Major issues of CHWs
Lack of Regularisation and position
The National Rural Health Mission (NHM)of India, is responsible for the health care of the nation through the public health care system, but the entire NHM work force including doctors, technicians and CHWs like ASHAs, are not government employees, but under contract.
Today NHM looks after the health of the nation's poor and unserved population on villages and slums on behalf of the government. The Mission has accomplished a mammoth task of training around 900000 village women as Community Health Workers ASHAs and then facilitating them to work in their own villages, under regular supervision and guidance. ASHAs like other CHW programs of governments across the globe, are selected, trained and supervised by the government, and work for the government’s health programs, yet are designated as volunteers.
While financial stability is the main concern of those higher up in the ladder of the NHM structure like the doctors, ASHAs can be exploited by their seniors, ridiculed by the community and pressurised by their families even as their work is appreciated by these stakeholders because they are the lowest rung of the ladder.
Further, research findings indicate that ASHAs want improved professional conditions also in order to sustain their inherent altruism. After all their living environment is not different from the deprived community that they serve. Like us all, the CHWs have to address their own needs and the demands of their families, although they realize the importance and enjoy the service that they provide to their communities. Looking at their life situations and working conditions, it is fair to conclude that we put CHWs in a bind when we expect their altruism to be their only motivating factor.
Regularisation of position, protects the rights of the workers and also facilitates good motivation. Accountability is best expected from stable employees, not workers living with job insecurity. A stable work force is the backbone of a stable health care system. Governments need to spend more on human resources development in the public health care systems for all the health care personnel. In this era of increasing privatization, is this wishful thinking.