ASHA: a successful public health experiment rooted in the village community

WHO has recognised country’s 10.4 lakh ASHA orkers as ‘Global Health Leaders’ for their efforts in connecting community to government’s health programmes.

ASHA workers

• They 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.
• Act as bridge connecting marginalised communities with facilities such as primary health centres, sub-centres and district hospitals.
• 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 b/w 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 programme guidelines.

Genesis & evolution

• ASHA programme was based on Chhattisgarh’s successful Mitanin programme.
• Under it Community Worker looks after 50 households.
• ASHA was to be a local resident, looking after 200 households.
• Dr. T. Sundararaman and Dr Rajani Ved among others provided a lot of support to this process.
• Many states tried to develop ASHA from a Community Worker to a Community Health Worker, and even to Auxiliary Nurse Midwife (ANM)/ General Nurse and Midwife (GNM), or a Public Health Nurse.

How many ASHAs are there across the country?

• Aim: 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.
• 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 latest National Health Mission data available from September 2019.

Success of the ASHAs

• ASHA has done well across the country.
• It allowed a local woman to develop into a skilled health worker.
• Created new cadre of skilled local health workers who were paid based on performance.
• They are widely respected as they brought basic health services to the doorstep of households.
• They enjoy confidence of the community.

Challenges

• With regard to performance-based compensation.
• In many states, payout is low, and often delayed.
• It has a problem of responsibility and accountability without fair compensation.
• There is a strong argument to grant permanence to some of these positions with a reasonable compensation as sustaining motivation.
• ASHA should be able to make more than salary of a government employee, with opportunities for promotion in formal primary health care system as an ANM/GNM or a Public Health Nurse.

Way forward

• Incremental development of local resident woman is an important factor in human resource engagement in community-linked sectors.
• It is important to ensure that compensation for performance is timely and adequate.
• Upgrading skill sets and providing easy access to credit and finance will ensure a sustainable opportunity to earn a respectable living.
• Strengthening access to health insurance, credit for consumption and livelihood needs at reasonable rates, and coverage under pro-poor public welfare programmes will contribute to ASHAs emerging as even stronger agents of change.

Exam track

Prelims take away

• ASHA workers
• National Health policy