New Delhi: Earlier this year in May, the World Health Organization (WHO) recognised India’s Accredited Social Health Activists (ASHAs) for their outstanding contribution towards protecting and promoting health. ASHA workers were among the six recipients of the WHO Director-General’s Global Health Leaders Award, honoured at the 75th World Health Assembly. ASHA, a Hindi word, which means hope, REFERS TO the more than one million accredited female health workers in India, connecting the community with the health system to ensure primary health care services.
ASHA Workers – group of primary healthcare workers in India; the other two are Anganwadi Workers (AWW) and Auxiliary Nurse Mid-wives (ANM). Together they work under the National Rural Health Mission (NRHM) launched by the Prime Minister on April 12, 2005, to provide accessible, affordable and quality health care to the rural population, especially the vulnerable groups.
The role of the primary unit of healthcare in India in improving health indices:
- One of the key components of the National Rural Health Mission is to provide every village in the country with a trained female community health activist – ASHA. They are the grassroot health workers assisting the Ministry of Health and Family Welfare (MoHFW) in delivering primary healthcare, particularly for women and children, in both rural and urban areas. ASHAs support maternal care and immunisation for children against vaccine-preventable diseases; tuberculosis, neglected tropical diseases, communicable disease prevention and control; and core areas of health promotion for nutrition, sanitation, and healthy living.
- ASHA workers are also empowered with knowledge and a drug kit to provide first-contact healthcare or community-level curative care for minor ailments such as diarrhoea, fevers, care for the normal and sick newborns, childhood illnesses and first aid. They also act as a depot holder for essential health products that a local community might need at any point in time. This includes Oral Rehydration Therapy (ORS) packet, Iron Folic Acid (IFA) tablets, chloroquine, Disposable Delivery Kits (DDK), oral pills and condoms.
- They counsel women and families on birth preparedness, the importance of safe delivery, breastfeeding and complementary feeding, immunisation, contraception and prevention of common infections including Reproductive Tract Infection/Sexually Transmitted Infection (RTIs/STIs) and care of the young child.
- Anganwadi workers are women volunteers providing services under the Integrated Child Development Services (ICDS) programme started by the Ministry of Women and Child Development (MWCD) on October 2, 1975, in a bid to tackle malnutrition among all pregnant women, lactating mothers and children in the age group 0-6 years. There are over 25 lakh Anganwadi Workers and helpers in the country. The work done by them includes providing supplementary nutrition, nutrition and health education, health check-ups, immunisation and pre-school informal education to children.
- Under the National Health Mission, a minimum of two Auxiliary Nurse Mid-wives (ANMs) are provided at each Sub Health Centre (SHC). ANMs are the crucial component which connects the ASHAs and the communities with the public health system. Over the years, their role has expanded to address communicable and non-communicable diseases along with traditional Reproductive and Child Health centric functions.
Strengthening The Primary Delivery of Healthcare
ANMs are paid a government salary whereas, Anganwadi workers are paid honorarium and ASHAs are entitled to activity-based incentives along with a fixed amount for routine tasks. For each institutional delivery, ASHAs get Rs. 300 in rural areas and Rs. 200 in urban areas. Similarly, Rs. 100 is given in favour of full immunisation of a child under one year.
Many Anganwadi and ASHA workers feel they are underpaid and overworked. They were at the forefront of India’s fight against the COVID-19 pandemic, risking their lives, without any health insurance. Low remuneration, no social security and lack of adequate infrastructure are some of the challenges they face. However, according to Karthyayani VC, Chairperson, Anganwadi Workers Welfare Association, Kerala, unlike other states, the state government provides them with benefits such as pension and free medical care.
Susanta Kumar Nayak, Senior Consultant, Community Process, National Health Mission, Government of Odisha has been managing the ASHA programme in the state since 2008. He believes incentives are important along with upskilling of ASHA workers. He said,
We need to ensure that all ASHA workers feel motivated and ensure their services are being done well. In Odisha, we ensure we increase ASHA workers’ incentives every year so that they all can stay motivated to do their job. India also needs to enhance the amount of salaries that ASHA workers receive. As the number of tasks and activities they do has increased over the years. Also, we need to pay them monthly, uplift them and strengthen their status.
NDTV – Dettol have been working towards a clean and healthy India since 2014 via the Banega Swachh India initiative, which is helmed by Campaign Ambassador Amitabh Bachchan. The campaign aims to highlight the inter-dependency of humans and the environment, and of humans on one another with the focus on One Health, One Planet, One Future – Leaving No One Behind. It stresses on the need to take care of, and consider, everyone’s health in India – especially vulnerable communities – the LGBTQ population, indigenous people, India’s different tribes, ethnic and linguistic minorities, people with disabilities, migrants, geographically remote populations, gender and sexual minorities. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign will continue to raise awareness on the same along with focussing on the importance of nutrition and healthcare for women and children, fight malnutrition, mental wellbeing, self care, science and health, adolescent health & gender awareness. Along with the health of people, the campaign has realised the need to also take care of the health of the eco-system. Our environment is fragile due to human activity, which is not only over-exploiting available resources, but also generating immense pollution as a result of using and extracting those resources. The imbalance has also led to immense biodiversity loss that has caused one of the biggest threats to human survival – climate change. It has now been described as a “code red for humanity.” The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene. Banega Swasth India will also be taking forward the dream of Swasth Bharat, the campaign feels that only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and the country can become a Swasth or healthy India.