying out activities related to COVID response?
E08
In your opinion, what other steps could have been taken by GoUP under COVID response?
E09
We might contact you again in the few months’ time. Would you like to participate in follow up interview?
Yes
No
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