Introduction
The ASHA (Accredited Social Health Activists) workers, working under the NRHM (National Rural Health Mission), should be praised and rewarded for their seminal role in improving the social indicators related to rural women and children. As of date there are more than 9 lakh women working as Accredited Social Health Activists in the country and they constitute the backbone of rural healthcare for women and infants. Unfortunately, they are not treated at par with other government employees working in the health sector.
Their working
conditions are dismal and they do not enjoy the status of regular government
employees. Of late, however, ASHA workers have begun organizing themselves, and
have also been participating in agitations in different states for improvement
in their working conditions.
The NRHM was established in April 2005, in 18 different states to provide
health care services to those regions in India which were the most backward
with respect to health care services. The ASHAs are local women trained to act
as health educators and promoters in their communities. The Ministry of Health
and Family Welfare, Government of India describes them as:
‘...health activists in the community, who will create awareness on health and
its social determinants, and mobilize the community towards local health
planning and increased utilization and accountability of the existing health
services.’
Their tasks include motivating women to give birth in hospitals, bringing
children to immunization clinics, encouraging family planning (e.g., surgical
sterilization), treating basic illness and injury with first aid, keeping demographic
records, and improving village sanitation. ASHAs are also meant to serve as a
key communication mechanism between the healthcare system and rural
populations.
As of now, the ASHA workers are only given performance-based incentives since
they are regarded as ‘honorary volunteers. In August 2014, replying to a
question during the Question Hour in the Rajya Sabha, the then Union Minister
for Health and Family welfare, Dr. Harsh Vardhan had replied,” there is no
proposal to give them (ASHA Workers) benefits like Government employees.”
Dr- Harsh Vardhan had also made a
startling statement that ASHA workers were getting an honorarium of only Rs.
800 to Rs.3000 in the different States of India. Putting this in perspective
one can see that an agricultural laborer in Haryana may earn Rs. 400 per day
and an ASHA worker four times less! Not only this, there are several financial
irregularities in the NRHM, which directly affect the ASHA workers. When the CBI inquired into the NRHM scam in Uttar Pradesh, after the
Allahabad High Court intervened2, it came to be known that the funds which had
been allocated for these health workers under the ‘safe motherhood programme’
or Janani Suraksha Yojana had actually never reached them and had been siphoned
off by the corrupt CMOs and medical officers working at the lower levels.
Subsequently, under the Mayawati regime, the CBI had only filed a preliminary
report and the affected ASHA workers could never get any compensation for the
loss suffered by them. While the ASHA workers are struggling for the status of
permanent government employees, in the last fiscal year, the Government
drastically slashed the allocation already made to the Union Health Ministry by
10 percent, which comes to around Rs. 2400 crore. The result was that the
agenda of expansion of the NRHM was badly hit, because of which further recruitment of ASHA workers was
stalled; the shortfall in the employees’ strength falling in the range of 20-30
percent. (Estimate of the National Commission for Macroeconomics and Health,
NCMH) The NRHM annual review reports came up with even higher percentages, i.e.,
around 40 percent for different States. We are yet to see what will be the fate
of the election promise of ‘Health for All’.
