UPSC Daily Editorial Analysis | 2 June 2022

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What the article is about?

  • Talks about the achievements of community-oriented health services and the way ahead.

Syllabus: GS-II Health, Social Justice

Community-oriented health services:

  • India’s one million Accredited Social Health Activists (ASHA) volunteers have received arguably the biggest international recognition in form of the WHO’s Global Health Leaders Awards 2022.
    • The ASHAs were among the six awardees announced at the 75th World Health Assembly in Geneva.
    • This award is in recognition of the work done by ASHA volunteers during the COVID-19 pandemic as well as for serving as a link between communities and health systems. 

ASHAs and contributions:

  • India launched the ASHA programme in 2005-06 as part of the National Rural Health Mission.
    • Initially rolled out in rural areas, with the launch of the National Urban Health Mission in 2013, it was extended to urban settings as well.
    • Each of these women-only volunteers work with a population of nearly 1,000 people in rural and 2,000 people in urban areas, with flexibility for local adjustments.
  • Even before the COVID-19 pandemic, ASHAs have made extraordinary contributions towards enabling increased access to primary health- care services; i.e. maternal and child health including immunisation and treatment for hypertension, diabetes and tuberculosis, etc., for both rural and urban populations, with special focus on difficult-to-reach habitations.
  • Over the years, ASHAs have played an outstanding role in making India polio free, increasing routine immunisation coverage; reducing maternal mortality; improving new-born survival and in greater access to treatment for common illnesses. 


  • Among the A-A-A, ASHAs are the only ones who do not have a fixed salary; they do not have opportunity for career progression.
  • Though performance-based incentives are supplemented by a fixed amount in a few Indian States, the total payment continues to remain low and often delayed.
  • These issues have resulted in dissatisfaction, regular agitations and protests by ASHAs in many States of India. 

Way Out:

  • Indian States need to develop mechanisms for higher remuneration for ASHAs.
  • In-built institutional mechanisms are to be created for capacity-building and avenues for career progression for ASHAs to move to other cadres such as ANM, public health nurse and community health officers are opened.
  • Extending the benefits of social sector services including health insurance (for ASHAs and their families) should be considered.
  • An independent and external review of the programme needs to be given urgent and priority consideration
  • There are arguments for the regularisation of many temporary posts in the National Health Mission and making ASHAs permanent government employees.
  • Need to acknowledge that the specific functions at the village level, which ASHAs play, may not be ideally suited for a permanent position.

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