Explained | All about India’s ASHA workers, recipients of WHO’s Global Leaders Award

The story so far: ASHA workers, India’s frontline rural healthcare workers, won the World Health Organisation’s (WHO) 2022 Global Leaders Award announced on Sunday. The honour recognises contributions to advancing global health, leadership, and commitment to regional health issues.

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“At a time when the world is facing an unprecedented convergence of inequity, conflict, food insecurity, the climate crisis and a pandemic, this award recognises those who have made an outstanding contribution to protecting and promoting health around the world,” said WHO Director-General Dr. Tedros Adhanom Ghebreyesus.

ASHA – means ‘hope’ in Hindi. These health workers provide maternal care & immunization for children against vaccine-preventable diseases; community health care; treatment for hypertension & tuberculosis & core areas of health promotion for nutrition, sanitation & healthy living pic.twitter.com/uId27EqjO1

— World Health Organization (WHO) (@WHO) May 22, 2022

A total of six recipients were given the awards. These included Dr. Paul Farmer, Dr. Ahmed Hankir, Ludmila Sofia Oliveira Varela, Polio workers in Afghanistan, and Yōhei Sasakawa.

In a tweet, Prime Minister Narendra Modi applauded the ASHA workers for “ensuring a healthy India”.

Delighted that the entire team of ASHA workers have been conferred the @WHO Director-General’s Global Health Leaders’ Award. Congratulations to all ASHA workers. They are at the forefront of ensuring a healthy India. Their dedication and determination is admirable. https://t.co/o8VO283JQL

— Narendra Modi (@narendramodi) May 23, 2022

Who are ASHA workers?

Accredited Social Health Activist Workers, or ASHA workers, are female community health workers trained to function as a bridge between the community and the public health system. ASHA workers are chosen through a process that involves community groups, self-help groups, Anganwadi Institutions, block nodal officer, district nodal officer, the village health committee and the general body of the village.

ASHA workers were instituted as community-based health functionaries under the National Rural Health Mission (NRHM) launched in 2005.

Women selected to be ASHA workers undergo a series of training programmes that enables them to fulfil their roles as the leader of community participation in community health programmes at village level.

ASHA workers are responsible for promoting nutrition, basic sanitation and hygiene practices, healthy living and working conditions, awareness of existing health services, and the need for timely utilisation of health and family welfare services within their communities. They are also provided with a drug kit to perform primary healthcare functions – ASHA workers are the first responders in situations where deprived sections of the population find it difficult to access healthcare services.

Encouraging women to give birth under safe conditions in hospitals and medical centres is another important responsibility shouldered by ASHA workers.

Members of the local village community can access basic essential medical provisions like oral rehydration solution (ORS), iron-folic acid tablets, chloroquine, disposable delivery kits, oral pills and condoms from ASHA workers.

How are ASHA workers selected?

Married, widowed or divorced women from the village community who possess basic literacy skills are eligible to be trained as ASHA workers. In most cases, women from the village itself are selected as ASHA workers who operate within the local community.

According to the guidelines laid down by the National Health Mission, these women are preferably between 25 and 45 years of age and preference is given to candidates who have qualified up to tenth standard. The education criteria is relaxed only if no qualified person is available.

What is the salary of ASHA workers?

On an average, an ASHA worker earns around ₹6,000-10,000 per month, including monthly honorarium from the Central and State governments, and incentives.

They receive performance-based incentives for promoting India’s universal immunisation programme, referral and escort services for the government’s Reproductive and Child Health (RCH) programme, and construction of household toilets.

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How have ASHA workers helped during the Covid-19 pandemic?

ASHA workers have helped in spreading awareness at the grassroots level during the COVID-19 pandemic. They are tasked with informing their local communities about safety protocols, tracking positive cases, and carrying out the vaccination drive.

Currently, there are around ten lakh ASHA workers across the country.

What are some of the difficulties that ASHA workers have faced during the pandemic?

At the beginning of the COVID-19 pandemic, ASHA workers faced several attacks in different parts of the country during their door-to-door visits for surveillance. ASHA workers were responsible for finding symptomatic patients and people with international or domestic travel history, and executing other tasks related to containment of the spread of the virus. They performed these tasks for no additional payment.

Despite the added responsibilities and demands for increased incentives, ASHA workers complained of not receiving adequate compensation throughout the pandemic. “We have risked our lives and worked during the Covid-19 period, but the government is not paying us. This is wrong,” said 48-year-old ASHA worker Sushila Devi, mother of three. By August 2021, around 6,000 women in Delhi were not paid monthly incentives since April for visiting Covid-19 patients under home isolation.

Non-payment of dues led to multiple protests by ASHA workers across the country. ASHA workers from Haryana, Delhi and Punjab protested near the Parliament in March 2022, alongside Anganwadi and mid-day meal workers, to raise incentives. In Tamil Nadu, ASHA workers staged a demonstration in April to draw the government’s attention to their demands. They have been demanding regularisation of jobs and a consolidated monthly pay of ₹18,000. In May, hundreds of ASHA workers gathered in Bengaluru’s Freedom Park to demand a fix for a web portal that is crucial to their payments.

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