Explained: Who are ASHA workers, the women healthcare volunteers honored by WHO

While congratulatory messages have since poured in from the Prime Minister and the Health Minister among others, the women health volunteers continue to fight for higher remuneration, regular jobs, and even health benefits.

While intermittent protests have been going on in several states, thousands of ASHAs from across the country took to the streets in September last year to fight for their demands.

Who are ASHA workers?

ASHA workers are volunteers from within the community who are trained to provide information and aid people in accessing benefits of various healthcare schemes of the government.

They act as a bridge connecting marginalized communities with facilities such as primary health centres, sub-centres and district hospitals.

The role of these community health volunteers under the National Rural Health Mission (NRHM) was first established in 2005.

ASHAs are primarily married, widowed, or divorced women between the ages of 25 and 45 years from within the community. They must have good communication and leadership skills; should be literate with formal education up to Class 8, as per the program guidelines.

How many ASHAs are there across the country?

The aim is to have one ASHA for every 1,000 persons or per habitation in hilly, tribal or other sparsely populated areas.

There are around 10.4 lakh ASHA workers across the country, with the largest workforces in states with high populations – Uttar Pradesh (1.63 lakh), Bihar (89,437), and Madhya Pradesh (77,531). Goa is the only state with no such workers, as per the latest National Health Mission data available from September 2019.

What do they do?

They go door-to-door in their designated areas creating awareness about basic nutrition, hygiene practices, and the health services available. They focus primarily on ensuring that women undergo ante-natal check-up, maintain nutrition during pregnancy, deliver at a healthcare facility, and provide post-birth training on breast-feeding and complementary nutrition of children. They also counsel women about contraceptives and sexually transmitted infections.

ASHA workers are also tasked with ensuring and motivating children to get immunised. Other than mother and child care, ASHA workers also provide medicines daily to TB patients under directly observed treatment of the national programme. They are also tasked with screening for infections like malaria during the season. They also provide basic medicines and therapies to people under their jurisdiction such as oral rehydration solution, chloroquine for malaria, iron folic acid tablets to prevent anaemia, and contraceptive pills.

“Now, we also get people tested and get their reports for non-communicable diseases. On top of that ASHA workers were given so much work during the pandemic. We are no longer volunteers,” said Ismat Arra Khatun, an ASHA worker from West Bengal and general secretary of the Scheme Workers Federation of India that led the national protest.

The health volunteers are also tasked with informing their respective primary health center about any births or deaths in their designated areas.

How did the ASHA network help in a pandemic response?

ASHA workers were a key part of the government’s pandemic response, with most states using the network for screening people in containment zones, getting them tested, and taking them to quarantine centers or help with home quarantine.

“During the first year of the pandemic, when everyone was scared of the infection, we had to go door-to-door and check people for Covid-19 symptoms. Those who had fever or cough had to be tested. Then, we had to inform the authorities and help the people reach the quarantine centres. We also faced a lot of harassment because there was so much stigma about the infection that people did not want to let us in,” said Ismat Khatun.

Kavita Singh from Delhi, a former ASHA worker and a member of Scheme Workers Federation of India, added, “We had to go to households with confirmed Covid-19 cases and explain the quarantine procedure. We had to provide them with medicines and pulse-oximeters. All of this on top of our routine work.”

With the vaccination drive for Covid-19 beginning in January last year, they have also been tasked with motivating people to get their shots and collect data on how many people are yet to get vaccinated.

How much are ASHA workers paid?

Since they are considered “volunteers”, governments are not obligated to pay them a salary. And, most states don’t. Their income depends on incentives under various schemes that are provided when they, for example, ensure an institutional delivery or when they get a child immunised. All this adds up to only between Rs 6,000 to Rs 8,000 a month.

“Her work would be so tailored that it does not interfere with her normal livelihood,” the National Health Mission states. However, with outreach of most health programs depending on them, that is not the case.

“Even if we work 24 hours, we will not be able to complete all the tasks. And, we do not get any benefits like pension or health insurance. If WHO recognises our role, if the government can call us veerangna (hero), shower us with flowers, why can’t they pay us fairly for all the work that we do,” said Ismat.

For quite some time now, ASHA workers have been demanding that they be made permanent employees of the government and provided benefits.

“If not that, they should at least fix our core incentives so that we get paid at least Rs 3,000 a month no matter what. All the work is graded 0 to 12 and if I do not get at least 6 points, I get paid only Rs 500 instead of Rs 3,000. I do not get points, even if a woman goes back to her home town to deliver the baby,” said Kavita.

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She said that Covid-19 pushed them to their limits.

“During Covid-19, we were only being paid Rs 1,000 for all of the additional work. Since the stopped in March this year, half incentive of the ASHA workers in Delhi decided not to participate in Covid-19 vaccination related activities,” added Kavita.


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