ASHAs (Accredited Social Health Activists) workers have gone on a strike. They have long demanded better pay and health insurance and this is a result of those unfulfilled demands. ASHAs besides forming the backbone of public health in India have been at the forefront of COVID-19 outbreak. They have been conducting door to door surveys and have been actively involved in screening of migrant workers returning home. This is besides their regular duties that are far reaching.
ASHAs in villages have been instrumental in bringing health to the doorsteps of many who have little or no access to health otherwise, especially women and children.
The counsel women on nutrition, delivery, birth control and pregnancy, birth preparedness and delivery, breastfeeding, immunisation and child care. They are repositories of information on hygiene, hand wash, safe water and toilet practices, sexually transmitted infections etc. and nodal point for provision of sanitary napkins, iron and folic acid tablets, oral rehydration solutions, contraceptives, essential drugs and disposable delivery kits. They facilitate use of existing health services and also provides a minimum package of curative care as appropriate and feasible for that level.
Hard work of ASHAs has been credited with eradication of polio. In fact most health indicators measured by host of human development indices and recorded in reports such as National Family Health Survey are the result of vital work of these grassroots workers. They are responsible for increase in India’s immunization coverage, institutional deliveries and reduction in maternal and child mortality. Ministries across the board – Ministry of Health and Family Welfare, Ministry of Women and Child Development, Ministry of Drinking Water and Sanitation and even Ministry of Panchayati Raj- depend on the efficient network of ASHAs for delivering a range of services and as a platform for access. They make possible functioning of major programmes likes National Health Mission and Integrated Child Development Scheme (ICDS). They are the lifeline of health and rural development services across India.
ASHAs haven’t been paid in months. Moreover they don’t have PPE and are regularly putting their and their family’s health at risk.
They are paid as little as INR 2000-5000 a month and several have succumbed to COVID-19 in the past month and are regularly visiting areas with hundreds of cases. Nearly 6 lakh ASHAs are expected to go on a strike and are supported by ten central trade unions. Apart from inadequate assistance from the government during recent pandemic, workers are minimum wages of INR 21,000 per month and pension of INR 10,000 per month besides other benefits of ESI and EPF. There are about a million ASHA workers across the country and it is expected more will join.
Rahul Gandhi has raised his voice in support of ASHA workers and called them warriors who deliver health protection to every home. He slammed the government for being dumb, blind and deaf to their condition and demand. Other politicians and civil society activists have also raised concerns, even though this issue has been largely ignored by mainstream media – one which has been covering COVID-19 regularly otherwise.
If the pandemic has made one thing clear it is the importance of frontline health workers. For surveillance, control and treatment of infectious diseases a dedicated and committed health cadre from within the community with great reach is essential. The pandemic has also shown the fragility of health systems in coping with health calamities of the scale such a COVID. Paucity of hospital beds has meant that home based care in less severe cases has become paramount. This means that health care has to reach people’s doorsteps. Moreover with infectious diseases it is quite evident that prevention is better than cure. Importance of clean water and use of toilets and regular hand washing can prevent majority of the infectious diseases and are tried and tested mantras even before spread of COVID. ASHAs have been instrumental in spreading information about the same.
Finally, ASHAs are often the first line of contact of people with often elusive health care in India.
How much faith they have in the state and its health care depends on how satisfied they are with their interaction with and the services of ASHAs. They are more likely to take regular vaccinations, want institutional deliveries, change for better health behaviours and follow rational approaches to raising children, planning healthy meals, seeking early treatment and diagnosis, family planning and reduce substance abuse or unhealthy habits like smoking. Similarly frontline health workers who are well paid and protected are more likely to perform better. This can have a cumulative effect on overall health of the nation and all the indicators.
Views are author’s own.