Saluting our indefatigable warriors — ASHA workers
ASHAs were unique to India and even as honouring them was imperative, their experience and potential needed to be harnessed.
The pandemic in India would have played out very differently had it not been for the extraordinary efforts of Accredited Social Health Activists (ASHAs). This is what the World Health Organization recognised recently when it honoured India’s ASHAs for what it described as their outstanding contribution to advancing global health and leadership and commitment to regional health issues.
Their greatest contribution is ensuring that those in rural areas were able to access primary health care services in the form of maternal care, immunisation of children, treatment for illnesses such as tuberculosis, and promotion of nutrition, sanitation and, in many areas, counselling.
In the battle against the pandemic, ASHAs won accolades, but little is known about the community resistance they faced and the stress of combining family responsibilities with work. For all the work they do, the maximum remuneration an ASHA receives is ₹10,000 per month — often, less.
Shailaja Chandra, former chief secretary, Delhi, and a former secretary in the health ministry, recounts how the ASHA scheme was designed, formulated, and implemented in 2004-05 despite several concerns about entrusting health-related responsibilities to Class 8 pass girls — and that too in village settings with traditional mindsets.
“Today, there is a global recognition for the stellar role these women have played during the pandemic — going door to door to help identify individuals needing hospitalisation, isolation, or home quarantining at great personal risk. Displaying the dexterity of paramedics, they played the role of the multi-purpose workers of the 80s and 90s,” she said. She felt that the ASHAs were unique to India and even as honouring them was imperative, their experience and potential needed to be harnessed.
In thousands of villages, they are the only link between the community and the auxiliary nurse midwife at the sub-centre and the doctor at the Primary Health Centre. That is where patients need to be persuaded to go for immunisation, the treatment of acute illnesses, and accessing drugs.
Varsha Maurya from Lucknow has been working as an ASHA since 2007 and won the best ASHA worker award three times. She has been trained in many health programmes, including home-based newborn care and dealing with diseases like leprosy. She was also trained by the National Tuberculosis Eradication Programme as well.
From this, she was given training in identifying and treating Covid patients and imparting the appropriate protocols at considerable risk to herself. Another ASHA hero is Chandrakanta Singh from Sahabpur Pachlakhi, Kaisarganj block, Bahraich. She says she used her knowledge gained during training to safeguard the community under her care. This earned her the district’s best ASHA award on three occasions. She cites among her achievements as facilitating three to four institutional deliveries every month, 100% Covid vaccination in her area and winning the trust of the families there.
Realising that the ASHAs’ work is extremely challenging, Akhila Sivadas, executive director, Centre for Advocacy and Research says. “It is this tenacity that got built over many years that stood them in good stead during the pandemic and enabled them to prove to the world that the ASHA worker is not just acting as a link but is taking health services to the people and strengthening health-seeking practices.”
WHO’s recognition is welcome, but a concerted effort must be made to ensure real-time employment for ASHAs and increase their incentives and remuneration. This is not something they should have to fight for, as they are doing now.
lalita.panicker@hindustantimes.com
The views expressed are personal