Paper short abstract:

ASHAs in India connect the rural population with the public health system. This paper focusses on their collective effort in raising their voice with the State. The paper highlights the important role they play at rural households in improving health care towards meeting global health goals.

Paper long abstract:

Over 35,000 Accredited Social Health Activists (ASHAs) working in about 29,000 villages of Karnataka in India organised a massive rally and a day long protest in Bengaluru recently. Since the last 10 years ASHAs have played an important role in improving health in remote, rural areas, reducing maternal and infant mortality. They are honorary volunteers and receive performance-based compensation based on reported activities. They are involved in a range of services such as antenatal care, institutional deliveries at a government facility, immunisation, follow up of low-birth weight babies, spacing of birth between children, health surveys among many othera. They work long hours, however the compensation is not just highly disproportionate to the work they do, but also very irregular. The payments are dependent on the data entry operators/approval of intermediaries at the Primary Health Centres.

They have been recently demanding better wages and work conditions. For example they work as DOT providers for tuberculosis treatment and bring samples to the health centres. However, they are not even provided safety gloves. ASHAs accompany pregnant women (during delivery) and children for treatment even during odd hours and to distant health facilities. However, they do not have a resting room and sometimes even staff in those health facilities are not supportive and do not treat them properly.

In response to their demands the State has threatened to withdraw their honorarium. If their concerns are not addressed the backbone of the public health collective at the grassroot level will be crippled.