The National Rural Health Mission (NRHM) seeks to address the issue of health and nutritional status of the rural population by strengthening the health care delivery system. According to the mission document, “it has as its key components provision of a female health activist in each village; a village health plan prepared through a local team headed by the health and sanitation committee of the panchayat.”
As it is recognised that issues like safe drinking water, sanitation and nutrition are equally important to have a healthy population, the document has give due recognition to this aspect. All this is being done to , “improve access of rural people , especially poor women and children, to equitable, affordable, accountable and effective primary health care”. One major component of the mission document is the Accredited Social Health Activists (ASHA). ASHA will be village women, selected by the community and accountable to the panchayat. They will act as the interface between the community and the public health system.
Though most of the ASHAs has been trained and their training will continue, but these days the health department is busy completing the training of the Village health and Sanitation committee members, through selected NGOs. These NGOs are also the district level training and resource centre for the ASHA. ASHA is a community based volunteer and receives performance based compensation for promoting and utilization of health services and other health care delivery programmes. She has to coordinate with Anganwadi workers, ANM and other welfare Departments. It is well known that ANM’s are heavily overworked, which impacts outreach services in rural areas. Now a new brand of community based functionaries named ‘ASHA’ are proposed to fill this void.
Earlier we had a village based health guide in the name of Community Health Guide (CHG). The CHGs were equated with the Chinese ‘Barefoot doctor’ model and eventually many of the CHGs started practicing medicine due to the ‘felt need’ of the people and poor medical services in rural areas. Later vested interests and government thought that quackery was being promoted and the scheme was shelved. The kind of training given and proposed for ASHA, what is the guarantee, that ASHA will not become a quack?
The National Rural Health Mission has once again taken up the idea of health volunteers at the village level, though now it is only female volunteers. ASHA gets no government honorarium, nor will she get a government ‘stamp’ for her job. She will only have incentives for her work, but what is the guarantee that ASHA will get her incentive in time and in full? Let us not close our eyes to the fact that getting the TA and incentive even for a government employee is Herculean task.
Today the ASHAs have formed their union just like the CHGs did and are demanding fix monthly salary/honorarium and regularization of their jobs, just like the Aganwadi workers of ICDS, thus negating the very idea of volunteerism and people’s participation. Knowing these ground realities, the question coming in the mind of the people associated with development sector- Is ASHA ushering hope?