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Myriad experiences of NGO health worker programmes have shown that insisting on formal education is not necessary provided the training of health workers is properly designed. However, with the present educational barrier, the women with strongest social motivation,
women who are representative of deprived groups, are likely to get excluded from the programme. ASHA is supposed to work primarily as a volunteer. She would be compensated on performance of certain specific tasks related to national programmes. However, for her major routine activities, such as immunization, weighing of newborns, facilitating ANC, treating patients, visiting households, giving education to mothers, mobilizing the community, etc., as per the financial norms, the maximum compensation from the Village Untied Fund that may be given is mentioned as Rs. 1,000 annually, or about Rs. 83 per month. It does not require a great degree of imagination to realize that with such a paltry compensation (equivalent to less than two days of wages in a month), the amount of work that can be expected from the ASHA cannot be very significant.

To sustain the motivation and activity of village women working as ASHAs, who would have many other competing work priorities and domestic responsibilities, will be a challenge given the very limited and uncertain compensation they would receive. One of the strongest felt needs expressed by communities is the need for basic curative care being made available within their village. Many NGOs have demonstrated that well-trained health workers can give a wide range of First Contact Care effectively. However, the ability of ASHA to give basic care in simple illnesses is dependent on adequate relevant training, provision of a proper kit and regular replenishment of the range of necessary medicines. The drug list for ASHA as has been presently proposed is extremely limited, and the budgetary norm for drugs is Rs. 50 per month (the same as for CHVs way back in 1978!) which raises doubts about her being made capable to meet people's needs for First Contact Care. If she is seen as a person who cannot give significant care to persons with health problems, her credibility in the village as a health facilitator and, hence, her overall effectiveness may also become limited.

By her very name - 'Accredited Social Health Activist' - the ASHA is supposed to be an 'Activist' mobilizing people and facilitating their access to health services as a right. However, given the fact that the ANM will be involved in sanctioning her compensation, and she would be reporting to the health system for implementation of various programme related activities, would she be realistically able to function as an 'activist' and lead people to put pressure on non-performing health services? Given the way in which the programme is presently structured, there are strong inhibiting forces to prevent her from really becoming an 'activist' vis-à-vis the health system.

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Dr. Gursharan Singh Kainth started his career as Lecturer at Post Graduate Dept. of Economics, Government College, Gurdaspur, and later at Khalsa College; Amritsar, specializes in Quantitative & Development Economics. Has the distinction of serving Punjab Agricultural Univ, Ludhiana, for more than 2 decades and remained Director-Principal of Saint Soldier Management & Technical Institute, Jalandhar. Currently, heading GAD Institute of Development Studies, Amritsar, a self-financed research institute. Has been honoured with various awards, including Guru Draunacharya Samman, Vijay Rattan Award, etc.
Article posted on December 14, 2008.