Ashas bring ray of hope for India’s primary healthcare (Health Feature)

New Delhi, April 14 (IANS) She is a harbinger of hope for milllions of village women across India – whether it is to take a pregnant woman to the hospital for delivery, vaccinating a child or ensuring family planning. For that is what her name, Asha, literally means.

And Prasadpur village of Purnea district of Bihar has such a one-woman answer – Poonam Devi, the village ‘Asha’, the name by which the primary health worker is commonly known.

Poonam starts her day early for she has a tight schedule, whether it is dealing with families that need to be convinced to send their women for institutional deliveries or discussing issues related to the nutritional requirements of the children of the village.

Similar is the case of Veena Devi, ‘Asha’ of Reasi village of Jammu, who carries her 10-month-old child – the youngest of her five children – with her to work, dealing with myriad social and health issues.

“I love my work, especially the respect which I get from my fellow villagers,” Poonam told IANS during her visit to the capital.

Veena and Poonam were among the 10 health workers awarded by the Indian government for their exemplary work.

Introduced into the village life when the National Rural Health Mission (NRHM) was launched in 2005, Ashas – acronym for Accredited Social Health Workers – have become an integral part of social life in India’s 600,000 odd villages in this vast country of 1.2 billion people.

The NRHM, a flagship scheme of the United Progressive Alliance (UPA) government, was started with the aim to provide quality healthcare to people living in the remotest and inaccessible areas of the country.

The government has earmarked over Rs. 210 million for the mission in this year’s budget, an increase of 24 percent from last year. The total health budget for 2013-14 is Rs.373 billion.

The success of the mission rests solely on Ashas as they are entrusted with various tasks, including taking women for institutional deliveries, organizing nutrition camps, vaccinating children, giving tuberculosis medicines and motivating people for family planning.

India has an over 3.4 million-strong Asha network.

“In many ways the Asha has emerged as the only link between the existing government machinery and the masses,” says Aparajita Gogoi, Director of CEDPA (Centre for Development and Population Activities), an NGO that works closely with the health workers across the country.

The biggest contribution of Ashas has been dissemination of information. “People expect Ashas to do everything,” she told IANS.

These health workers have played a pivotal role in bettering the country’s health indicators like Maternal Mortality Rate (MMR), said Dinesh Baswal, deputy commissioner, maternal health department in the health ministry.

The Ashas are the backbone of the mission, but many lamented the low remuneration for the wide variety of roles they play.

“We are paid around Rs. 150 for a family planning initiative and Rs. 350 for hospital delivery. So actually the amount depends on the number of cases we handle per month,” Poonam said.

Veena agreed.

“The monthly amount we manage to make is only around Rs.2,000. It is less,” Veena told IANS.

According to government data, an Asha gets Rs. 350 for institutional delivery in rural areas, Rs. 150 for tubectomy, Rs. 150 for an immunization session and Rs. 75 on pulse polio days, each with a cap on the total amount earned per head annually.

The other remuneration includes Rs. 150 for organising village nutrition days and Rs. 250 for TB treatment, added another Asha worker, who refused to be identified.

Ashas are playing a crucial role but are not given enough incentives, said Manju Chugnani, Principal of Rusaida Nursing College in Jamia Hamdard University and a member of the White Ribbon Alliance that is closely working with the health workers.

Chugnani said that India has seen considerable progress in bringing down the number of women dying due to childbirth-related causes.

India has significantly reduced its MMR from 437 per100,000 live births in 1999 to 212 now. The credit, Chugnani said, goes partially to Ashas too.

India’s Millennium Development Goal (MDG) target for the MMR is 109 per 100,000 live births by 2015.

Gogoi said India is moving well on the MMR.

“We have made progress in this regard. The MMR recorded a 38 percent decline in maternal deaths between 1999 and 2009,” she said.

Shanti Kurmi, an Asha in Assam’s Dibrugarh district, said the people’s attitude towards health issues has also changed.

“There has been a sea change in people’s attitude since the time I began work in 2005. It is now heartening to see that people give more importance to health issues,” she said.

“I am more respected in the village and this is one way of connecting to people,” she added.

(Sreeparna Chakrabarty can be contacted at [email protected])

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