Relevance: GS-2: Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources

Key Phrases: Accredited Social Health Activists, Global Health Leader's Award, World Health Assembly, National family Health Survey, National Family Health Mission, Volunteer Polio Workers, Primary Health Care Services, Last Mile Health

Why in News?

• The World Health Organisation has recently recognised the country’s 10.4 lakh ASHA workers as ‘Global Health Leaders’ in the backdrop of the ongoing 75th World Health Assembly for their efforts in connecting the community to the government’s health programmes.
• The other recipients include eight volunteer polio workers who were shot and killed by armed gunmen in Takhar and Kunduz provinces in Afghanistan in February this year.

Key Highlights:

• Recognition to those at the top of the social hierarchy goes very often and stays there but the credit seldom trickles down to the worker at the bottom of the social strata.
• The World Health Organization’s act of recognising India’s ASHA (accredited social health activists) and the polio workers of Afghanistan is an attempt to right that wrong.
• It is a rare, and commendable act of applauding for workers at the very bottom of the social hierarchy, and give credit where it is due.
• Over one million ASHAs and eight volunteer polio workers found themselves being counted amidst people leading from the front when the WHO Director General announced the names of six Global Health Leader Awardees at the opening session of the World Health Assembly.
• The award recognises those who have made an outstanding contribution to protecting and promoting health around the world, at a time when the world is facing an unprecedented convergence of inequity, conflict, food insecurity, climate crisis, and a pandemic.

Who are ASHA workers?

• ASHA workers 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.
• They act as a bridge connecting marginalised communities with facilities such as primary health centres, sub-centres and district hospitals.
• The role of these community health volunteers was first established in 2005 under the National Rural Health Mission (NRHM)ASHAs are primarily married, widowed, or divorced women between the 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 the programme guidelines.

How many ASHAs are there across the country?

• The aim is to have 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, with the 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 the latest National Health Mission data available from September 2019.

What do ASHA workers do?

1. Awareness Creation:
   • They go door-to-door in their designated areas creating awareness about basic nutrition, hygiene practices, and the health services available.
   • They focus primarily on ensuring that women undergo ante-natal check-ups, maintain nutrition during pregnancy, deliver at a healthcare facility, and provide post-birth training on breastfeeding and complementary nutrition of children.
2. Screening of Infections and timely Medications:
   • They are also tasked with screening for infections like malaria during the season.
   • They also provide basic medicines and therapies to people under their jurisdiction such as oral rehydration solution, chloroquine for malaria, iron folic acid tablets to prevent anaemia, and contraceptive pills.
   • Now, they also get people tested and get their reports for non-communicable diseases.
   • Other than mother and child care, ASHA workers also provide medicines daily to TB patients under directly observed treatment of the national programme.
3. Counselling of Women and Children:
   • They counsel women about contraceptives and sexually transmitted infections.
   • ASHA workers are also tasked with ensuring and motivating children to get immunised.

How did the ASHA network help in pandemic response?

• ASHA workers were a key part of the government’s pandemic response, with most states using the network for screening people in containment zones, getting them tested, and taking them to quarantine centres or help with home quarantine.
• During the first year of the pandemic, when everyone was scared of the infection, they had to go door-to-door and check people for Covid-19 symptoms.
• They also faced a lot of harassment because there was so much stigma about the infection that people did not want to let them in.
• They had to go to households with confirmed Covid-19 cases and explain the quarantine procedure and provide them with medicines and pulse-oximeters. All of this was to be done on top of their routine work.
• With the vaccination drive for Covid-19 beginning in January last year, they have also been tasked with motivating people to get their shots and collect data on how many people are yet to get vaccinated.
• On top of that ASHA workers were given so much work during the pandemic that they are no longer volunteers.
• The health volunteers were also tasked with informing their respective primary health centre about any births or deaths in their designated areas.

How much are ASHA workers paid?

• Governments are not obligated to pay them a salary since they are considered “volunteers”. And, most states don’t pay at all.
• Their income depends on incentives under various schemes that are provided when they, for example, ensure an institutional delivery or when they get a child immunised.
• All this adds up to only between Rs 6,000 to Rs 8,000 a month.

Challenges faced by them:

• These workers, all women, faced harassment and violence for their work during the pandemic, well documented in the media.
• While the pandemic rewrote the rules, creating danger where mere routine existed, it must be stressed that in general, their job, which takes them into difficult-to-reach places and hostile communities, confers a measure of privations.
• Even as they contribute to better health outcomes, this workforce continues to protest across the country, for better remuneration, health benefits and permanent posts.
• The eight volunteer polio workers of Afghanistan (four of them women) were shot and killed by gunmen in Takhar and Kunduz provinces in February 2022.
• Their work was crucial in a country where wild polio virus type 1 is still circulating, WHO recorded.
• Clearly, certain kinds of basic public health work are fraught with perils in several continents across the world.

Conclusion:

• The ASHAs are honoured for their crucial role in linking the community with the health system to ensure those living in rural poverty can access primary health care services.
• Thus, it is the duty of the governmental agencies that employ them to ensure their welfare, safety and security.
• While cheerleading about the award is rightfully raising the glory for these people, what matters is how the Indian government serves its last mile health as they would again be on their feet on the ground, once the dust raised by their unexpected recognition has settled down.

Source: The Hindu

Mains Question:

Q. ASHA workers have recently received the Global Health Leaders Award-2022 in the backdrop of the ongoing 75th World Health Assembly. In this respect, discuss the role played and the challenges faced by them in linking the community with the health system to ensure those living in rural poverty can access primary health care services. (250 words).