ASHA Workers & Related Challenges

• 28 Feb 2024

For Prelims: Accredited Social Health Activist, National Rural Health Mission, ORS, Anaemia, Malnutrition, Non-communicable diseases

For Mains: Major Roles and Responsibilities of ASHA Workers and Challenges Faced by Them.

Source: TH

Why in News?

The recent protest by Accredited Social Health Activist (ASHA) workers in Bengaluru underscores persistent concerns surrounding their working conditions and pay, shedding light on challenges within India's rural healthcare system.

Who are ASHA Workers and What are their Responsibilities?

• Background: In 2002, Chhattisgarh pioneered a revolutionary approach to community healthcare by appointing women as Mitanins, or community health workers.
  • Mitanins served as advocates for underprivileged communities, bridging the gap between distant health systems and local needs.
  • Inspired by the success of Mitanins, the central government launched the ASHA program in 2005-06 under the National Rural Health Mission and expanded to urban areas with the introduction of the National Urban Health Mission in 2013.
• About: Selected from the village itself and accountable to it, the ASHA workers are trained to work as an interface between the community and the public health system.
  • They are primarily women residents of villages, aged between 25 to 45 years, preferably literate up to 10th grade.
  • Typically, there is 1 ASHA for every 1000 people. However, in tribal, hilly, and desert regions, this ratio may be adjusted to one ASHA per habitation based on workload.
• Major Responsibilities:
  • They serve as the first point of contact for health-related needs, especially for women and children.
  • They receive performance-based incentives for promoting immunization, reproductive & child health services, and construction of household toilets.
  • They counsel on birth preparedness, safe delivery, breastfeeding, immunization, contraception, and prevention of common infections.
  • They facilitate community access to health services available at Anganwadi/sub-centre/primary health centers.
  • They act as depot holders for essential provisions like ORS, IFA tablets, contraceptives, etc.

What are the Challenges Faced by ASHA Workers?

• Heavy Workload: ASHAs are often burdened with multiple responsibilities, it sometimes becomes overwhelming, especially considering the vast scope of their duties.
  • Also, they themselves remain at risk of anaemia, malnutrition and non-communicable diseases.
• Inadequate Compensation: ASHAs, primarily relying on meager honorariums, face economic challenges aggravated by delayed payments and out-of-pocket expenses.
  • They lack basic support like social security benefits like leave, provident fund, gratuity, pension, medical assistance, life insurance and maternity benefits.
• Lack of Adequate Recognition: ASHAs' contributions are not always recognized or valued, leading to feelings of underappreciation and frustration.
• Lack of Supportive Infrastructure: ASHAs face challenges related to inadequate infrastructure, including limited access to transportation, communication facilities, and medical supplies. This hinders their ability to effectively carry out their duties.
• Gender and Caste Discrimination: ASHAs, who are predominantly women from marginalised communities, face discrimination based on gender and caste within the healthcare system.

Way Forward

• Formalise Employment Status: There is a need to transition ASHA workers from voluntary positions to formalized employment status within the healthcare system.
  • This would provide them with job security, regular salaries, and access to benefits such as health insurance and paid leave.
• Strengthen Infrastructure and Logistics: Investing in improving infrastructure, logistics, and supply chain management to ensure ASHA workers have access to essential equipment, supplies, and transportation is also important.
• Recognition and Rewards: instituting formal recognition and rewards programs to acknowledge the contributions and achievements of ASHA workers, such as certificates of appreciation, public recognition ceremonies, or performance-based bonuses.
  • They also need to be provided with opportunities for career advancement within the existing healthcare system, leading to positions such as Auxiliary Nurse Midwives (ANMs).

UPSC Civil Services Examination, Previous Year Questions (PYQs)

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 immunization.
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)