The National Human Rights Commission (NHRC) organised a core group meeting on the theme ‘Empowering Accredited Social Health Activists (ASHAs): Securing the right to work with dignity’ in New Delhi. It was chaired by NHRC chairperson Justice (retd) V. Ramasubramanian. He highlighted the remarkable contributions made by ASHA workers over the past 20 years towards improvements in the healthcare sector in the country. 

Accredited Social Health Activist (ASHA) Programme

• The ASHA programme is a key component of the community processes element of National Health Mission (NHM), intended to achieve the goal of increasing community engagement with the health system. 

• The programme was launched initially in 18 high focus states and tribal areas in 2006 and later expanded to the whole country in 2009.

• ASHA workers are honorary community health volunteers who are entitled to task/activity based incentives for a varied set of activities related to maternal and child health, communicable diseases and non-communicable diseases for community level health interventions. 

• ASHA workers receive a monthly incentive of Rs 2,000 per month for routine and recurring activities from the central government.

• Additionally, ASHA workers are provided with performance-based incentives for a varied set of activities under various National Health Programmes.

• Further, states/UTs in their Programme Implementation Plans (PIPs) have also been given flexibility to provide a range of monetary incentives to ASHA workers.

• There are over 10 lakh ASHA workers across the country in rural and urban areas under the NHM who act as a link between the community and the public health system.

• ASHA workers have been widely acknowledged for their substantial contribution in improving access to care for the community. 

• After the launch of Ayushman Arogya Mandir, ASHA workers are eligible additionally for Team Based Incentives (TBIs) based on monitored performance indicators (up to 1,000 per month). 

• They are also entitled to non-monetary incentives like ASHA uniform, identity card, cycle, mobile phone, ASHA diary, drug kit, etc. 

• The government has also approved a cash award of Rs 20,000 and a citation to ASHA workers who leave the programme after working for a minimum of 10 years.

Challenges faced by ASHA workers

• Low honorarium and irregular payments under the current incentive-based structure.

• Excessive workload and lack of basic resources such as transport, PPE kits, and rest areas.

• No formal employment status, limiting their access to pensions, maternity benefits, and accident insurance.

• Exposure to workplace risks, including harassment and unsafe working conditions.

Some suggestions to improve work conditions of ASHA workers

• Need to consider granting ASHA workers a formal worker status with fixed monthly emoluments, social security, pensions, paid leave, etc.

• Standardise honorarium/wages across states, ensuring that honorariums align with minimum wage regulations.

• Replace incentive-based payment structure with a fixed amount plus performance-based benefits.

• Provide health insurance, maternity benefits, and accident coverage to ASHA workers.

• Ensure free personal protective equipment (PPE), transport allowances, and access to clean rest areas during field visits.

• Enforce strict policies against harassment and violence, ensuring safe working conditions in all regions.

• Utilise Rs 49,269 crore of unspent funds from the Building and Other Construction Workers Welfare Cess Act for childcare, elderly care, and ASHA welfare.

• Allocate Rs 70,051 crore health sector grants towards strengthening early childhood care and healthcare workers’ training.

• Establish state-funded creches at primary health centres and community centres to support ASHA workers who are also primary caregivers at home.

• Develop structured career pathways for ASHA workers to transition into higher-paying healthcare roles, such as nursing, midwifery, and public health administration.

• Provide regular skill enhancement training in disease surveillance, mental health counseling, and emergency medical response.

• Introduce bridge courses in collaboration with medical colleges and universities to certify ASHA workers for formal healthcare roles.

• Incentivise private sector investments in childcare and elderly care infrastructure, with tax benefits for employers offering workplace childcare solutions.

• Foster public-private partnerships to expand affordable community-based care services, creating decent job opportunities for ASHA workers.

(The author is a trainer for Civil Services aspirants.)