ASHA Workers and Honorarium
Kartavya Desk Staff
Syllabus: Governance
- •Source: IE*
Context: ASHA workers in Kerala have been on strike for over a month, demanding fair wages, formal employment status, and social security benefits.
About Accredited Social Health Activists (ASHA Workers):
What is ASHA?
• A community-based health worker program under the National Rural Health Mission (NRHM).
• ASHAs serve as the link between rural communities and the public health system.
Established In: 2005, as part of NRHM, now under the National Health Mission (NHM).
Ministry Involved: Ministry of Health and Family Welfare (MoHFW)
• Improve maternal, newborn, and child health.
• Promote awareness and accessibility of healthcare services in rural areas.
• Enhance preventive healthcare measures at the grassroots level.
Key Functions:
• Health Monitoring & Record-Keeping: Track birth, death, and disease outbreaks.
• Maternal & Child Health Services: Ensure institutional deliveries, immunization, and nutrition support.
• Disease Control & Prevention: Implement programs for communicable & non-communicable diseases.
• Community Sanitation & Hygiene: Promote clean drinking water and hygiene practices.
• COVID-19 Response: Played a crucial role in awareness, vaccination, and disease surveillance.
ASHA Workers’ Role in India’s Development:
• Improving Maternal & Child Health: ASHA workers have been instrumental in reducing maternal and infant mortality rates.
E.g. India’s Maternal Mortality Ratio (MMR) dropped from 130 per 100,000 live births in 2014-16 to 97 in 2018-20, largely due to ASHA-led institutional deliveries and antenatal care awareness.
• Strengthening Rural Healthcare: With over 10 lakh ASHA workers across India, they serve as the first point of contact for basic healthcare in rural areas, bridging the gap between communities and health facilities.
• Disease Prevention & Surveillance: ASHAs played a critical role in COVID-19 management, conducting active case surveillance, community awareness, and vaccination enrollment.
• Women Empowerment & Livelihood Generation: ASHAs, 98% of whom are women, have been empowered through income generation and leadership roles in community health.
• Enhancing Public Health Outreach: ASHAs assist in sanitation programs, menstrual hygiene awareness, and nutrition initiatives like Poshan Abhiyaan, improving overall community well-being.
Issues Surrounding ASHA Workers’ Payments:
• Low & Irregular Payments: ASHA workers receive ₹5,000–₹15,000 per month, with only a fixed honorarium and incentives per task.
• No Fixed Salary: Unlike other government health workers, ASHAs are not classified as employees, denying them minimum wages, pensions, and social security benefits.
• Inconsistent State Payments: Honorariums vary by state, leading to disparities in earnings and frequent delayed payments.
• No Job Security: Despite being the backbone of rural healthcare, ASHAs lack formal employment status.
Why the Government Did Not Opt for a Regular Salary?
• Volunteer-Based Model: ASHAs were originally designated as volunteers to keep costs low and encourage community participation.
• Financial Constraints: Providing fixed salaries and benefits would place a significant financial burden on the central and state governments.
• Decentralized Implementation: State-wise variations in payments allow flexibility but lead to wage disparities and administrative inefficiencies.
• Performance-Based Incentives: The current model encourages task-specific incentives rather than a fixed wage system.
Way Ahead:
• Grant ASHAs Worker Status: Recognize ASHAs as government employees to provide fixed salaries and benefits.
• Ensure Timely Payments: Strengthen financial mechanisms to avoid payment delays and ensure livelihood security.
• Improve Incentive Structure: Offer higher performance-linked bonuses while guaranteeing a base salary.
• Enhance Social Security: Provide pension, health insurance, and maternity benefits for long-term financial stability.
• Increase Budget Allocation: Allocate higher funds for ASHA programs under the National Health Mission (NHM).
Conclusion:
ASHA workers have been the backbone of India’s rural healthcare system for nearly two decades. However, their low wages, lack of job security, and informal status continue to be major concerns. Recognizing them as formal employees with fair wages and social security is crucial to ensuring better healthcare delivery and empowering women in the workforce.
• The increase in life expectancy in the country has led to newer health challenges in the community. What are those challenges and what steps need to be taken to meet them? (UPSC-2022)