ASHA Workers & National Health Mission (NHM)

GS II-Health

Context

In Kerala, ASHA workers have gone on strike, demanding better honorariums and retirement benefits, bringing attention to their pivotal role in India’s healthcare system.
Despite India progressing towards achieving Sustainable Development Goals (SDGs) in health before 2030, the Union Cabinet has extended the NHM for an additional two years to further enhance healthcare services.

Accredited Social Health Activists (ASHA Workers)

• Origins: Inspired by Chhattisgarh’s Mitanin Programme (2002), ASHA workers were introduced in 2005 under the National Rural Health Mission (NRHM).
• Urban Expansion: Their role was extended to urban areas in 2013 with the launch of the National Urban Health Mission (NUHM).
• Eligibility Criteria:
  • Women aged 25-45 years from the local community.
  • Preference for those who are married, widowed, or divorced and have at least a Class 10 education.
  • Deployed across all states and union territories, except Goa.
• Training: Provided by Anganwadi Workers (ANWs) and Auxiliary Nurse Midwives (ANMs).

Role of ANMs and ANWs

• Auxiliary Nurse Midwives (ANMs):
  • First-line health workers stationed at health sub-centres.
  • Function as Multipurpose Workers (MPWs) overseeing public health programs.
  • Manage maternal health, immunization, and family planning services.
• Anganwadi Workers (ANWs):
  • Operate under the Integrated Child Development Scheme (ICDS).
  • Support immunization and family planning efforts.
  • Provide supplementary nutrition, preschool education, and maternal healthcare.

Key Responsibilities of ASHA Workers

• Healthcare Bridge: Connect marginalized communities with the healthcare system, promoting maternal care, immunization, and nutritional awareness.
• Disease Prevention: Conduct screenings for malaria, tuberculosis (TB), and other infections, while offering basic medicines and first aid.
• TB Treatment Assistance: Facilitate access to Directly Observed Treatment (DOT) for TB patients.
• Women’s Health Advocacy: Provide counseling on contraception, menstrual hygiene, and sexually transmitted infections (STIs).
• Sanitation Awareness: Encourage household toilet construction to improve hygiene and sanitation.
• Community Health Engagement: Spread awareness about nutrition and hygiene, while maintaining records of births and deaths in their areas.

Compensation Structure

• ASHA workers are classified as volunteers, not government employees.
• They receive a fixed honorarium of ₹2,000 per month (state-specific variations apply).
• Additionally, they earn performance-based incentives under various national health programs.

Funding Mechanism

• NHM follows a 60:40 funding ratio between the Centre and States.
• For Northeastern and Himalayan states, the ratio is 90:10.
• Union Territories without a legislature receive 100% central funding.
• States have flexibility in structuring salaries and incentives within NHM guidelines.

National Health Mission (NHM)

• Originally launched in 2005 as the NRHM, later expanded in 2013 to incorporate NUHM.
• Aims to ensure accessible, affordable, and high-quality healthcare for all.

Core Focus Areas

1. Strengthening Health Systems: Improving infrastructure, workforce capacity, and digital health initiatives.
2. RMNCH+A Approach: Focuses on Reproductive, Maternal, Neonatal, Child, and Adolescent Health.
3. Disease Control Initiatives: Targets both communicable and non-communicable diseases.

RMNCH+A Framework

• Vision: Aims for a future where preventable maternal and child deaths are eliminated, ensuring that every pregnancy is safe and every child thrives.
• Objectives:
  • Reduce Total Fertility Rate (TFR), Infant Mortality Rate (IMR), and Maternal Mortality Ratio (MMR).
• Policy Integration: Aligns with key national strategies, including:
  • Sustainable Development Goals (SDGs)
  • National Population Policy (2000)
  • National Health Policy (2002)
  • Vision 2020 India
• Targeted Healthcare Initiatives: Focused on vulnerable populations, ensuring accessible and quality primary healthcare and family welfare services.

Maternal & Child Mortality Goals (by 2030)

• Maternal Mortality: Reduce maternal deaths to below 70 per 1,00,000 live births.
• Child Mortality:
  • Lower neonatal mortality rate to 12 per 1,000 live births.
  • Reduce under-5 mortality rate to 25 per 1,000 live births.
• Global Benchmarking: Strives to align India’s health indicators with those of developed nations.