ASHAs’ Health Services

The intrinsic commitment of the accredited social health activists towards the well-being of the community is unduly exploited by the state in the name of “volunteerism.” It is high time a wholesome definition of work is adopted to understand the inconspicuous contributions made by these front-line healthcare workers, who form a key link in the public health system in India.

The author expresses her gratitude to Awanish Kumar and Sonya Gill for their guidance in developing this article, and to the district committee activists of the All India Democratic Women’s Association for their assistance during her field visits.

The Alma Ata Declaration of 1978 identified primary healthcare as the cornerstone of health systems. To attain the goal of “Health for All,” the role of community health workers (CHWs) in bridging the gap between people and the formal healthcare system was highlighted. In India, the Bhore Committee (1946) and Sokhey Sub-Committee (1948) had made recommendations to the government to include CHWs in public health services. However, it was the “Mitanin” Programme of Chhattisgarh in 2002 that inspired the accredited social health activist (ASHA) model under the National Rural Health Mission(NRHM), 2005. As providers of preventive and curative primary healthcare, these frontline female health workers have contributed in containing disease outbreaks in addition to significantly reducing infant and maternal mortality in the country (Mane and Khandekar 2014). Yet, a gendered understanding of care work by the ASHA herself, the village community and her family determines whether she sees herself as a social worker or a health worker. This article analyses the ASHAs’ consciousness as a woman worker through the theoretical lens of care work.

First, I analyse the devaluation theory of care work by capturing the perception of the ASHA’s family and her community. This understanding is important because it affects her position in society, the motivation for work, and even shapes how the state negotiates with her. Second, this article tries to capture the self-identity of an ASHA. What are her perceptions about the nature of her work, and how does being part of the public health delivery system impact her life, while challenging gender norms? Third, in the context of the ASHAs’ poor working conditions, how does their relationship with the health bureaucracy pan out in the delivery of healthcare?