The conferment of the World Health Organisation’s Global Health Leaders Award-2022 on India’s Accredited Social Health Activists (ASHAs) is a well-deserved recognition of the services rendered by this great body of health workers. They were selected for the award for their role in linking the community with the health systems to ensure those living in rural poverty can access primary healthcare services. WHO Director-General Tedros Ghebreyesus said ASHAs worked to provide maternal care and immunisation for children against vaccine-preventable diseases and treatment for hypertension and tuberculosis and core areas of health promotion even in the midst of the pandemic. They were among the six recipients of the award who included polio volunteers from Afghanistan, and others who worked in the areas of leprosy elimination and mental health.
The role of India’s 10-lakh strong force of ASHA workers in providing public health services in the country is well-known. They provide the last-mile connectivity to people who need basic health services. They did phenomenal work during the pandemic, spreading awareness about Covid-19, identifying and tracking positive cases and carrying out vaccination drives, often risking their own safety and lives. Many of them succumbed to the pandemic. Their work was over and above their routine duties of providing care and services during normal times. But for the contribution of ASHA workers India’s performance on the Covid front would have been much worse. They have received praise for their work from all quarters, including the Prime Minister.
But their terms of service and conditions of work are poor. Their remuneration is low and its payment is irregular. They are not entitled to amenities like maternity leave and social security. Gloves, masks and rest room facilities are often not available in many work locations. Irregular working hours create problems in many families and many of them have to face harassment from doctors and other health staff. Their conditions need to be improved and better facilities should be provided in recognition of the services rendered by them. They have sought regular monthly salaries and facilities such as leave. They have also voiced the need for easy access to credit. There should also be opportunities for career advancement in nursing and midwifery. These are reasonable demands and governments should exert themselves to meet them. Awards and tokens of recognition will be meaningful only if the ASHA workers are given their due.