Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Story of ASHAs: Navigating Challenges in Public Health


From UPSC perspective, the following things are important :

Prelims level: ASHA

Mains level: NA



  • ASHAs, or Accredited Social Health Activists, have emerged as pivotal figures in India’s public health landscape, embodying the promise of compassionate care and community advocacy.

Who are the ASHA workers?

  • Inception: Established in 2002 in Chhattisgarh, ASHAs were envisioned as community health workers, modeled after the ‘Mitanins’, to bridge the gap between the health system and local populations. Initiated in 2005-06 as part of the National Rural Health Mission (NRHM); Expanded to urban settings since 2013 via the National Urban Health Mission.
  • Number: Around 10.4 lakhs employed across India. The highest numbers are in populous states like Uttar Pradesh and Bihar.
  • Geographical Distribution: One ASHA per 1,000 people in rural areas, adjusted to one per habitation in tribal, hilly, and desert regions.
  • Global Recognition: Awarded by the World Health Organization (WHO) in 2013.
  • Functions and Responsibilities: Register newborns, pregnant women, and deaths; accompany patients to health centers; distribute medicines; conduct immunization drives; and report health statistics.

Criteria for selection of ASHA worker:

  • For Rural:
    • The prospective candidate must be a married, widowed or divorced female resident of the village she’s applying to work at.
    • Must be aged between 25 and 45 years.
    • Candidates must be literate. Preference is given to those with a 10th pass certificate. There are several interviews at the Anganwadi, block and district levels. The health committees maintain a thorough selection process.
  • For Urban:
    • The prospective candidates must be female residents of vulnerable clusters or slums within an urban setup.
    • This slum or cluster must be identified by the City or District Health Society as priority zones for ASHA healthcare workers. The candidate should preferably be married, widowed, separated or divorced.
    • Must be aged between 25 and 45 years.
    • Candidates must be literate and must have fluency in the native language of the community.

Challenges Faced by ASHAs

[1] Work Challenges

  • Overwork and Underpayment: ASHAs endure a “triple shift,” balancing household responsibilities, community outreach, and health center duties, often without adequate compensation or rest.
  • Systemic Inequities: ASHAs experience power imbalances along gender and caste lines, compounded by their status as “volunteers,” leading to economic, physical, and psychological vulnerabilities.
  • Social Stigma: Despite their crucial role in improving health outcomes, ASHAs often face social stigma and discrimination within their communities, hindering their effectiveness and well-being.

[2] Occupational Hazards

  • Physical Strain: Irregular meals, inadequate sleep, and exposure to extreme weather conditions contribute to health issues like malnutrition, anaemia, and non-communicable diseases among ASHAs.
  • Mental Health Challenges: The demanding nature of their work and limited social support expose ASHAs to high levels of stress, anxiety, and burnout, affecting their overall well-being and job satisfaction.
  • Safety Concerns: ASHAs, particularly those working in remote or conflict-affected areas, face risks of harassment, violence, and assault while performing their duties, highlighting the need for enhanced security measures and support systems.

[3] Social and Economic Implications

  • Economic Precarity: ASHAs’ honorariums serve as primary family income, yet delays in payment and out-of-pocket expenses exacerbate financial strain, perpetuating cycles of poverty and dependence.
  • Gendered Burden: ASHAs, predominantly women, often bear the brunt of caregiving responsibilities within their households, leading to gender disparities in workload distribution and access to resources.
  • Empowerment and Agency: Despite facing numerous challenges, ASHAs demonstrate resilience and agency in advocating for their rights, mobilizing communities, and demanding policy reforms to improve their working conditions and livelihoods.

Advocacy and Policy Recommendations

  • Recognition and Fair Compensation: Advocate for institutional recognition, fair wages, and improved working conditions for ASHAs, aiming for them to become government employees with access to social security benefits and maternity support.
  • Capacity Building: Support initiatives aimed at enhancing ASHA skills, knowledge, and confidence through targeted training and skill development programs.
  • Community Engagement: Encourage local communities to recognize and appreciate the contributions of ASHAs, fostering stronger support, trust, and collaboration.
  • Safety Measures: Enhance safety protocols and support systems for ASHAs, especially those working in remote or conflict-affected areas, to minimize risks of harassment, violence, and assault.
  • Address Systemic Barriers: Tackle gender and caste-based inequalities experienced by ASHAs, promoting equal opportunities and access to resources.
  • Financial Security: Ensure timely payments and reduce out-of-pocket expenses for ASHAs, mitigating financial strain and perpetual cycles of poverty.


  • The plight of ASHAs reflects broader structural injustices within India’s healthcare sector, underscoring the urgent need for policy reforms and systemic support.
  • As frontline warriors in public health, ASHAs deserve equitable treatment, recognition, and protection, essential for advancing both individual well-being and community health outcomes.
  • Through collective advocacy, empowerment, and solidarity, ASHAs can continue to drive positive change and make lasting contributions to public health in India.

Try this PYQ from CSP 2012:

With reference to the National Rural Health Mission, which of the following are the jobs of ASHA, a trained community health worker?

  1. Accompanying women to the health facility for antenatal care checkups
  2. Using pregnancy test kits for early detection of pregnancy
  3. Providing information on nutrition and immunization
  4. Conducting the delivery of the baby

Select the correct answer using the codes given below:

  1. 1, 2 and 3 only
  2. 2 and 4 only
  3. 1 and 3 only
  4. 1, 2, 3 and 4

Post your answers here.
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