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Tuesday, May 24, 2022

Who are ASHA workers, the women healthcare volunteers honoured by WHO?

 The World Health Organisation has recognised the country’s 10.4 lakh ASHA (Accredited Social Health Activist) workers as ‘Global Health Leaders’ for their efforts in connecting the community to the government’s health programmes.

While congratulatory messages have since poured in from the Prime Minister and the Health Minister among others, the women health volunteers continue to fight for higher remuneration, regular jobs, and even health benefits.While intermittent protests have been going on in several states, thousands of ASHAs from across the country took to the streets in September last year to fight for their demands.

Who are ASHA workers?

ASHA workers are volunteers from within the community who are trained to provide information and aid people in accessing benefits of various healthcare schemes of the government.hey act as a bridge connecting marginalised communities with facilities such as primary health centres, sub-centres and district hospitals.

The role of these community health volunteers under the National Rural Health Mission (NRHM) was first established in 2005.

ASHAs are primarily married, widowed, or divorced women between the ages of 25 and 45 years from within the community. They must have good communication and leadership skills; should be literate with formal education up to Class 8, as per the programme guidelines.

How many ASHAs are there across the country?

The aim is to have one ASHA for every 1,000 persons or per habitation in hilly, tribal or other sparsely populated areas.

There are around 10.4 lakh ASHA workers across the country, with the largest workforces in states with high populations – Uttar Pradesh (1.63 lakh), Bihar (89,437), and Madhya Pradesh (77,531). Goa is the only state with no such workers, as per the latest National Health Mission data available from September 2019.

What do ASHA workers do?

They go door-to-door in their designated areas creating awareness about basic nutrition, hygiene practices, and the health services available. They focus primarily on ensuring that women undergo ante-natal check-up, maintain nutrition during pregnancy, deliver at a healthcare facility, and provide post-birth training on breast-feeding and complementary nutrition of children. They also counsel women about contraceptives and sexually transmitted infections.

ASHA workers are also tasked with ensuring and motivating children to get immunised. Other than mother and child care, ASHA workers also provide medicines daily to TB patients under directly observed treatment of the national programme. They are also tasked with screening for infections like malaria during the season. They also provide basic medicines and therapies to people under their jurisdiction such as oral rehydration solution, chloroquine for malaria, iron folic acid tablets to prevent anaemia, and contraceptive pills.

“Now, we also get people tested and get their reports for non-communicable diseases. On top of that ASHA workers were given so much work during the pandemic. We are no longer volunteers,” said Ismat Arra Khatun, an ASHA worker from West Bengal and general secretary of the Scheme Workers Federation of India that led the national protest.

The health volunteers are also tasked with informing their respective primary health centre about any births 

How did the ASHA network help in pandemic response?

ASHA workers were a key part of the government’s pandemic response, with most states using the network for screening people in containment zones, getting them tested, and taking them to quarantine centres or help with home quarantine.

“During the first year of the pandemic, when everyone was scared of the infection, we had to go door-to-door and check people for Covid-19 symptoms. Those who had fever or cough had to be tested. Then, we had to inform the authorities and help the people reach the quarantine centres. We also faced a lot of harassment because there was so much stigma about the infection that people did not want to let us in,” said Ismat Khatun.

Kavita Singh from Delhi, a former ASHA worker and a member of Scheme Workers Federation of India, added, “We had to go to households with confirmed Covid-19 cases and explain the quarantine procedure. We had to provide them with medicines and pulse-oximeters. All of this on top of our routine work.”

With the vaccination drive for Covid-19 beginning in January last year, they have also been tasked with motivating people to get their shots and collect data on how many people are yet to get vaccinated.or deaths in their designated areas. 

How much are ASHA workers paid?

Since they are considered “volunteers”, governments are not obligated to pay them a salary. And, most states don’t. Their income depends on incentives under various schemes that are provided when they, for example, ensure an institutional delivery or when they get a child immunised. All this adds up to only between Rs 6,000 to Rs 8,000 a month.

“Her work would be so tailored that it does not interfere with her normal livelihood,” the National Health Mission states. However, with outreach of most health programmes depending on them, that is not the case.

“Even if we work 24 hours, we will not be able to complete all the tasks. And, we do not get any benefits like pension or health insurance. If WHO recognises our role, if the government can call us veerangna (hero), shower us with flowers, why can’t they pay us fairly for all the work that we do,” said Ismat.

For quite some time now, ASHA workers have been demanding that they be made permanent employees of the government and provided benefits.

“If not that, they should at least fix our core incentives so that we get paid at least Rs 3,000 a month no matter what. All the work is graded 0 to 12 and if I do not get at least 6 points, I get paid only Rs 500 instead of Rs 3,000. I do not get points, even if a woman goes back to her home town to deliver the baby,” said Kavita.

She said that Covid-19 pushed them to their limits.“During Covid-19, we were only being paid Rs 1,000 for all of the additional work. Since the incentive stopped in March this year, half of the ASHA workers in Delhi decided not to participate in Covid-19 vaccination related activities,” added Kavita.

Written by Anonna Dutt 

Source: Indian Express, 24/05/22


ASHA: A successful public health experiment rooted in the village community

 

It is a programme that has done well across the country. As skill sets improved, recognition and respect for the ASHA went up. In a way, it became a programme that allowed a local woman to develop into a skilled health worker.

The World Health Organisation (WHO) has recognized the contribution of India’s 1 million Accredited Social Health Activists (ASHAs) during the Covid-19 pandemic. It is acknowledged that ASHAs facilitate linking households to health facilities, and play pivotal roles in house-to-house surveys, vaccination, public health and Reproductive and Child Health measures.

In many states, ASHAs are involved in national health programmes, and in the response to a range of communicable and non-communicable diseases. They get performance-based payments, not a fixed salary like government servants. There have been agitations demanding employee status for ASHA workers. The idea of performance-based payments was never to pay them a paltry sum — the compensation was expected to be substantial.

The ASHA programme was based on Chhattisgarh’s successful Mitanin programme, in which a Community Worker looks after 50 households. The ASHA was to be a local resident, looking after 200 households. The programme had a very robust thrust on the stage-wise development of capacity in selected areas of public health. Dr T Sundararaman and Dr Rajani Ved among others provided a lot of support to this process. Many states tried to incrementally develop the ASHA from a Community Worker to a Community Health Worker, and even to an Auxiliary Nurse Midwife (ANM)/ General Nurse and Midwife (GNM), or a Public Health Nurse.

Important public policy and public management lessons emerge out of the successful experiment with Community Workers who were not the last rung of the government system — rather, they were of the community, and were paid for the services they rendered. The idea was to make her a part of the village community rather than a government employee.

Over 98 per cent ASHAs belong to the village where they reside, and know every household. Their selection involved the community and key resource persons. Educational qualification was a consideration. With newly acquired skills in health care and the ability to connect households to health facilities, she was able to secure benefits for households. She was like a demand-side functionary, reaching patients to facilities, providing health services nearer home.

The Expert

Amarjeet Sinha is a retired civil servant who was associated with the design and capacity-building thrust of the ASHA programme for more than five years.

Building of a cadre

It is a programme that has done well across the country. As skill sets improved, recognition and respect for the ASHA went up. In a way, it became a programme that allowed a local woman to develop into a skilled health worker.

The ASHAs faced a range of challenges: Where to stay in a hospital? How to manage mobility? How to tackle safety issues? The solutions were found in a partnership among frontline workers, panchayat functionaries, and community workers. This process, along with the strengthening of the public infrastructure for health with flexible financing and innovations under the Health Mission and Health and Wellness Centres, led to increased footfall in government facilities. Accountability increased; there would be protests if a facility did not extend quality services.

The Community Worker added value to this process. Incentives for institutional deliveries and the setting up of emergency ambulance services like 108, 102, etc. across most states built pressure on public institutions and improved the mobility of ASHAs. Overall, it created a new cadre of incrementally skilled local workers who were paid based on performance. The ASHAs were respected as they brought basic health services to the doorstep of households.

Issue of compensation

There have been challenges with regard to the performance-based compensation. In many states, the payout is low, and often delayed. The original idea was never to deny the ASHA a compensation that could be even better than a salary — it was only to prevent “governmentalisation”, and promote “communitisation” by making her accountable to the people she served.

There were serious debates in the Mission Steering Group, and the late Raghuvansh Prasad Singh made a very passionate plea for a fixed honorarium to ASHAs. Dr Abhay Bang and others wanted the community character to remain, and made an equally strong plea for skill and capacity development of Community Workers. Some states incentivised ASHAs to move up the human resource/ skilling ladder by becoming ANMs/ GNMs and even Staff Nurses after preferential admission to such courses.

The important public policy lessons are the need to incrementally develop a local worker keeping accountability with the community, make performance-based payments, and provide a demand-side push with simultaneous augmentation of services in public systems. The system can sustain and grow only if the compensation is adequate, and the ASHA continues to enjoy the confidence of the community.

Debate over status

There is a strong argument to grant permanence to some of these positions with a reasonable compensation as sustaining motivation. The incremental development of a local resident woman is an important factor in human resource engagement in community-linked sectors. This should apply to other field functionaries such as ANMs, GNMs, Public Health Nurses as well.

It is equally important to ensure that compensation for performance is timely and adequate. Ideally, an ASHA should be able to make more than the salary of a government employee, with opportunities for moving up the skill ladder in the formal primary health care system as an ANM/ GNM or a Public Health Nurse. Upgrading skill sets and providing easy access to credit and finance will ensure a sustainable opportunity to earn a respectable living while serving the community. Strengthening access to health insurance, credit for consumption and livelihood needs at reasonable rates, and coverage under pro-poor public welfare programmes will contribute to ASHAs emerging as even stronger agents of change.

Written by Amarjeet Sinha

Source: Indian Express, 24/05/22

Monday, May 23, 2022

Quote of the Day May 23, 2022

 

“The real secret of happiness is simply this: to be willing to live and let live, and to know very clearly in one's own mind that the unpardonable sin is to be an unpleasant person.”
Galen Starr Ross
“खुशी का वास्तविक रहस्य निम्नलिखित है: जीवन जीने और जीने देने का उत्साह, तथा अपने मन में यह स्पष्ट आभास कि झगड़ालू व्यक्ति होना एक अक्षम्य अपराध है।”
गैलेन स्टार्र रोस्स

Current Affairs- May 23, 2022

 

INDIA

– Navies of India and Bangladesh conducting CORPAT (Coordinated Patrol) in Bay of Bengal

– Union Home Minister Amit Shah inaugurates & lays foundation stones of various infrastructure projects worth Rs 1180 crore in Arunachal Pradesh

 Year-long celebrations of 250th Birth Anniversary of Raja Ram Mohan Roy begin

– National Recruitment Agency to conduct computer-based online CET for recruitment to non-gazetted posts by year end

– IIT-JEE (IIT-Joint Entrance Exam) to go global and be open to students from 25 nations, from US to Vietnam

– Centre forms 3-member panel to investigate Ramban tunnel collapse on Jammu-Srinagar highway on May 19

– West Bengal: Arjun Singh, BJP MP from Barrackpore, joins Trinamool Congress

ECONOMY & CORPORATE

– Govt giving additional fertiliser subsidy of Rs 1.10 lakh crore this fiscal: FM Nirmala Sitharaman

– India Ideas Conclave ‘India 2.0: Rebooting to Meta Era’ organised by the India Foundation in Bengaluru

– Salil Parekh reappointed as Infosys CEO & MD for another five years

WORLD

– Annual meeting of World Economic Forum begins in Davos, Switzerland with its theme as “Working Together, Restoring Trust”; Commerce & Industry Minister Piyush Goyal leads Indian delegation

– International Day for Biological Diversity celebrated on May 22; theme: “Building a shared future for all life”

– World Day for Cultural Diversity for Dialogue and Development celebrated on May 21

– International Tea Day celebrated on May 21

SPORTS

– Australian swimmer Ariarne Titmus sets women’s 400-meter freestyle world record

Scientific Social Responsibility (SSR) Guidelines

 Department of Science and Technology recently released the Scientific Social Responsibility (SSR) Guidelines.

What is the need to introduce SSR guidelines?

India has taken great strides in the advancement of Science, Technology, and Innovation (STI). However, there is an inadequate transfer of scientific knowledge to society. There is a need for greater integration of science and technology with society in today’s age. In this regard, the 104th session of the Indian Science Congress held in 2017 also stressed the need to introduce SSR guidelines.

SSR guidelines aim to ensure greater integration of S&T with society at all levels. SSR is based on the moral obligation of scientists to give back the benefits of science to society. Thus, SSR will be the convergence of scientific knowledge and social conscience.

The guidelines will bridge the following gaps: science-society (passing on the benefits of science to meet public needs), science-science (creating an atmosphere to share ideas), and society-science (working with the public to identify their needs and developing appropriate solutions).

Who are the stakeholders?

The SSR guidelines involve four categories of stakeholders:

  1. Beneficiaries (any community group or individuals),
  2. Implementers (educational and scientific institutions),
  3. Assessors (internal or external),
  4. Supporters (funds provided by government, individuals, or any other agencies).

Thus, SSR guidelines create an ecosystem with a two-way engagement between science and society.

What are the other highlights?

An Anchor Scientific Institution (ASI) will be identified in every district of India, which will map the issues faced by a society that requires immediate scientific solutions and establish links with the implementers of the area. A national digital portal will connect all the ASIs and State Science and Technology Council (SSTCs).

The knowledge institutions should prepare their SSR implementation plan. Every scientist in the country is expected to contribute at least 10 working days annually towards SSR activities for which there will be weightage in their annual performance evaluation.

Economic and Political Weekly: Table of Contents

 

Vol. 57, Issue No. 21, 21 May, 2022

Comment

From the Editor's Desk

From 50 Years Ago

Alternative Standpoint

Commentary

Book Reviews

Insight

Special Articles

Current Statistics

Letters

Behind the unprecedented pre-monsoon devastation in Assam

 

While the monsoons are yet to arrive, Assam has already been beset by floods and landslides that have left 15 people dead and more than 7 lakh affected.


The monsoons bring destruction to Assam like a clockwork almost every year. However, this year, while the monsoons are yet to arrive, the state has already been beset by floods and landslides that have left 15 people dead and more than 7 lakh affected. The hill district of Dima Hasao, in particular, has been ravaged by flash floods and landslides, with connectivity to the rest of the state snapped.

What is behind this unprecedented devastation?

Experts point out that there are a combination of factors. First, extraordinarily acute pre-monsoon rains. While the average rainfall for the period of March 1 to May 20 in Assam is 434.5 mm, the corresponding number for this year is 719 mm. That amounts to a 65 per cent excess. That is a “large excess”, according to the Indian Meteorological Department. The neighbouring state of Meghalaya has recorded an even greater excess: of 137 per cent.

“Normally we have rains coming in June and July when we experience big floods,” said Dr DC Goswami, an eminent environmentalist and a retired professor of hydrology from the Gauhati University. “This time it has come with a bang. The difference is the timing and scale.” Goswami attributed the changes in “rainfall intensity, arrival and departure times” to climate change.

Partha Jyoti Das, who heads the Water, Climate and Hazard Division of the Guwahati-based environment non-profit Aaranyak, concurred. “Because of climate change, there are more and more concentrated rain and heavy rainfall episodes,” said Das.

He added that it was even more worrisome since the southwest monsoons were expected early (end May) in the northeast region this year. “There may be little respite between the recession of this pre-monsooBut it is not just floods that have wreaked destruction. There have been several episodes of landslides, especially in south Assam’s Dima Hasao and Cachar districts. At least three people have been buried alive in Dima Hasao’s Haflong. In a particularly horrific incident, mudslides washed away a portion of the rail tracks that connect the south of Assam with the rest of the country. The New Haflong railway station was also severely damaged with bogeys of a train at the station overturning under the force of landslide-induced debris. Portions of the road connecting Guwahati to Dima Hasao, and beyond to Barak Valley districts, have caved in.nal flood and the advent of the first monsoonal flood surge, especially in Assam,” he said.

But what is causing these landslides?

Das said that while landslides in that part of the state are not unheard of, the scale and the intensity was higher than usual. Das blamed this on the “undesirable, unpragmatic, unplanned structural intervention on the fragile landscape of hills”.

A case in point is the Lumding-Badarpur railway line. The affected railway line that connects Lumding in central Assam to Badarpur in south Assam and passes through the hill district of Dima Hasao was expanded into a broad gauge in 2015. The expansion work of this much-delayed project had begun in 1997, but the tricky landscape meant progress was woefully slow. Besides, the expansion project was marred by several red flags and even after its  inauguration, there have been accusations about it having flouted safety norms.  The current spate of landslides have affected the line in at least 58 spots, said railways officials. The trains in that section stand cancelled till July 1.

Das said that the damage to the line suggested what many had been pointing out for years: that corners may have been cut in carrying out the construction.

Apart from the railway line itself, residents of Dima Hasao say that the district has seen hectic construction, both of public infrastructure like roads and private property, in recent times. “Over the years, there has not only been massive deforestation for the extension of the railway line and the four-line highway, there has also been rampant riverbed mining often done in collusion with the district authorities,” said Uttam Bathari, a historian and professor at Gauhati University, who hails from Haflong.

Also, allegations abound of roads being built over streams and spring water sources – the reason, many say, so many roads have caved in.

Mirza Zulfiqur Rahman, an independent researcher based in Guwahati, said similar hastily carried out infrastructure developmental work in Arunachal Pradesh had led to an increase in landslides in the state in recent years. This month itself, five people have been killed. “Construction is sped up in the name of national security in Arunachal and improving connectivity elsewhere in Northeast India,” alleged Rahman.

Das of Aaranyak said that construction needed to be “tuned to the ecological fragility of the region”.

Goswami also spoke of “conscious construction” and an “integrated holistic approach across state boundaries”.

Rahman suggested keeping “traditional knowledge systems in mind” and involving  the local community to build “sustainable infrastructure”. “As long as it is top-down it will depend on the masculinist engineering bureaucracies,” he said.

Blaming climate change for everything was not enough, said Rahman. “We have to look back at the mess we have created on the ground level in combination with climate change to account for such disasters.”

Written by Tora Agarwala

Source: Indian Express, 21/05/22