Asha Workers : Creating an Oasis in the Last Mile.
The other day I was watching the issues of ASHA (Accredited Social Health Activists) workers in Video Volunteers a.k.a. VV (www.videovolunteers.org, a community media non profit based in Goa and NY) website. They have community correspondents from across India creating ground reports of the media dark areas. These ground reports on ASHA workers give you an understanding of the welfare economics and the harsh realities they are facing now in India. They, the ASHA workers are consistently at the forefront of Covid care and relief without necessary remunerations and even safety kits. I wondered how they have embedded the ‘thinking beyond self’ idea collectively in their hearts!?
These ASHA workers were instituted by ‘Ministry of Health and Family Welfare’ under ‘National Rural Health Mission.’ Formed in 2005, their target was to have 10 lakh workers under this scheme - “An ASHA in every village” (There are just a little less than a million villages in India). ASHA workers are at the bottom of the pyramid - the humane interface between the community and Indian Public Health System - standing in the last mile.
Their main job is to create awareness and mobilise the community towards utilisation of central and local public health plans and programs. ASHA workers, post their training, provide minimal curative care at community level and refer the needy to nearby health centres. As an interface, she is the voice of the Government’s health and family welfare services at community level - whether it is information about existing health services or awareness about basic sanitation and hygiene practices. (1)
After the devastating 2nd wave of Covid -19, India is expecting a 3rd wave and already there are cases rising across the country, of a mutant variation called the Delta. In this pessimistic scenario, us, Indians, and more specifically the people who are staying in remote areas, far flung villages, away from regular access to healthcare, are obliged to rely heavily on the ASHA workers. After the deadly 2nd Wave this year, we, the citizens, expect the Government and the Policy Makers to take note of the situation and prepare a comprehensive plan for addressing this issue.?
Mrs. Nirmala Sitharaman, The Finance Minister, in her budget speech this year allocated 2.23 lakh crore for ‘Health and Well Being’ expenditure (2) But this ‘Health and Well being’ includes “Drinking Water and Sanitation’, ‘Nutrition’, ‘Covid 19 vaccine related special allocation’ and the ‘Finance Commission’s Grants’ - and the money is distributed in these barrels. The Government is stating this as a Holistic approach to health’ (for e.g. - safe drinking water, open defecation free villages, nutrition supplements etc) but there’s hardly any thought on Public Health Service delivery.?
India is almost at par with China, population wise, and public health services delivery is extremely critical because of this volume. (3) Government is implementing many policies to minimise the disparities in economic inequalities but there is a glaring gap in health disparities between social and economic classes. India has the lowest density of health workforce (World Health Statistics 2015) and the situation is particularly worse in rural areas. This is one of the prime reasons we should be ever thankful to the ASHA workers, they are the bridge that connects the rural community with the much needed health care system, for a healthy, dignified India.
We now know that responsibility of health delivery in rural and semi urban India is on the shoulders of ASHA workers. But the issue is that they do not get monthly salaries, their job is not regulated, they work without health insurance and basically get paid through incentives. Add a layer more, their payments are often delayed or deducted. And on top of that, the Government is providing them a meagre amount of safety or testing equipment (4). There are plenty of newspaper articles published regarding this problem.?
ASHA workers were asked to do Covid related surveys and relief work, apart from their regular work (Maternal health and awareness), from the start of the pandemic. There are around 9.5 lakh ASHA workers and their struggles are a pan India phenomenon now. There are protests coming up by them in Delhi, Madhya Pradesh, Chattisgarh and many other areas with their demand for better remuneration, regularisation of jobs, timely payment, health insurance, protective equipment allocation and their personal safety.
We hope that the Government will make the Public Health System more responsive to the needs of ASHA workers. In Maharashtra, this June, they went on a week long strike and Health Minister Rajesh Tope announced an increment of 1500 Rupees along with Health Insurance and Smart Phones. (5) The irony is that they have to go on a strike to get their demands fulfilled. You can search for ‘ASHA’ on the Video Volunteers website to know more about the ground situation and grievances.
Ideally, our frontline workers should be equipped to take on this impending 3rd wave and they should be compensated for their earlier work and dues, with regularisation of their salaries. 110 of ASHA workers died due to covid in these two years while at work. Video Volunteers and several other NGOs and publications are consistently raising these issues for better investment in the Public Health Delivery system, through various mediums. This support of the civil society organisations for ASHA workers is a ray of hope now, for them.
The next campaign of VV is crucial. Started in September, they will be addressing this issue on a war footing, with a determination that the ASHA workers grievances are fulfilled, before the impending 3rd wave. This is important because if the civil society is silent about the woes of these front line, selfless workers, their voice may stay unheard. Video Volunteers are raising these seven points below and request other civil society organisations to collaborate with them.
11 Demands of the ASHA Workers : (Written in Hindi followed by English)
https://docs.google.com/forms/d/e/1FAIpQLSdmp5FImpa2Gi5qhbmxweKaiaGOMf8uJTjBQh4Wp6Sodo0N_A/viewform?
Hope the Government and Policy Makers will be empathetic to these collective demands and proactive in their implementations. We can not afford to lose another ASHA worker, she’s not an individual, she’s the embodiment of hope for all the people she connects with.
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Footnotes/ Sources -?
Budget Allocation for Public Health
VV Videos on ASHA workers-?