By Veroli Zhimo
Since 2017, December 12 has been proclaimed as an official UN-designated day: International Universal Health Coverage Day—a day when the global community calls on world leaders to review progress and identify gaps in ensuring that everyone, everywhere, can access the healthcare they need, close to where they live and without falling into financial hardship.
In India’s movement to alleviate health inequities, there are thousands of Accredited Social Health Activists or ASHA workers who play critical roles in promoting healthy practices, providing on-ground support, and spreading awareness about various health programmes of the Government of India at the grassroots.
Acting as the primary caregivers in most of the country’s rural communities, ASHAs are the local implementation point of the National Rural Health Mission (NRHM). Their critical roles were further amplified when the pandemic hit the country—ASHAs were roped in to form the frontline of COVID-19 monitoring, undertaking door-to-door collection of health data during these critical times.
Even when the government launched an aggressive COVID vaccination drive, ASHA workers played a major role in mass mobilization of the unvaccinated by going door to door like they do in any government health programme.
Remuneration for most ASHA workers come in the form of performance based incentives. While many states pay fixed honorariums varying between Rs 3,500 and Rs 6,000, most states offer incentives for meeting targets and since the pandemic, a small COVID duty allowance. Several complaints of wages as low as Rs 3,000 and delayed, irregular payments are common across the country too.
When the Seventh Pay Commission recognised Rs 18,000 as the minimum pay for the lowest ranked central employee, ASHA workers also sought parity. Many state governments have argued that ASHAs are volunteers and not government employees; hence, fixed salary provision is not possible as per rules.
In this context, a look into the cause of ASHA workers based on this year’s theme ‘Leave No One’s Health Behind: Invest in health systems for all,’ would prove beneficial. As the theme highlights the critical need for sustained investments in primary healthcare at all levels, it would augur well for governments to analyse the contributions of ASHAs who, since their inception in 2006, have massively aided the nation in achieving milestones in motivating institutional deliveries and child immunisation.
As the pandemic has proven, having resilient health systems at the grassroots serve as a foundation for emergency preparedness and response. Considering that majority of the country’s healthcare is heavily dependent on ASHAs, investing in their well-being is akin to investing in health systems for all.
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