ACCREDITED SOCIAL HEALTH ACTIVISTS (ASHAs)
1. Context
For over two months now, a section of Kerala’s 26,125-strong community of Accredited Social Health Activists (ASHAs) have been on a day-night agitation on the streets demanding better remuneration and retirement benefits. While the agitation gained much attention and was also raised in Parliament, the issues raised by the ASHAs remain unresolved
2. Accredited Social Health Activists (ASHAs)
- Accredited Social Health Activists (ASHAs) are a vital component of India’s public healthcare system, especially in rural and underserved areas. Introduced under the National Rural Health Mission (NRHM) in 2005 (now part of the National Health Mission), ASHAs are community-based female health workers selected from within the village itself.
- Their main role is to act as a bridge between the community and the public health system, ensuring that people, especially women and children, are aware of and can access essential health services.
- An ASHA is usually a woman resident of the village she serves, ideally between the ages of 25 to 45, with a minimum education level of 8th grade. Being a local resident allows her to understand the cultural dynamics, language, and healthcare challenges of her community.
- She is not a full-time government employee but works as a volunteer and is incentivized based on her performance and the health services she facilitates.
- ASHAs are trained to provide basic health education and first-contact healthcare. They promote institutional deliveries by encouraging pregnant women to give birth at health facilities, support immunization drives, and counsel mothers on breastfeeding, nutrition, and hygiene.
- They also assist in identifying symptoms of diseases such as tuberculosis and malaria, refer patients to appropriate health centers, and help ensure adherence to treatment protocols.
- Importantly, ASHAs play a critical role in maternal and child health. They visit pregnant women regularly, help arrange antenatal check-ups, and provide information about birth preparedness and postnatal care. Their efforts have significantly contributed to the improvement of maternal and child health indicators in many parts of the country.
- During health emergencies like the COVID-19 pandemic, the role of ASHAs became even more crucial.
- They were on the frontlines—spreading awareness about safety measures, tracking symptoms, conducting door-to-door surveys, and coordinating the delivery of medicines and essentials to households in isolation.
- Despite their immense contribution, ASHAs often face challenges such as low or delayed remuneration, high workloads, and lack of adequate support or recognition.
- Nonetheless, their grassroots presence and trust within communities have made them indispensable to India’s public health outreach, making them a cornerstone in achieving health-related goals and promoting community well-being
3. Accredited Social Health Activist Functions
- The functions of an Accredited Social Health Activist (ASHA) are wide-ranging and focus on promoting health awareness, facilitating access to healthcare services, and providing basic healthcare at the community level. ASHAs serve as a crucial link between the public health system and the rural population. Their key functions can be broadly explained as follows:
- ASHAs act primarily as health educators and promoters in their communities. They spread awareness about important health-related issues such as maternal and child health, family planning, nutrition, sanitation, personal hygiene, and the prevention and control of communicable and non-communicable diseases.
- By conducting household visits and group meetings, they educate families about healthy practices and encourage behavior change toward improved health outcomes.
- Another major function of ASHAs is to promote and facilitate the use of health services provided by the government.
- They encourage pregnant women to register for antenatal care, support them in receiving tetanus toxoid injections and iron-folic acid supplements, and promote institutional deliveries by linking them with nearby health facilities.
- They also ensure that newborns and infants receive timely immunization and monitor the growth and development of children.
- ASHAs also play a vital role in community-level disease control and surveillance. They help in the early identification of symptoms of diseases such as tuberculosis, malaria, leprosy, and other communicable illnesses.
- Once identified, they guide the patients to appropriate health centers and follow up to ensure the completion of treatment. Their support is also crucial in managing chronic illnesses and providing home-based care for minor ailments.
- In addition to this, ASHAs are trained to provide basic first-aid and certain essential medicines such as oral rehydration salts (ORS), iron tablets, contraceptives, and antimalarial drugs.
- They also assist in distributing health commodities and support the implementation of national health programs at the village level, including those related to child nutrition, sanitation, and adolescent health.
- During public health emergencies such as pandemics or outbreaks, ASHAs become the first responders in their communities. They help in spreading accurate information, maintaining records of symptomatic individuals, facilitating testing and vaccination, and coordinating relief support.
- Overall, ASHAs play a multipurpose role that includes being a healthcare facilitator, a service provider, a social mobilizer, and a key figure in strengthening the grassroots healthcare delivery system in India
4. Protests in Kerala
- In Kerala, Accredited Social Health Activists (ASHAs) receive a monthly honorarium of ₹7,000 along with a fixed incentive of ₹3,000. Additional incentives are provided based on the specific regions they serve, such as tribal areas.
- However, the disbursement of both the honorarium and incentives is contingent upon meeting certain work-related performance criteria. The State government is responsible for the honorarium, while the incentives are jointly funded by the Centre and the State in a 60:40 ratio.
- According to the State, Kerala offers one of the most generous honorarium packages for ASHAs in the country. Yet, the incentive rates provided by the Union government have remained unchanged since the scheme was launched.
- Health Minister Veena George claimed that most ASHAs in Kerala earn between ₹10,000 and ₹13,000 per month.
- This was challenged by the ASHAs themselves, who asserted that they receive significantly less in practice, primarily due to the stringent conditions attached to the payments. In a state known for its high minimum wage standards—where daily wages for various occupations range from ₹700 to ₹1,200—ASHAs effectively earn less than ₹250 per day.
- While a key demand from ASHAs is the immediate release of pending dues, they are also calling for the removal of performance-based criteria for receiving their honorarium. Their primary appeal is for an increase in the monthly honorarium to ₹21,000, which would align their earnings with the state’s minimum wage of ₹700 per day.
- Additionally, they are seeking a retirement benefit of ₹5 lakh as a lump sum. When the ASHA program was first introduced in 2005, it envisioned these workers as community health volunteers rather than formal employees.
- As a result, ASHAs do not receive a fixed salary, pension, or social security benefits. They argue that unless they are officially recognized as part of the regular healthcare workforce, they will continue to be marginalized
5. Way Forward
The Union Health Minister recently informed the Rajya Sabha that the incentive structure for ASHAs is set to be revised. However, no specific timeline has been provided for when this revision will take place.
In the previous round of discussions, the State Government proposed forming a committee to examine various concerns raised by ASHAs, including the demand for an increase in their honorarium. Meanwhile, the Kerala Accredited Health Workers Association (KAHWA) recommended an interim raise of ₹3,000 per month—equivalent to a daily increment of ₹100. This proposal, however, was turned down by the State Government
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For Prelims: Accredited Social Health Activists (ASHA) , National Health Mission
For Mains: Role and Significance of ASHA in India's healthcare system, Issues Relating to the Management of Social Sector/Services relating to Health and Human Resources
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Previous Year Questions
1.With reference to the National Rural Health Mission, which of the following are the jobs of ‘ASHA’, a trained community health worker? (2012)
Select the correct answer using the codes given below: (a) 1, 2 and 3 only |
Source: The Hindu
