In recent months, Accredited Social Health Activists (ASHAs) in Kerala have been at the forefront of agitation. This movement marks their demands for improved remuneration and retirement benefits. The ASHA community, comprising over 26,000 members, has engaged in continuous protests, drawing attention from media and governmental bodies.
Background of ASHA Scheme
The ASHA scheme was launched in 2005 with the aim of employing health volunteers to improve healthcare access in rural areas. ASHAs are not considered regular employees. They receive a monthly honorarium and incentives based on work performance. The current monthly honorarium is ₹7,000, supplemented by a fixed incentive of ₹3,000. Additional incentives are available depending on the area of service.
Current Compensation Structure
Despite claims from the Kerala government that ASHAs earn between ₹10,000 and ₹13,000, many ASHAs argue that their actual earnings are lower. Their pay is contingent on meeting specific work criteria. The disparity between their earnings and the state’s high minimum wage has intensified their agitation. In Kerala, daily wages for various jobs range from ₹700 to ₹1,200, while ASHAs earn less than ₹250 daily.
Demands of the ASHA Workers
The primary demands of the protesting ASHAs include an increase in their monthly honorarium to ₹21,000 and a retirement lump sum of ₹5 lakh. They also seek the removal of performance criteria linked to their payments. ASHAs argue that their current status as health volunteers denies them essential benefits such as pensions and social security.
Government Response and Stalemate
The Kerala government has maintained that ASHAs fall under the purview of the Union government. It argues that any changes to the ASHA scheme must come from the Centre. The state has also brought into light a funding crisis, citing a ₹636 crore shortfall from the Union government, which has affected the National Health Mission’s functioning.
Recent Developments
The Union Health Minister has indicated a willingness to revise ASHA incentives, yet no specific timeline has been provided. During negotiations, the Kerala government proposed the formation of a committee to address ASHA issues. However, the ASHA representatives have rejected a modest interim hike of ₹3,000, insisting on more substantial changes.
Implications for Health Workforce
The ongoing protests tell a broader issue regarding the treatment of health workers in India. The ASHA agitation raises questions about the recognition and compensation of community health workers. If their demands are unmet, the future of health services in Kerala may be jeopardised.
Questions for UPSC:
- Discuss the role of community health workers in enhancing public health outcomes in India.
- Critically examine the impact of financial constraints on the delivery of healthcare services in Kerala.
- Explain the significance of social security benefits for informal sector workers in India.
- With suitable examples, discuss the challenges faced by women workers in achieving equitable pay in the workforce.
Answer Hints:
1. Discuss the role of community health workers in enhancing public health outcomes in India.
- Community health workers (CHWs) bridge the gap between healthcare systems and underserved populations.
- They promote health education, preventive care, and access to services, improving health literacy.
- CHWs are instrumental in disease surveillance and management, especially in rural areas.
- They encourage community participation in health initiatives, enhancing trust and cooperation with health services.
- Evidence shows that CHWs can reduce morbidity and mortality rates through targeted interventions.
2. Critically examine the impact of financial constraints on the delivery of healthcare services in Kerala.
- Financial constraints limit the availability and quality of healthcare services, affecting patient care and outcomes.
- Budget cuts can lead to understaffing and inadequate resources, diminishing service delivery effectiveness.
- Delayed payments to health workers, like ASHAs, can disrupt community health initiatives and outreach programs.
- Funding shortages may hinder the implementation of essential public health programs and preventive measures.
- Increased financial pressure can lead to a reliance on private healthcare, exacerbating inequalities in access to care.
3. Explain the significance of social security benefits for informal sector workers in India.
- Social security benefits provide a safety net, protecting informal workers from economic vulnerabilities and unexpected hardships.
- They enhance job security and overall worker morale, leading to improved productivity and commitment.
- Benefits like pensions and healthcare contribute to better long-term health outcomes for workers and their families.
- Social security can reduce poverty levels and economic disparities, promoting social equity.
- Such benefits encourage formalization of the workforce, improving labor rights and conditions in the long run.
4. With suitable examples, discuss the challenges faced by women workers in achieving equitable pay in the workforce.
- Women often face wage discrimination, earning less than men for the same work, exemplified in sectors like manufacturing and services.
- Occupational segregation limits women to lower-paying jobs, reducing their overall earning potential.
- Family responsibilities and societal expectations can hinder women’s career advancement and negotiating power.
- Lack of access to education and training perpetuates skill gaps, affecting women’s employability and pay rates.
- Gender biases in hiring and promotion processes continue to impede women’s progress toward equitable pay.
