Editorials/Opinions Analysis For UPSC 26 May 2022
- ASHA workers earn WHO’s global plaudits
- Xinjiang leak puts Uighurs in spotlight
The country’s frontline health workers or ASHAs (accredited social health activists) were one of the six recipients of the WHO’s Global Health Leaders Award 2022 which recognizes leadership, contribution to the advance of global health and commitment to regional health issues.
GS-II: Development Processes and the Development Industry — the Role of NGOs, SHGs, various groups and associations, donors, charities, institutional and other stakeholders.
Dimensions of the Article
- Who are ASHA workers?
- Genesis & Evolution
- Qualifications for ASHA Workers
- How many ASHAs are there across the country?
- What do ASHA workers do?
- How much are ASHA workers paid?
- Success of the ASHAs
- Challenges to ASHAs
- Way Forward
Who are ASHA workers?
- ASHA workers are volunteers from within the community who are trained to provide information and aid people in accessing benefits of various healthcare schemes of the government.
- The role of these community health volunteers under the National Rural Health Mission (NRHM) was first established in 2005.
- They act as a bridge connecting marginalized communities with facilities such as primary health centers, sub-centers and district hospitals.
Genesis & Evolution
- The ASHA programme was based on Chhattisgarh’s successful Mitanin programme, in which a Community Worker looks after 50 households.
- The ASHA was to be a local resident, looking after 200 households.
- The programme had a very robust thrust on the stage-wise development of capacity in selected areas of public health.
- Many states tried to incrementally develop the ASHA from a Community Worker to a Community Health Worker, and even to an Auxiliary Nurse Midwife (ANM)/ General Nurse and Midwife (GNM), or a Public Health Nurse.
Qualifications for ASHA Workers
- ASHAs are primarily married, widowed, or divorced women between the ages of 25 and 45 years from within the community.
- They must have good communication and leadership skills; should be literate with formal education up to Class 8, as per the programme guidelines.
How many ASHAs are there across the country?
- The aim is to have one ASHA for every 1,000 persons or per habitation in hilly, tribal or other sparsely populated areas.
- There are around 10.4 lakh ASHA workers across the country, with the largest workforces in states with high populations – Uttar Pradesh (1.63 lakh), Bihar (89,437), and Madhya Pradesh (77,531).
- Goa is the only state with no such workers, as per the latest National Health Mission data available from September 2019.
What do ASHA workers do?
- They go door-to-door in their designated areas creating awareness about basic nutrition, hygiene practices, and the health services available.
- They focus primarily on ensuring that pregnant women undergo ante-natal check-up, maintain nutrition during pregnancy, deliver at a healthcare facility, and provide post-birth training on breast-feeding and complementary nutrition of children.
- They also counsel women about contraceptives and sexually transmitted infections.
- ASHA workers are also tasked with ensuring and motivating children to get immunized.
- Other than mother and child care, ASHA workers also provide medicines daily to TB patients under directly observed treatment of the national programme.
- They are also tasked with screening for infections like malaria during the season.
- They also provide basic medicines and therapies to people under their jurisdiction such as oral rehydration solution, chloroquine for malaria, iron folic acid tablets to prevent anemia etc.
- Now, they also get people tested and get their reports for non-communicable diseases.
- The health volunteers are also tasked with informing their respective primary health center about any births or deaths in their designated areas.
How much are ASHA workers paid?
- Since they are considered “volunteers/activists”, governments are not obligated to pay them a salary. And, most states don’t.
- Their income depends on incentives under various schemes that are provided when they, for example, ensure an institutional delivery or when they get a child immunized.
- All this adds up to only between Rs 6,000 to Rs 8,000 a month.
- Her work is so tailored that it does not interfere with her normal livelihood.
Success of the ASHAs
- It is a programme that has done well across the country.
- In a way, it became a programme that allowed a local woman to develop into a skilled health worker.
- Overall, it created a new cadre of incrementally skilled local health workers who were paid based on performance.
- The ASHAs are widely respected as they brought basic health services to the doorstep of households.
- Since then ASHA continues to enjoy the confidence of the community.
Challenges to ASHAs
- The ASHAs faced a range of challenges: Where to stay in a hospital? How to manage mobility? How to tackle safety issues?
- There have been challenges with regard to the performance-based compensation. In many states, the payout is low, and often delayed.
- It has a problem of responsibility and accountability without fair compensation.
- There is a strong argument to grant permanence to some of these positions with a reasonable compensation as sustaining motivation.
- Ideally, an ASHA should be able to make more than the salary of a government employee, with opportunities for moving up the skill ladder in the formal primary health care system as an ANM/ GNM or a Public Health Nurse.
- The incremental development of a local resident woman is an important factor in human resource engagement in community-linked sectors.
- It is equally important to ensure that compensation for performance is timely and adequate.
- Upgrading skill sets and providing easy access to credit and finance will ensure a sustainable opportunity to earn a respectable living while serving the community.
- Strengthening access to health insurance, credit for consumption and livelihood needs at reasonable rates, and coverage under pro-poor public welfare programs will contribute to ASHAs emerging as even stronger agents of change.
Source – The Hindu
A leak of thousands of photos and official documents from China’s Xinjiang has shed new light on the atrocious methods used to enforce mass internment in the region.
GS-III: Effect of Policies and Politics of Developed and Developing Countries on India’s interests, Indian Diaspora.
Dimensions of the Article
- What is the leak about?
- Who are the Uighurs?
- Where is Xinjiang?
- What was the build-up to the crackdown?
- Chinese Narrative
What is the leak about?
- After initially denying their existence, Beijing has claimed the facilities are vocational training schools, attended voluntarily and aimed at stamping out religious extremism.
- But the leaked documents give an insight into how leaders saw the minority population as a security threat.
- Photos appear to show officers restraining hooded and shackled inmates with batons, while other guards wearing camouflage stand by with firearms.
Who are the Uighurs?
- There are about 12 million Uighurs, mostly Muslim, living in north-western China in the region of Xinjiang, officially known as the Xinjiang Uyghur Autonomous Region (XUAR).
- The Uighurs speak their own language, similar to Turkish, and see themselves as culturally and ethnically close to Central Asian nations.
- They make up less than half of the Xinjiang population.
- In recent decades, there’s been a mass migration of Han Chinese (China’s ethnic majority) to Xinjiang, and the Uighurs feel their culture and livelihoods are under threat.
- In the early 20th Century, the Uighurs briefly declared independence, but the region was brought under complete control of mainland China’s new Communist government in 1949.
Where is Xinjiang?
- Xinjiang lies in the north-west of China and is the country’s biggest region.
- Like Tibet, it is autonomous, meaning – in theory – it has some powers of self-governance. But in practice, both face major restrictions by the central government.
- It is a mostly desert region, producing about a fifth of the world’s cotton.
- It is also rich in oil and natural gas and because of its proximity to Central Asia and Europe is seen by Beijing as an important trade link.
What was the build-up to the crackdown?
- Anti-Han and separatist sentiment rose in Xinjiang from the 1990s, flaring into violence on occasion.
- In 2009 some 200 people died in clashes in Xinjiang, which the Chinese blamed on Uighurs who want their own state.
- Xinjiang is now covered by a pervasive network of surveillance, including police, checkpoints, and cameras that scan everything from number plates to individual faces.
- According to Human Rights Watch, police are also using a mobile app to monitor peoples’ behaviour, such as how much electricity they are using and how often they use their front door.
- Since 2017 when President Xi Jinping issued an order saying all religions in China should be Chinese in orientation, there have been further crackdowns.
- China says the crackdown is necessary to prevent terrorism and root out Islamist extremism and the camps are an effective tool for re-educating inmates in its fight against terrorism.
- It insists that Uighur militants are waging a violent campaign for an independent state by plotting bombings, sabotage and civic unrest.
- China has dismissed claims it is trying to reduce the Uighur population through mass sterilizations as “baseless”, and says allegations of forced labour are “completely fabricated”.
Source – The Hindu