**Question:** Which of the following is not a grass-root level worker: September 2011

A. Auxiliary Nurse Midwife (ANM)
B. Health Extension Worker (HEW)
C. Accredited Social Health Activist (ASHA)
D. Village Health Worker (VHW)

**Core Concept:** Grass-root level health workers are essential components of primary healthcare systems, playing a crucial role in community health promotion, disease prevention, and treatment. These workers are trained to provide basic health services and collaborate with higher-level healthcare professionals.

**Why the Correct Answer is Right:** D) Village Health Worker (VHW) is not mentioned in the list as an established grass-root level worker in the context of September 2011. While VHW might exist in some regions or initiatives, the question specifically asks for established roles in the mentioned timeframe.

**Why Each Wrong Option is Incorrect:**

A) Auxiliary Nurse Midwife (ANM): ANMs are trained nurses who work at the Community Health Centre (CHC) level in India. Although they are not at the grass-root level, they are a higher level of healthcare worker, thus making option A incorrect.

B) Health Extension Worker (HEW): HEWs are primary healthcare workers found in Ethiopia, not relevant to the context of September 2011 in India.

C) Accredited Social Health Activist (ASHA): ASHAs are trained community health workers in India, working at the grass-root level. This option is relevant and correct, making options A, B, and D incorrect.

**Clinical Pearl / High-Yield Fact:**

Grass-root level health workers play a vital role in primary healthcare delivery, community health education, and disease surveillance. Examples include ASHAs in India and CHWs (Community Health Workers) in various countries. Establishing and supporting these workers can significantly improve access to healthcare services, especially in rural or underserved areas.