Twenty years ago, we, the ASHA workers, came into existence.
In 2005, the central government, in an attempt to improve the health system in India, instituted the National Rural Health Mission. Under this mission, they created a cadre of women-led community health workers — the Accredited Social Health Activists or ASHA workers — to provide free health services to people living in villages and poor urban settlements. In a country where maternal and child health was under a lot of stress – with high rates of maternal and child mortality – ASHA workers were tasked with the critical responsibility of preventing the deaths of women and children and improving their overall health.
This year, we, the ASHA workers, complete 20 years of vital community healthcare work. In this two-decade journey, our work in transforming the country’s healthcare system has been nothing short of a miracle. In a country where the healthcare system hardly served the public, we brought it to the community’s doorstep. In that sense, we are the ‘Bridges of Care’ linking the community and the healthcare system. The health data we collect regularly at the community level is the foundation of this bridge that helps the government in making crucial decisions to improve the healthcare metrics.
Remember our yeoman’s service during the Covid-19 pandemic? It was our work in the community tracking and tracing those with the virus, ensuring they were placed within quarantines, and providing timely information to the government that helped it contain the spread of the virus. We did all this without adequate protection, no extra pay and often at great risk to us and our families. For this, the World Health Organization honoured us with the Global Health Leader Award.
But we are neglected by our own governments.
ASHA workers, who play such a pivotal role in building the healthcare system, are not recognised by the government as its employees. We are poorly paid with paltry incentives for some of our work while a lot of it remains unpaid.
Over the last 20 years, our workload has increased manifold, sometimes up to 12 hours a day, and it ranges from healthcare activities to even election duties and almost every survey that the government decides to undertake. Yet, our honorarium and incentive structures have remained unchanged for years, which amounts to less than the minimum wage. And we are not entitled to any social security benefits, not even maternity leave that is the constitutional right of every working woman in India. This is a worrying situation.
India needs a robust healthcare system that works for the people if it is to set itself on the path of progress. It needs to be accessible, affordable and equitable. An ASHA worker is an important cog in that wheel. I believe no one can do this job better than an ASHA worker. But, we need to be recognised and offered dignity of work — fair pay, social security benefits and every right that is accorded to a government employee. By underplaying our role, the government is undercutting the public healthcare system itself.
ASHA workers, many of whom come from extremely poor families, go beyond the call of their duty. We are proud of our work within the community and our contribution to the healthcare system in the country. But the system needs to be fair to us. There must be a collective demand for recognising the ASHA cadre and this is possible only with the support of the public.
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