Context

• One of the biggest issues facing rural health services is lack of information. ASHA workers are the first respondents even when there is lack of access to medical aid are threatened with violence and abused on the number of occasions while handlining the prospected patients in COVID19 pandemic.

Evolution of “ASHA” you may want to know

• The ASHA programme was based on Chhattisgarh’s successful Mitanin programme, in which a Community Worker looks after 50 households.
• The ASHA was to be a local resident, looking after 200 households.
• The programme had a very robust thrust on the stage-wise development of capacity in selected areas of public health.
• Many states tried to incrementally develop the ASHA from a Community Worker to a Community Health Worker, and even to an Auxiliary Nurse Midwife (ANM)/ General Nurse and Midwife (GNM), or a Public Health Nurse.

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.
• The role of these community health volunteers under the National Rural Health Mission (NRHM) was first established in 2005.
• They act as a bridge connecting marginalized communities with facilities such as primary health centers, sub-centers and district hospitals.

Qualifications for ASHA Workers

• 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 programme guidelines.

What role do the ASHA Workers play? 

• Involved in Awareness programs: They go door-to-door in their designated areas creating awareness about basic nutrition, hygiene practices, and the health services available. They also counsel women about contraceptives and sexually transmitted infections.
• Ensures Mother and child health: They focus primarily on ensuring that pregnant 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.
• Actively involved in Immunization programs: ASHA workers are also tasked with ensuring and motivating children to get immunized.
• Providing medicines and therapies: Other than mother and childcare, ASHA workers also provide medicines daily to TB patients under directly observed treatment of the national programme. 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 anemia etc.
• Tasked with Screening tests: They are also tasked with screening for infections like malaria during the season. They also get people tested and get their reports for non-communicable diseases. They were tasked to quarantine the covid 19 infected patients in the pandemic.
• Informing the birth and death in respective areas:  The health volunteers are also tasked with informing their respective primary health center about any births or deaths in their designated areas.

What are the challenges that ASHA workers face?

• Lack of communication threating the job of ASHA Workers: One of the biggest issues facing rural health services is lack of information.
• Lack of resources burdening the ASHA works job: Another area of concern is the lack of resources. Over the years, with the closest hospital being 9 km away and ambulances taking hours to respond, ASHA workers had to take multiple women in labour to the hospital in auto rickshaws.
• Poor medical health facilities: Medical facilities are understaffed and lack adequate equipment for various basic procedures like deliveries. Simple tests, like for sickle cell anemia and HIV, cannot be conducted in no of respective areas of ASHA workers.
• Low wages according to the job they do: The initial payment used to be paid was Rs 250 a month in 2009. Since ASHA’s unionized and agitated for a living wage. Thirteen years on, they earn around Rs 4,000 a month. It is simply not enough to sustain a family of four.
• Covid 19 disruptions added to the existing problems: Low wages forcing ASHA’s to work two or more jobs. In the pandemic, no of women lost their husband or the means of earnings and had to revert to farming. Weather fluctuations disrupting the farm produce leaving no of ASHA’s the sole earner for the family. Those who don’t have land are living in miserable conditions.
• Delayed payments reduce the morale: Payments are also delayed by months, Desperation for work leaves us unable to focus on the groundwork we do.

What can be done to improve the work conditions of ASHA workers?

• Improving the communication channels: Channels of communication between the government and the rural population need to be robust. A deadly pandemic makes the value of these channels obvious but in order to get people on board, information needs to be sent out much more effectively and in a hands-on manner. ASHA workers play a crucial role in aiding this effort. ASHA’s can’t do this alone. They need new systems to ensure the dissemination of life-saving information in remote areas.
• ASHA’s should have fixed income: ASHA’s should have a fixed income, giving them the stability in a job where they spend between eight to twelve hours daily.
• Role needs to be formalized ensuring the dignity: ASHA’s are recognized as “volunteers” currently. Their role needs to be formalized. Recognizing them as workers provides dignity and protection, and helps them to be taken seriously, by the state, the gram panchayat responsible for the disbursal of funds, and patients.
• Recognizing and awarding their role will empower and motivate ASHA’s further: For people in villages, ASHA’s have become lifelines. They have led innumerable immunization drives and are everybody’s first call in a medical emergency. They have labored to build trust and serve as a bridge with the state. Examples shows recognition gives some leverage to circumvent the system and seek funds for people in my community.

Conclusion

• ASHA’s are lifelines of rural primary healthcare, they are playing critical role on no of fronts ensuring the basic health of India. A better, stronger India is possible if ASHA’s are enabled to serve people. Giving them due recognition would serve this end, along with making rural India’s needs medical or otherwise a priority.

Mains Question

Q. For the villagers, ASHA has been a lifeline in the last few years. Acknowledge the problems they face on a daily basis and suggest solutions to raise their morale for the primary health of the village community and the nation as a whole.

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