When an acronym was coined to refer to a newly-created cadre of health workers for the country, as political gestures are wont to, care was taken to ensure the word invoked a sense of promise. The government decided to call them Accredited Social Health Activists (ASHA in Hindi means hope). In 2005, the Centre launched the National Rural Health Mission, and nominated ASHAs to be the link between the community and the public health-care delivery system. Today, there are over a million ASHAs across the country, and each one is firmly ensconced as the fulcrum of public health care in their area of operation in rural India. They now perform a full complement of functions: record birth and death data, implement interventions in non-communicable diseases and communicable diseases, neglected tropical diseases; and serve a crucial reproductive, maternal, new born, child and adolescent health role, among others. Monitoring health, hygiene and sanitation in the community is also upon them. The role that the ASHAs played during the COVID-19 pandemic as health-care workers trusted by the community raised their profile significantly, and the humble Indian health worker went global. The ASHAs were chosen for the WHO Director-General’s Global Health Leaders Award in 2022, and were recognised for their ‘outstanding contribution towards protecting and promoting health’. A recent PLOS Global Public Health study established that the likelihood women access maternal services, and have a safer, institution-based delivery, goes up by 1.6 times if they were connected with ASHAs.
And yet, 20 years after the ASHAs were created, the workers are still on the streets, protesting for fair wages and equitable treatment. The flaw lies in the way they were designated at the inception — as volunteers. As such, they remain eligible only for a meagre fixed salary from the Centre and the rest of the compensation provided as incentive (shared by the Centre and States) against a deliverable, for instance, for facilitating an institutional birth. As per estimates, an ASHA worker can make anything between ₹5,000 and ₹15,000 a month. In 2018, the government approved an ASHA benefit package, providing coverage for accidents, deaths and disability. But the truth is there is a heavy load on the ASHAs; they work long hours, travel long distances, frequently miss meals, and have little time to take care of their own health needs. It is high time that the government fulfils the hopes of its warriors of hope, and treats ASHAs as permanent employees, instead of as volunteers, to enable them to draw adequate compensation and emoluments comparable to what is given to government employees.
Published – March 06, 2025 12:10 am IST