Accredited Social Health Activists

• 12 Oct 2023

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,

Source: DTE

Why in News?

Recently, a study published in the journal Social Science and Medicine has unveiled the hidden struggles faced by Accredited Social Health Activists (ASHA) in India.

• The study exposes a significant research gap, with over 50% of prior articles solely focusing on the health system's perspective, overlooking ASHA workers' individual struggles. It engaged 59 ASHA workers in six focus groups, allowing them to openly discuss their work-related stress, encompassing workload, gender, caste discrimination, and relationship dynamics.

What are the Key Findings from the Study?

• Caste Discrimination:
  • Many ASHAs recounted instances where they were discriminated against based on their caste.
    • ASHA workers were not allowed inside the homes of residents belonging to a higher social caste. In some instances they were permitted entry but denied a seat on the chair.
• Gender-Based Disrespect:
  • ASHA workers experienced derogatory comments and discriminatory behaviour from community members when seen in public with men who were not their family members.
    • These incidents also extended to their interactions with male relatives of patients or counselling male clients on reproductive health and family planning.
• Toxic Work Relationships:
  • ASHA workers described their interactions with supervisors, auxiliary nurse midwives (ANMs), medical officers, and hospital staff as unhealthy, bordering on toxic. Instances of insensitivity and lack of support were common.
• Domestic Conflicts:
  • Balancing their work and domestic responsibilities often led to conflicts at home, sometimes to the extent of divorce threats.
    • Many ASHA workers had to grapple with the pressure of fulfilling their familial duties while performing their demanding jobs.
• The Need for Support and Coping Mechanisms:
  • The study suggests that with appropriate support and coping mechanisms, ASHA workers can better manage their stress.

What is Accredited Social Health Activists (ASHA)?

• About:
  • The ASHA program was launched in 2005-06 as part of the National Rural Health Mission, initially in rural areas.
    • It was later extended to urban settings with the introduction of the National Urban Health Mission in 2013.
  • The ASHA programme was introduced as a key component of the community process intervention and now it has emerged as the largest community health worker programme in the world and is considered a critical contribution to enabling people's participation in health.
    • As of June 2022, there are over 10.52 Lakh ASHAs in all states/UTs (except Goa).
• Role of ASHA:
  • ASHA is a community-level worker whose role is to function as a health care facilitator, and a service provider and to generate awareness on health issues.
  • Besides delivering key services to maternal child health and family planning, they also render important services under the National Disease Control Programme.
  • ASHA workers, all women, serve populations of approximately 1,000 in rural areas and 2,000 in urban settings, with room for local adjustments.
    • Generally, there is “1 ASHA per 1000 population”. However, this norm can be relaxed in tribal, hilly and desert areas to “1 ASHA per habitation” depending upon the workload.
• Selection of ASHA:
  • ASHA must primarily be a woman resident of the village married/ widowed/ divorced, preferably in the age group of 25 to 45 years.
  • She should be a literate woman with due preference in selection to those who are qualified up to 10 standard wherever they are interested and available in good numbers. This may be relaxed only if no suitable person with this qualification is available.
  • ASHA workers are not recognized as the government's "workers", but are instead classified as holding an "honorary/volunteer" position.

Way Forward

• Establish mentorship initiatives to provide ASHAs with emotional support and guidance. Empower them to navigate the complexities they face.
• Strengthen advocacy efforts to address caste and gender discrimination, ensuring ASHAs are treated with dignity and respect in their communities.
• Create open channels of communication between ASHAs and their supervisors to encourage constructive dialogue, understanding, and collaboration.
• Educate ASHAs' families about the significance of their work, fostering support and understanding. Highlight how their efforts benefit the entire community.
  • Explore flexible working arrangements to help ASHAs balance their work and family responsibilities effectively.
• Promote community-wide recognition of ASHAs' contributions, instilling a sense of pride and appreciation.

UPSC Civil Services Examination, Previous Year Questions (PYQs)

Prelims

Q. With reference to the National Rural Health Mission, which of the following are the jobs of ‘ASHA’, a trained community health worker? (2012)

1. Accompanying women to the health facility for antenatal care checkup
2. Using pregnancy test kits for early detection of pregnancy
3. Providing information on nutrition and immunisation.
4. Conducting the delivery of baby

Select the correct answer using the codes given below:

(a) 1, 2 and 3 only
(b) 2 and 4 only
(c) 1 and 3 only
(d) 1, 2, 3 and 4

Ans: (a)