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Performance-based allowance for ASHAs

Aarti Dhar
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They will have to perform basic set of activities to claim the package

A file photo of a protest demonstration in Rohtak seeking minimum wages and other benefits for Accredited Social Health Activists.
A file photo of a protest demonstration in Rohtak seeking minimum wages and other benefits for Accredited Social Health Activists.

The Health and Family Welfare Ministry has approved an assured monthly monetary package for the Accredited Social Health Activists (ASHAs) — voluntary community health workers— which will be based on a basic set of activities which they will have to perform every month. In addition to enhancing incentives for the existing activities, new activities have also been added which will earn her more money.

This performance-based payment would lead to an `Assured Monthly Performance Incentive (AMPI) of Rs 1,000 per month for each ASHA. These activities are mobilising and attending Village Health and Nutrition Day for which she gets Rs 200, convening and guiding Village Health, Sanitation and Nutrition Committee meeting for which she is paid Rs. 150, attending Primary Health Centre review meeting that earns her Rs. 150 and carrying out and recording all activities related to mother and child health, including contraception, ante and post-natal care from which she can earn Rs 500.

Now an ASHA earns between Rs. 500 to Rs. 1,500 per month depending on her performance which was also, many a times, linked to population. If the population of the areas was less, there were lesser pregnancies and lesser number of children which reduced her activities and incentives.

“The package has been designed in such a way that if an ASHA performs some basic activities, she will take home a minimum of Rs. 1,000 every month. Monetary incentives for some of these activities have been enhanced like under Pulse Polio Programme, the benefit has been increased from the present Rs. 75 to Rs. 100 (per ASHA). But this basic package will be available to her only if she performs these basic activities,’’ Anuradha Gupta, Mission Director, National Rural Health Mission (NRHM) told The Hindu .

The additional activities which an ASHA can also perform now including identifying cases of communicable diseases like filarial, malaria, kalazar, Japanese encephalitis, leprosy eradication, care of low birth weight babies, care of new born sick babies, and malnourishment among others. For each of the activity undertaken by the ASHA, she will get paid in addition to her basic activities. An ASHA is also a TB care provider at many places.

It has been decided to introduce specialised certificate courses for ASHAs to accredit them. The course, to be conducted by the National Open School, will be voluntary. The States, too, have been advised to give preference to ASHAs who have studied up to Class 12 for admissions to nursing schools.

The government has also decided to enhance incentives for Directly Observed Treatment Short-Course (DOTS) providers who persuade tuberculosis patients to seek and continue treatment. This has been done to ensure that TB patients do not miss out on their treatment or drop out, particularly in case when they have to travel for taking an injection or tablets and it involves out-of-pocket expenses. Dropping out on treatment is a major cause of drug resistant TB which is emerging as a major public health issue in the country.

To ensure adherence to treatment for 24-27 months, management of side effects and for counselling and default retrieval, the government has enhanced the incentive for providers from Rs. 2,500 to Rs. 5,000. Of this, Rs. 2,000 will be given after the successful completion of Incentive Phase and the remaining after Completion Phase. In addition, for management of patients who cannot travel to a nearest health centre to get daily injections, an incentive of Rs 25. per prick will be given for qualified providers to administer such injection. Also, to enhance reach and accessibility of programme especially for drug resistant TB patients who have to report to health facilities at least 11 times during their course of treatment, travel support of up to Rs 1,000 (for travel outside the district) and up to Rs. 400 ( for travel within the district) will be given. In case patients are unable to travel, a provision of Rs. 300 will be given for transportation of sputum to the nearest laboratory.


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