Why in news?

Opposition MPs from Kerala protested in Parliament, demanding higher honorariums and retirement benefits for ASHA workers. The leaders highlighted that ASHAs earn only ₹233 per day, often irregularly.

In response, Health Minister J P Nadda stated that the NHM Steering Group had approved increased incentives, which would be implemented soon.

What’s in today’s article?

• Role of ASHAs in Rural Healthcare
• Earnings of ASHAs
• ASHA Honorariums: Kerala vs Other States

Role of ASHAs in Rural Healthcare

• ASHA stands for Accredited Social Health Activist. 
• ASHAs are community health workers who are part of India's National Rural Health Mission (NRHM). 
• The Ministry of Health and Family Welfare (MoHFW) employs them.
• Launch of ASHAs
  • NRHM launched ASHAs in 2005 as community health functionaries working alongside Anganwadi workers under the Integrated Child Development Scheme (ICDS).
  • In 2013, NRHM and the National Urban Health Mission were merged into the National Health Mission (NHM).
• Responsibilities of ASHAs
  • Serve as the first point of contact for marginalized communities, particularly women and children, for healthcare needs.
  • Promote awareness of good health practices and assist in accessing public health services.
  • Support maternal and childcare, immunization drives, family planning, and disease prevention programs.
  • Conduct periodic home visits and maintain health records.
• Selection Criteria
  • Women aged 25-45, preferably married, widowed, or divorced.
  • Minimum education qualification of Class 10.
  • Selection involves gram panchayats, Anganwadi institutions, community groups, and self-help groups.
• Coverage and Workforce
  • One ASHA is assigned per 1,000 people.
  • As of 2022-23, India had 9.2 lakh rural ASHAs and approximately 79,900 urban ASHAs.
  • The highest number of ASHAs are in Uttar Pradesh, Bihar, Chhattisgarh, and Madhya Pradesh.

Earnings of ASHAs

• Volunteer Status and Payment Structure
  • Initially, ASHAs were considered honorary volunteers whose work was designed not to interfere with their livelihood.
  • However, many now work full-time as they serve as the first point of contact for marginalized households.
  • Despite this, the NHM still classifies them as volunteers, making them ineligible for fixed salaries beyond task-based incentives.
• Monthly Incentives and Honorarium
  • ASHAs receive a monthly incentive of ₹3,000, shared between the Centre and the state.
  • Payment is tied to completing specific tasks and is often not fully disbursed.
  • Kerala ASHAs get ₹500 for the Rashtriya Bal Swasthya Karyakram (early childcare scheme), but its applicability is limited in areas with low childbirth rates.
• State-Specific Honorarium and Task-Based Earnings
  • In Kerala, ASHAs receive a monthly honorarium of ₹7,000, funded by the state.
  • Payment depends on completing 10 tasks, such as running clinics and maintaining ward reports, each valued at ₹700.
  • Additional task-based incentives vary depending on different national health schemes and their applicability in specific areas.

ASHA Honorariums: Kerala vs Other States

• Kerala Health Minister Veena George stated that the state offers the highest honorarium to ASHAs.
• However, some states provide higher payments and additional benefits.
• Sikkim: Paying ₹10,000 per month since October 2022.
• Andhra Pradesh: Increased honorarium to ₹10,000 and introduced ₹15 lakh gratuity for ASHAs completing 30 years of service.
• Karnataka: Raised honorarium from ₹5,000 to ₹10,000 (effective April) following an ASHA workers’ strike demanding ₹15,000 as a fixed monthly honorarium.