Providing ASHAs with health insurance, maternity benefits, and accident coverage

New Delhi, Feb 21, 2025 : The National Human Rights Commission (NHRC), India organised a core group meeting in hybrid mode on women on the theme ‘Empowering Accredited Social Health Activists (ASHAs): Securing the right to work with dignity’ at its premises in New Delhi. It was chaired by the NHRC, India Chairperson, Justice Shri V. Ramasubramanian in the presence of Member, Justice (Dr) Bidyut Ranjan Sarangi, Secretary General, Shri Bharat Lal, senior officers, experts, and ASHAs.

Addressing the participants, Chairperson, Justice Shri V. Ramasubramanian highlighted the remarkable contributions made by ASHAs over the past 20 years towards improvements in the healthcare sector in the country. He emphasised that the significant impact of ASHAs has led to notable progress in reducing neonatal and infant mortality rates. They showed that individuals without formal education can still be trained to become skilled workers. He also noted that while there are many educated people today, the number of skilled workers is decreasing. This gap is being addressed by the ASHA scheme. However, he pointed out that ASHAs’ have been stating that their remuneration is not in proportion to their contribution to society. The irony is that at times, those who contribute the most often receive the least; those who care for the marginalized end up being marginalized themselves.

Justice Ramasubramanian said that public health and fixing of minimum wages is a subject coming under the State. Population control and family planning fall under the Concurrent list. Hence, there should be a collaborative effort between the Centre and State Governments to address the issues concerning ASHAs' welfare. He also called for a concrete policy and actionable measures for improving the working conditions and living standards of ASHAs.

NHRC, India Member, Justice (Dr) Bidyut Ranjan Sarangi said that the ASHAs are the first responders to any distress related to pregnant women and children in the village areas before consultation with any doctors materializes. Therefore, their role as activists should be better recognized with adequate incentives, compensation, and security to ensure their right to life with dignity.

Before this, while setting the agenda of the meeting and providing background, the Secretary General, Shri Bharat Lal highlighted the theme of the three technical sessions. These included: ‘The Evolving Nature of Challenges faced by ASHA’, ‘Role of the Government in Protecting and Promoting the Rights of ASHAs’, and ‘Way Forward: Ensuring the Right to Work with Dignity for ASHAs.’ He said that the Government has come up with various schemes for women's empowerment and given the contribution of ASHAs in primary healthcare, their issues such as low honorarium, excessive workload, and insufficient resources also need to be addressed. He highlighted their role during COVID-19 as frontline workers have been exemplary, which has also been acknowledged by the WHO.

The speakers included Shri Saurabh Jain, Joint Secretary, MoHFW; Ms Pallavi Agarwal, Joint Secretary, Ministry of Women & Child Development; Dr Shweta Khandelwal, Senior Advisor Jhpiego India; Ms Ruth Manorama, President, The National Alliance of Women (NAWO); Dr Sabiha Hussain, Professor and Director, Sarojini Naidu Center for Women’s Studies, Jamia Islamia University; Ms. Vaishali Barua, National Coordinator, UN Women India; Ms Dipa Sinha, Visiting Professor, Azim Premji University; Ms Surekha Secretary, ASHA Workers’ and Facilitators’ Federation of India (AWFFI); Ms Sunita, ASHA Worker, Haryana, NHRC, India DG (I), Shri R Prasad Meena, Registrar (Law), Joginder Singh, Director, Lt Col Virender Singh among others.

Some of the suggestions that emanated from the discussion included;

• Need to consider granting ASHAs formal worker status with fixed monthly emoluments, social security, pensions, paid leave, etc.;

• Standardize honorarium/ wages across states, ensuring that honorariums align with minimum wage regulations;

• Replace incentive-based payment structure with a fixed amount plus performance-based benefits;

• Provide health insurance, maternity benefits, and accident coverage to ASHAs;

• Ensure free personal protective equipment (PPE), transport allowances, and access to clean rest areas during field visits;

• Enforce strict policies against harassment and violence, ensuring safe working conditions for ASHAs in all regions;

• Utilize Rs 49,269 crore (As of 2022) of unspent funds from the Building and Other Construction Workers Welfare Cess Act for childcare, elderly care, and ASHA welfare;

• Allocate Rs 70,051 crore health sector grants towards strengthening early childhood care and healthcare workers’ training;

• Establish state-funded creches at primary health centres and community centres to support ASHAs who are also primary caregivers at home;

• Develop structured career pathways for ASHAs to transition into higher-paying healthcare roles, such as nursing, midwifery, and public health administration;

• Provide regular skill enhancement training in disease surveillance, mental health counseling, and emergency medical response;

• Introduce bridge courses in collaboration with medical colleges and universities to certify ASHAs for formal healthcare roles;

• Incentivize private sector investments in childcare and elderly care infrastructure, with tax benefits for employers offering workplace childcare solutions;

• Promote cooperative models, like the SEWA model, to ensure ASHAs have decision-making power over wages and working conditions; and

• Foster public-private partnerships to expand affordable community-based care services, creating decent job opportunities for ASHAs.

The Commission will further deliberate on the suggestions, seek additional inputs and deliberate to take a view in the matter to ensure the welfare of ASHAs.