Lok Sabha Question No. 3418 (UNSTARRED), answered on 2020-03-13
Subject: ASHA Workers
Ministry: HEALTH AND FAMILY WELFARE
Asked by: K. Subbarayan, Uttam Kumar Nalamada Reddy

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILY WELFARE

## LOK SABHA UNSTARRED QUESTION NO. 3418 TO BE ANSWERED ON 13 TH MARCH, 2020

## ASHA WORKERS

## 3418. SHRI SUBBARAYAN K.: SHRI UTTAM KUMAR REDDY NALAMADA:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

- (a) the number of ASHA workers engaged in the country, State/UT -wise;
- (b) the details of the tasks assigned to the ASHA workers and the average weekly working hours assigned for them;
- (c)  whether  the  ASHA  workers  get  fixed  and  uniform pay  in  all  States,  if  not,  whether  the Government proposes to make it uniform across all the States;
- (d) whether the Government proposes to make services of ASHA workers permanent, if so, the details thereof and if not, the reasons therefor;
- (e) the details of incentives being paid to the ASHA workers along with the average monthly payments madeto them; and
- (f) the other measures the Government plans to take to improve the financial security of ASHA workers?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (SHRI ASHWINI KUMAR CHOUBEY)

- (a): Statement  showing  State/UT - wise  details  of  ASHAs  engaged  under  National  Health Mission (NHM),is given at Annexure -I
- (b): Under the National Health Mission, ASHAs act as a critical link between Healthcare  delivery  system  and  community.  The  details  of  task  assigned ASHAs under National Health Mission are given at Annexure -II.

(c): No  as  the  States/UTs  have  flexibility  to decide  on  type  of  incentive  to  be  given  to ASHAs as per their specific context/need in addition to routine and recurring incentives National Health Mission.

(d): No. Under the National Health Mission, ASHA are envisaged to be community health volunt eers.

(e): Under the National Health Mission, ASHA are entitled to task/activity based incenti List of various activities for which incentives are provided to ASHA is given at Annexure -III.

(f): To  improve the financial   security of ASHAs, the Gov ernment of  India has already taken several steps in addition to routine and recurring incentives, which inter - alia includes :

- Benefits of Life insurance, accident insurance and pension to eligible ASHAs and AS facilitators are extended by enrolling them under:
- Pradhan Mantri Jeevan Jyoti Beema Yojana (premium of Rs. 330 contributed by GOI).
- Pradhan Mantri Suraksha Beema Yojana (premium of Rs. 12 contributed by GOI).
- Pradhan Mantri Shram Yogi MaanDhan (PM - SYM) (50% contribution of premium by GOI and 50% by beneficiaries).
- The government has also approved a cash award of Rs. 20,000/ -and a citation to ASHAs who  leave  the  programme  after  working  as  ASHAs  for  minimum  of  10  years,  as acknowledgement of th eir contribution

Statement showing State/UT-wise details of ASHAs workers engaged under National Health Mission (NHM)

| S.N   | States/UTs        |   ASHAs workers |
|-------|-------------------|-----------------|
| 1     | Bihar             |           89437 |
| 2     | Chhattisgarh      |           69515 |
| 3     | Himachal Pradesh* |           32376 |
| 4     | Jammu & Kashmir   |           12356 |
| 5     | Jharkhand         |           41312 |
| 6     | Madhya Pradesh    |           77531 |
| 7     | Odisha            |           46566 |
| 8     | Rajasthan         |           64243 |
| 9     | Uttar Pradesh     |          163407 |
| 10    | Uttarakhand       |           12212 |
| 11    | Arunchal Pradesh  |            3880 |
| 12    | Assam             |           32256 |
| 13    | Manipur           |            4009 |
| 14    | Meghalaya         |            6697 |
| 15    | Mizoram           |            1170 |
| 16    | Nagaland          |            1992 |
| 17    | Sikkim            |             656 |
| 18    | Tripura           |            8044 |
| 19    | Andhra Pradesh    |           42346 |
| 20    | Goa               |               0 |
| 21    | Gujarat           |           46287 |
| 22    | Haryana           |           20115 |
| 23    | Karnataka         |           43500 |
| 24    | Kerala            |           30113 |
| 25    | Maharashtra       |           70282 |
| 26    | Punjab            |           21470 |
| 27    | Tamil Nadu        |            3965 |
| 28    | Talengna          |           32575 |
| 29    | West Bengal       |           61545 |
| 30    | A & N Islands     |             422 |
| 31    | Chandigarh        |              18 |
| 32    | D & N Haveli      |             542 |
| 33    | Daman & Diu       |             134 |
| 34    | Delhi             |            6035 |
| 35    | Lakshadweep       |             110 |
| 36    | Puducherry        |             206 |
| Total |                   |         1047324 |

Source: NHM-MIS report as on Sept 2019. Note- * Including Link workers

The  details  task  assigned    to  ASHA  workers  under  National  Health Mission

1. To create awareness and provide information to  the  community  on determinants  of  health  such  as  nutrition,  basic  sanitation  and  hygienic practices,  healthy  living  and working  conditions,  information  on  existing health services and the need for timely use of health services.
2. To counsel women and families on birth preparedness, importance of safe delivery, breastfeeding and complementary feeding, immunization, contraception and prevention of common infections including Reproductive Tract  Infection/Sexually  Transmitted  Infection  (RTIs/STIs)  and  care  of  the young child.
3. To  mobilize  the  community  and  facilitate  people's  access  to  health  and health  related  services  available at  the  village/sub-centre/primary  health centres,  such  as  Immunization,  Ante  Natal  Check-up  (ANC),  Post  Natal Check-up (PNC), ICDS, sanitation and other services being provided by the government.
4. To  work  with  the  Village  Health,  Sanitation  and  Nutrition Committee  to develop a comprehensive village health plan, and promote convergent action by the committee on social determinants of health. In support with VHSNC, ASHAs  will  assist  and  mobilize  the  community  for  action  against  gender based violence.
5. To arrange escort/accompany pregnant women  &  children requiring treatment/  admission  to  the  nearest  preidentified  health  facility  i.e. Primary Health Centre/Community Health Centre/First Referral Unit (PHC/CHC/FRU).
6. To  provide  community  level  curative  care  for  minor  ailments  such  as diarrhoea, fevers, care for the normal and sick newborn, childhood illnesses and first aid. She will be a provider of Directly Observed Treatment Shortcourse  (DOTS)  under  Revised  National  Tuberculosis  Control  Programme. She will also act as a depot holder for essential health products appropriate to  local  community  needs.  A  Drug  Kit  will  be  provided  to  each  ASHA. Contents of the kit will be based on the recommendations  of the expert/technical advisory group set up by the Government of India. These will be updated from time to time, States can add to the list as appropriate.
7. To act as a care provider can be enhanced based on state needs. States can explore the possibility of graded training to the ASHA to provide palliative care, screening for non communicable diseases, childhood disability, mental health, geriatric care and others.
8. To  provide  information  on  about  the  births  and  deaths  in  her  village  and any unusual health problems/disease outbreaks in the community to the Sub-Centres/Primary  Health  Centre.  She  will  promote  construction  of household toilets under Total Sanitation Campaign.

## \_\_\_\_\_\_\_

| List of   | List of                                                                                                                                                                                                                                                                                                        | Annexure-III                                                           |
|-----------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------------------------------------------------------|
|           | Activities                                                                                                                                                                                                                                                                                                     | Amount in Rs/case                                                      |
| I         | Maternal Health                                                                                                                                                                                                                                                                                                |                                                                        |
| 1         | JSY financial package                                                                                                                                                                                                                                                                                          |                                                                        |
| a.        | For ensuring antenatal care for the woman                                                                                                                                                                                                                                                                      | Rs.300 for Rural areas and Rs. 200 for areas                           |
| b.        | For facilitating institutional delivery                                                                                                                                                                                                                                                                        | Rs. 300 for Rural areas and Rs. 200 for areas                          |
| 2         | Reporting Death of women (15 - 49 years age group) by ASHA to PHC Medical Officer                                                                                                                                                                                                                              | Rs. 200 for reporting within 24 hours of occurrence of death by phone  |
| II        | Child Health                                                                                                                                                                                                                                                                                                   |                                                                        |
| 1         | Undertaking Home Visit for the care of the New Born Post Partum mother 1 - Six Visits in Case of Institutional Delivery (Days 3 rd , 7 th , 14th, 21 st , 28 th & 42 nd )- Seven visits in case of Home Deliveries (Days 1 st , 3 rd , 7 th , 14th, 21 st , 28 th & 42 nd )                                    | and Rs. 250                                                            |
| 2         | Undertaking Home Visits of Young Child for Strengthening of Health & Nutrition of young child through Home (recommended schedule -3 rd , 6 th , 9 th , 12 th and 15 th months)- (Rs.50 x 5 visits) - in 1st phase the programme is proposed to implement only in 235 POSHAN Abhiyan and Aspirational districts | -Visits Rs. 50/visit with talto Rs. 250/per child for making 05 visits |
| 3         | For follow up visits to a child discharged from Severe Acute Malnutrition (SAM) management centre                                                                                                                                                                                                              | facility or Rs. 150 only after MUAC is equal to nor - more than 125mm  |
| 4         | Ensuring quarterly follow up of low birth weight newborns discharged after treatment from Specialized born Care Units 2                                                                                                                                                                                        | babies and New Rs. 50/ Quarter - f om the 3 rd month until 1 year age  |
| 5         | Child Death Review for reporting child death of under5 years of age                                                                                                                                                                                                                                            | children Rs. 50                                                        |
| 6         | For mobilizing and ensuring every eligible child - 19 years out - of- school and non - enrolled) is administered Albendazole.                                                                                                                                                                                  | (1 Rs. 100/ ASHA/Bi - Annual                                           |
| 7         | Week - 1- ASHA incentive for prophylactic distribution ORS to families with under - five children                                                                                                                                                                                                              | of Rs. 1 per ORS packet for 100 under five                             |
| 8         | Week - 2-ASHA incentive for facilitating growth of all children in village; screening and referral undernourished children to Health centre; IYCF counselling tounder - five children household                                                                                                                | monitoring of Rs. 100 per ASHA for completing at least household       |
| 9         | MAA(Mother's Absolute Affection) Programme Promotion of Breastfeeding -Quarterly mother meeting                                                                                                                                                                                                                | Rs. 100/ASHA/ Quarterly meeting                                        |

| III                                                                                                                                                | Immunization                                                                                                                                                                                                      |                                                                                                                                                                                                                   |
|----------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| 1                                                                                                                                                  | Fullimmunization for a child under one year                                                                                                                                                                       | Rs. 100                                                                                                                                                                                                           |
| 2                                                                                                                                                  | Complete immunization per child up - to two years age (all vaccination received between 1st and 2 nd year of age after completing full immunization after 01year                                                  | Rs. 75 3                                                                                                                                                                                                          |
| 3                                                                                                                                                  | Mobilizing children for OPV immunization under Pulse polio Programme                                                                                                                                              | Rs. 100/day 4                                                                                                                                                                                                     |
| 4                                                                                                                                                  | DPT Booster at -5 6years of age                                                                                                                                                                                   | Rs.50                                                                                                                                                                                                             |
| IV                                                                                                                                                 | Family Planning                                                                                                                                                                                                   |                                                                                                                                                                                                                   |
| 1                                                                                                                                                  | Ensuring spacing of 2years after marriage 5                                                                                                                                                                       | Rs. 500                                                                                                                                                                                                           |
| 2                                                                                                                                                  | Ensuring spacing of 3 years after birth of 1 st child 5                                                                                                                                                           | Rs. 500                                                                                                                                                                                                           |
| 3                                                                                                                                                  | Ensuring a couple to opt for permanent limiting method children 6                                                                                                                                                 | after 2 Rs. 1000                                                                                                                                                                                                  |
| 4                                                                                                                                                  | Counselling, motivating and follow up of the cases for                                                                                                                                                            | Tubectomy Rs. 200 in 11 states with high fertility rates Bihar, MP, Rajasthan, Chhattisgarh, Jharkhand, Odisha, Uttarakhand, As sam, Haryana and Gujarat) Rs.300 in 146 MPV districts Rs. 150 in remaining states |
| 5                                                                                                                                                  | Counselling, motivating and follow up of the cases for Vasectomy/ NSV                                                                                                                                             | Rs. 300 in 11 states with high fertility rates Bihar, MP, Rajasthan, Chhattisgarh, Jharkhand, Odisha, Uttarakhand, Assam, Haryana and and 400 in 146 MPV districts and Rs. 200 in remaining states                |
| 6                                                                                                                                                  | Female Postpartum sterilization                                                                                                                                                                                   | Rs. 300 in 11 states with high fertility rates Bihar, MP, Rajasthan, Chhattisgarh, Jharkhand, Odisha,Uttarakhand, Assam, Haryana and Gujarat) and 400 in 146 MPV districts                                        |
| 6                                                                                                                                                  | Social marketing of contraceptives -as home delivery through ASHAs                                                                                                                                                | Rs. 1 for a pack of 03 condoms, Rs. 1 for OCP, Rs. 2 for a pack of ECPs                                                                                                                                           |
| 7                                                                                                                                                  | Escorting or facilitating beneficiary to the health facility PPIUCD insertion                                                                                                                                     | for the Rs. 150/per case                                                                                                                                                                                          |
| 8                                                                                                                                                  | Escorting or facilitating beneficiary to the health PAIUCD insertion                                                                                                                                              | facility for the Rs. 150/case                                                                                                                                                                                     |
| Mission Parivar Vikas -In selected 146 districts in six states -(57 in UP, 37 in Bihar, 14 RJS, 9 in Jharkhand, 02 in Chhattisgarh and 2 in Assam) | Mission Parivar Vikas -In selected 146 districts in six states -(57 in UP, 37 in Bihar, 14 RJS, 9 in Jharkhand, 02 in Chhattisgarh and 2 in Assam)                                                                | Mission Parivar Vikas -In selected 146 districts in six states -(57 in UP, 37 in Bihar, 14 RJS, 9 in Jharkhand, 02 in Chhattisgarh and 2 in Assam)                                                                |
| 9                                                                                                                                                  | Injectable Contraceptive MPA (Antara Program) and a no - hormonal weekly centchroman pill (Chhaya)-Incentive to ASHA                                                                                              | Rs. 100 per dose                                                                                                                                                                                                  |
| 10                                                                                                                                                 | Mission Parivar Vikas Campaigns Block level activities - ASHA to be oriented on eligible couple survey for estimation of beneficiaries and will be expected conducted eligible couple survey -maximum four rounds | to Rs. 150/ ASHA/round                                                                                                                                                                                            |
| 11                                                                                                                                                 | Nayi Pahel -an FP kit for newly weds -a FP kit would be given to the newly wed couple by ASHA (In initial                                                                                                         | phase Rs. 100/ASHA/Nayi Pahel kit distribution                                                                                                                                                                    |

- ASHA may be given 2 kits/ ASHA)

- 12 Saas Bahu Sammelan -mobilize Saas Bahu for the Sammelan -maximum four rounds

- Rs. 100/ per meeting

- 13 Updating of EC survey before each MPV campaign - Note- updating of EC survey register incentive is already part of routine and recurring incentive

- Rs.150/ASHA/Quarterly round

- V Adolescent Health

- 1 Distributing sanitary napkins to adolescent girls

- Rs. 1/ pack of 6 sanitary napkins

- 2 Organizing monthly meeting with adolescent girls pertaining to Menstrual Hygiene

- Rs. 50/meeting

- 3 Incentive for support to Peer Educator (for facilitating selection process of peer educators)

- Rs. 100/ Per PE

- 4 Incentive for mobilizing adolescents for Adolescent Health day

- Rs. 200/ Per AHD

- VI Incentive for Routine Recurrent Activities

- 1 Mobilizing and attending VHND or (outreach session/Urban Health and Nutrition Days)

- Rs. 200 per session

- 2 Convening and guiding monthly meeting of VHSNC/MAS

- Rs. 150

- 3 Attending monthly meeting at Block PHC/5U - PHC

- Rs. 150

- 4 a) Line listing of households done at beginning of the year and updated every six months Rs. 1500 7

- b) Maintaining records as per the desired norms like - village health register

- c) Preparation of due list of children to be immunized updated on monthly basis

- d) Preparation of due list of ANC beneficiaries to be updated on monthly basis

- e) Preparation of list of eligible couples updated on monthly basis

## VI I Participatory Learning and Action -(In selected 10 states that have low RMNCH+A indicators - Assam, Bihar, Chhattisgarh, Jharkhand, MP, Meghalaya, Odisha, Rajasthan, Uttarakhand and UP)

- 1 Conducting PLA meetings -2 meetings per month - Note- Incentive is also applicable for AFs @Rs.100/ -per meeting for 10 meetings in a month

- Rs. 100/ASHA/per meeting for 02 meetings in a month

- VI Revised National Tuberculosis Control Programme 8

II

Honorarium and counselling charges for being a DOTS provider

7 Increased from Rs. 500 to Rs. 1500 from Oct-2018

8 Initially ASHAs were eligible to an incentive of Rs 250 for being DOTS provider to both new and previously treated TB cases. Incentive to ASHA

for providing treatment and support Drug resistant TB patients have now been revised from Rs 2500 to Rs 5000 for completed course of treatment

| 1   | For Category I of TB patients (New cases of                                                                                                      | Tuberculosis) Rs. 1000 for 42 contacts over six or months of treatment                                                                           | seven                                                                                                                         |
|-----|--------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------|
| 2   | For Category II of TB patients (previously treated                                                                                               | TB cases) Rs. 1500 for 57 contacts over eight to months of treatment including 24 - 36 injections intensive phase                                | TB cases) Rs. 1500 for 57 contacts over eight to months of treatment including 24 - 36 injections intensive phase             |
| 3   | For treatment and support to drug resistant TB                                                                                                   | patients Rs. 5000 for completed course of treatment 2000 should be given at the end on phase and Rs. 3000 at the end of phase                    | patients Rs. 5000 for completed course of treatment 2000 should be given at the end on phase and Rs. 3000 at the end of phase |
| 4   | For notification if suspect referred is diagnosed patient by MO/Lab 9                                                                            | to be TB Rs.100                                                                                                                                  | to be TB Rs.100                                                                                                               |
| IX  | National Leprosy Eradication Programme 10                                                                                                        | National Leprosy Eradication Programme 10                                                                                                        | National Leprosy Eradication Programme 10                                                                                     |
| 1   | Referral and ensuring compliance for complete treatment pauci - bacillary cases of Leprosy -for 33 states (except Chandigarh & Puducherry).      | Referral and ensuring compliance for complete treatment pauci - bacillary cases of Leprosy -for 33 states (except Chandigarh & Puducherry).      | in Goa, Rs. 250 (for facilitating diagnosis case)+ Rs. 400 (for follow up on completion treatment)                            |
| 2   | Referral and ensuring compliance for complete treatment multi - bacillary cases of Leprosy -for 33 states (except Goa, Chandigarh & Puducherry). | Referral and ensuring compliance for complete treatment multi - bacillary cases of Leprosy -for 33 states (except Goa, Chandigarh & Puducherry). | in Rs. 250 (for facilitating diagnosis case)+ Rs. 600 (for follow up on of treatment)                                         |
| X   | National Vector Borne Disease Control Programme                                                                                                  | National Vector Borne Disease Control Programme                                                                                                  | National Vector Borne Disease Control Programme                                                                               |
| A)  | Malaria 11                                                                                                                                       | Malaria 11                                                                                                                                       | Malaria 11                                                                                                                    |
| 1   | Preparing blood slides ortesting through RDT                                                                                                     | Preparing blood slides ortesting through RDT                                                                                                     | Rs. 15/slide or test                                                                                                          |

| 2   | Providing complete treatment for RDT positive Pf                                                                                                                                                                                             |                                                                                                                                                                          |
|-----|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| 3   | cases Providing complete radical treatment to positive Pf detected by blood slide, as per drug regime                                                                                                                                        | Rs. 75/ -per positive cases and Pv case                                                                                                                                  |
| 4   | For referring a case and ensuring complete treatment                                                                                                                                                                                         | Rs. 300 (not in their updated list)                                                                                                                                      |
| B)  | Lymphatic Filariasis                                                                                                                                                                                                                         | Lymphatic Filariasis                                                                                                                                                     |
| 1   | For one time line listing of lymphoedema and hydrocele all areas of -non endemic and endemic districts                                                                                                                                       | cases in Rs. 200                                                                                                                                                         |
| 2   | For annual Mass Drug Administration for cases of Lymphatic Filariasis 12                                                                                                                                                                     | Rs. 200/day for maximum three days to cover 50 houses and 250 persons                                                                                                    |
| C)  | Acute Encephalitis Syndrome/Japanese Encephalitis                                                                                                                                                                                            | Acute Encephalitis Syndrome/Japanese Encephalitis                                                                                                                        |
| 1   | Referral of AES/JE cases to the nearest CHC/DH/Medical College                                                                                                                                                                               | Rs. 300 per case                                                                                                                                                         |
| D)  | Kala Azar elimination                                                                                                                                                                                                                        |                                                                                                                                                                          |
| 1   | Involvement of ASHAs during the spray rounds (IRS) sensitizing the community to accept indoor spraying 13                                                                                                                                    | for Rs. 100/ -per round during Indoor Spray i.e. Rs 200 in total for two                                                                                                 |
| 2   | ASHA Incentive for referring a suspected case and complete treatment.                                                                                                                                                                        | ensuring Rs. 500/per notified case                                                                                                                                       |
| E)  | Dengue and Chikungunya                                                                                                                                                                                                                       | Dengue and Chikungunya                                                                                                                                                   |
| 1   | Incentive for source reduction & IEC activities for prevention control of Dengue and Chikungunya in 12 High endemic (Andhra Pradesh, Assam, Gujarat, Karnataka, Kerala, Maharashtra, Odisha, Punjab, Rajasthan, Tamil Nadu, and West Bengal) | and States Telangana Rs. 200/ -(1 Rupee /House for maximum 200 houses PM for 05 months -during peak transmission season). The incentive not be exceed Rs. 1000/ASHA/Year |
| F)  | National Iodine Deficiency Disorders Control Programme                                                                                                                                                                                       | National Iodine Deficiency Disorders Control Programme                                                                                                                   |
| 1   | ASHA incentive for salt testing                                                                                                                                                                                                              | Rs.25 a month for testing 50 salt samples                                                                                                                                |
| XI  | Incentives under Comprehensive Primary Health Care (CPHC) and Universal NCDs Screening                                                                                                                                                       | Incentives under Comprehensive Primary Health Care (CPHC) and Universal NCDs Screening                                                                                   |

| 1    | Maintaining data validation and collection of additional information -per completed form/family for NHPM - Ayushman Bharat                               | Rs. 5/form/family                                        |
|------|----------------------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------------------------------|
| 2    | Filling up of CBAC forms of every individual - onetime activity for enumeration of all individuals, filling CBAC for individuals 30 or > 30 years of age | all Rs. 10/per form/per individual as incentive          |
| 3    | Follow up of patients diagnosed with Hyper tension/Diabetes three common cancer for ignition of treatment and ensuring compliance                        | and Rs. 50/per case/Bi - Annual                          |
| 4    | Delivery of new service packages under CPHC component                                                                                                    | Rs.1000/ASHA/PM (linked with new packages of activities) |
| XI I | Drinking waterand sanitation                                                                                                                             | Drinking waterand sanitation                             |
| 1    | Motivating Households to construct toilet and promote toilets.                                                                                           | the use of Rs. 75 per household                          |
| 2    | Motivating Households to take individual tap connections                                                                                                 | Rs. 75 per household                                     |