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Insights into Editorial: Serving those who serve: On WHO honour for ASHA workers

 

Context:

India’s one million all-women ASHA (Accredited Social Health Activist Workers) workers were awarded and honoured by WHO for their ‘outstanding’ contribution to advancing global health, demonstrated leadership and commitment to regional health issues.

ASHA, which means “hope” in English, comprises more than one million female volunteers.

 

Global Health Leaders Awards:

The World Health Organization Director-General’s Global Health Leaders Awards has recognized ASHA’s “crucial role in linking the community with the health system and ensuring that those living in rural poverty can access primary health care services”.

WHO added that ASHA workers, throughout the COVID-19 pandemic, have “ensured  living in rural poverty can access primary health care services.”

WHO praised that the all-women workers “provide maternal care and immunization for children against vaccine-preventable diseases; community health care; treatment for hypertension and tuberculosis and core areas of health promotion for nutrition, sanitation and healthy living.”

 

Outstanding contribution to protecting and promoting health around the world:

  1. Recognition very often goes to those at the top of the pecking order, and stays there.
  2. Credit seldom trickles down to the worker at the bottom. The World Health Organization’s act of recognizing India’s ASHA (accredited social health activists) and the polio workers of Afghanistan is an attempt to right that wrong.
  3. It is a rare, and commendable doffing of the hat for workers at the very bottom of the rung, and gives credit where it is due.
  4. When WHO Director General Tedros Adhanom Ghebreyesus announced the names of six Global Health Leader awardees at the opening session of the World Health Assembly, over one million ASHAs and eight volunteer polio workers found themselves being counted amidst people leading from the front.
  5. The award recognizes 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.

 

Working of ASHA volunteers even under extreme conditions:

  1. The ASHAs were 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”.
  2. These workers, all women, faced harassment and violence for their work during the pandemic, well documented in the media.
  3. 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.
  4. Even as they contribute to better health outcomes, this workforce continues to protest across the country, for better remuneration, health benefits and permanent posts.
  5. 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.

 

How are ASHA workers paid?

  1. The government had started deploying ASHA workers under the National Rural Health Mission (NRHM) in 2005.
  2. The mission document of the programme had defined ASHA workers as ‘honorary volunteers’, receiving performance-based compensation for their contribution in promoting immunization, construction of household toilets, and other healthcare delivery programmes.
  3. As ASHA workers are categorized as volunteers, neither the state government nor the Centre has a legal obligation to pay them a minimum wage.
  4. As such, ASHAs earn money through incentives by delivering 60 tasks set under the National Health Mission.
  5. The states set the incentives for ASHAs. Incentives can range from Rs 1 for distributing ORS packets, condoms or sanitary napkins to Rs 5,000 for helping a drug-resistant TB patient with treatment.
  6. The Union government in 2018 doubled the incentives to ASHA workers for some tasks from Rs 1,000 to Rs 2,000.
  7. Attempts to eradicate this crippling virus from parts of Afghanistan and Pakistan have been seriously hampered by deadly targeting of vaccination teams in recent years by militants, who oppose these drives, claiming that polio drops cause infertility.

 

Way Ahead:

WHO recorded that ASHA volunteers work was crucial in a country where wild polio virus type 1 is still circulating.

Clearly, certain kinds of basic public health work are fraught with perils in several continents across the world.

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 reaching a crescendo, what matters is how the Indian government serves its last mile health workers who are its feet on the ground, once the dust raised by their unexpected recognition has settled down.

 

Conclusion:

At a time when the world is facing an unprecedented convergence of inequity, conflict, food insecurity, the climate crisis and a pandemic, this award recognizes those who have made an outstanding contribution to protecting and promoting health around the world.

These awardees embody lifelong dedication, relentless advocacy, a commitment to equity, and selfless service of humanity.