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1. Warriors of hope: On India’s ASHA’s, inadequate compensation
When an acronym was coined to refer to a newly created cadre of health workers for the country, as political gestures often do, care was taken to ensure the word invoked a sense of promise. The government decided to call them Accredited Social Health Activists (ASHA, which means “hope” in Hindi). In 2005, the Centre launched the National Rural Health Mission and nominated ASHAs as the link between the community and the public health-care delivery system.
Role of ASHAs in healthcare
Today, there are over a million ASHAs across the country, each firmly established as the fulcrum of public health care in rural India. They now perform a full complement of functions: recording birth and death data, implementing interventions for non-communicable and communicable diseases, addressing neglected tropical diseases, and playing a crucial role in reproductive, maternal, newborn, child, and adolescent health. Additionally, they monitor health, hygiene, and sanitation in their communities.
Global Recognition
The role ASHAs played during the COVID-19 pandemic as trusted health-care workers significantly raised their profile, gaining global recognition. In 2022, they were awarded the WHO Director-General’s Global Health Leaders Award for their outstanding contribution to protecting and promoting health. A recent PLOS Global Public Health study established that women who were connected with ASHAs were 1.6 times more likely to access maternal services and have a safer, institution-based delivery.
Ongoing Struggle
And yet, 20 years after their creation, ASHAs are still protesting on the streets for fair wages and equitable treatment. The flaw lies in how they were designated at their inception—as volunteers. As a result, they remain eligible only for a meagre fixed salary from the Centre, while the rest of their compensation comes in the form of incentives (shared by the Centre and States) based on deliverables, such as facilitating institutional births. Estimates suggest that an ASHA worker earns between ₹5,000 and ₹15,000 a month.
In 2018, the government approved an ASHA benefit package, covering accidents, deaths, and disabilities. However, the reality remains harsh: ASHAs work long hours, travel long distances, frequently miss meals, and have little time for their own health needs.
It is high time the government fulfills the hopes of its “warriors of hope” by treating ASHAs as permanent employees instead of volunteers. This will ensure they receive adequate compensation and emoluments comparable to government employees, recognizing the indispensable role they play in India’s health-care system.
Disclaimer:
This analysis is based on the editorial content published in The Hindu and is intended solely for informational and educational purposes. The views, opinions, and interpretations expressed herein are those of the author of original article. Readers are encouraged to refer to the original article for complete context and to exercise their own judgment while interpreting the analysis. The analysis does not constitute professional advice or endorsement of any political, economic, or social perspective.
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