India’s voluntary health workers underpaid, badly trained

Accredited Social Health Activists (ASHAs) — considered to be voluntary workers — are paid a honorarium by the government and most make about a measly Rs 1,000 a month. ASHAs are required to undergo a 23-day training spread across 12 months, but a third of them in a block in north Bihar were not trained at induction, and the rest received seven days of training and learnt the rest by reading the manual, according to a 2015 study conducted in 187 villages.

An ASHA serves as a healthcare facilitator, and goes door to door visiting the poorest and most vulnerable sections of the society — nearly 22 per cent or 269 million Indians still live under the poverty line. Her responsibilities are related to reproductive and child health, immunisation, family planning and community health. This includes home visits and counselling of pregnant women, helping with village health plans, providing medical care for minor ailments, such as diarrhoea, fever and first aid for minor injuries.

India accounted for close to a fifth of 303,000 maternal deaths and 26 per cent of the neonatal deaths globally. Only 62 per cent of children between the ages of 12 and 23 months were fully immunised— for BCG, measles, and three doses each for polio and diphtheria and tetanus.

As many as 70-90 per cent ASHAs said they needed better training, monetary support and timely replenishment of the drug kit to perform better. ASHAs also said they received no assistance from the panchayat and limited support from auxiliary nurse midwives and anganwadi workers. Only 22 per cent of the ASHAs surveyed had some understanding of their role, according to the 2015 study in north Bihar; most ASHAs were involved in maternal and child care but did not work in local health planning or duties related to health activism.

“The study demonstrates that the knowledge and skills of ASHAs regarding newborn care is sub-optimal,” the authors said.

Sandhya Vaidya, 32, became an ASHA in 2010 in her village of Wansadi in Naxal-affected Korpana taluka in Chandrapur district, Maharashtra. The work was gratifying: Vaidya remembered saving a baby’s life among her achievements. But the pay was paltry, she told IndiaSpend.

It took two full years before she received the drug kit she was supposed to carry around to the households, she added. The drug kit consisted medicines for simple ailments. While they were given training every year, Vaidya said, most times they were asked to read from the manual. The programme to recruit more ASHAs is also stuck at inadequate training: The sluggish pace of training leads to attrition of knowledge and skills, and affects the state’s readiness to register ASHAs for certification, according to this July 2016 update, the latest available, by the National Health Systems Resource Centre.