Lok Sabha Question No. 3859 (UNSTARRED), answered on 2022-03-25
Subject: Compensation to ASHA Workers
Ministry: HEALTH AND FAMILY WELFARE
Asked by: M V V Satyanarayana, Goddeti Madhavi, Nandigam Suresh, Midhun Reddy, Kinjarapu Ram Mohan Naidu

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

## LOK SABHA UNSTARRED QUESTION NO. 3859

## TO BE ANSWERED ON THE 25 th  MARCH, 2022

## COMPENSATION TO ASHA WORKERS

## 3859.  SHRI M.V.V. SATYANARAYANA:

SHRI NANDIGAM SURESH:

SHRIMATI GODDETI MADHAVI:

SHRI P.V. MIDHUN REDDY:

SHRI RAM MOHAN NAIDU KINJARAPU:

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

- (a) the average number of daily working hours of Accredited Social Health Activist (ASHA) workers and ASHA facilitators for 2019-20, 2020-21, 2021-22 under the National Rural Health Mission (NRHM);
- (b) whether  ASHA  workers  and  facilitators  have  been  assigned  additional  responsibilities during  the  pandemic  period  and  if  so,  the  details  thereof  along  with  the  percentage increase in their remuneration to compensate for the additional work load during the last three years, State/UT-wise;
- (c) whether  the  Government  has  taken  steps  to  ensure  physical  and  mental  well  being  of frontline COVID workers, in particular NRHM workers and ASHA workers, if so, the details thereof, State-wise and district-wise;
- (d) whether the Government has provided monetary support and benefits to ASHA workers to cover additional healthcare costs in the form of insurance cover or covering additional medical expenses in case of illness; and
- (e) if so, the details thereof?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND

## FAMILY WELFARE (DR. BHARATI PRAVIN PAWAR)

- (a)  to  (e)  ASHAs  are  envisaged  to  be  community  health  volunteers  and  are  entitled  to task/activity based incentives. ASHAs receive a fixed monthly incentive of Rs. 2000 per month for routine and recurring activities and the details are placed at Annexure-I . Additionally, they

are provided performance-based incentives for a varied set of activities under various National Health Programmes and is placed at Annexure-II . States/UTs in their programme implementation plans have also been given flexibility to provide a range of monetary incentives to the ASHAs and the details is placed at Annexure-III. However, during the pandemic period, they  have  been  assigned  number  of  activities  additionally  for  community  level  surveillance, counselling, house visits and follow-up of COVID-19 patients, identification of high-risk groups, provision of essential services and recording & reporting of COVID-19 cases.

In view of the significant contribution towards the COVID-19 pandemic related work by ASHAs, States were advised to  pay  an  additional  incentive  of  Rs.1000/-  per  month  for  those ASHAs engaged in COVID-19 related work using the resources of COVID-19 Health System Preparedness and Emergency Response Package.

States were requested to ensure that incentive for routine and recurrent activities was paid in full for all the ASHAs during the COVID-19 pandemic also.

Under  National  Health  Mission  (NHM),  Government  of  India  provides  financial  and technical  support  to  States/UTs  to  strengthen  their  healthcare  systems  including  support  for activities  requiring  mental  and  physical  wellbeing  of  health  human  resource  based  on  the requirements posed by them in their Programme Implementation Plans (PIPs) within their overall resource  envelope.  With  respect  to  safeguarding  physical  wellbeing  of  the  NRHM  &  ASHA workers during the pandemic, States/UTs have also been asked to ensure provision of safety tools like  masks,  gloves,  soaps  and  sanitizers  etc  and  supplying  adequate  PPE  and  ensuring  her protection.

The ASHA benefit package was introduced acknowledging significant contribution and commitment of ASHAs. The package providing coverage for:

-  Pradhan Mantri Jeevan Jyoti Beema Yojana (PMJJBY) with a benefit Rs. 2.00 Lakh in case of death of the insured (annual premium of Rs. 330 contributed by GOI).
-  Pradhan  Mantri  Suraksha  Beema  Yojana  (PMSBY)  with  a  benefit  of  Rs.2.00  lakh  for accidental  death  or  permanent  disability;  Rs.  1.00  lakh  for  partial  disability  (annual premium of Rs. 12 contributed by GOI).
-  Pradhan Mantri Shram Yogi Maan Dhan (PM-SYM) with pension benefit of Rs. 3000 pm after age of 60 years (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 their contribution.

Under the Pradhan Mantri Garib Kalyan Package, Insurance Scheme has been introduced for all health workers, including ASHAs. This insurance scheme provides an insurance cover of Rs. 50.00 Lakhs in-case of loss of life on account of COVID-19 related duty.

## The details of incentives for routine and recurring activities given to ASHAs

| S. No.   | Incentives                                                                                                                           | Incentives (from September, 2018)   |
|----------|--------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------|
| 1        | Mobilizing and attending Village Health and Nutrition Days or Urban Health and Nutrition Days                                        | Rs.200/session                      |
| 2        | Conveying and guiding monthly meeting of VHSNC/MAS                                                                                   | Rs. 150                             |
| 3        | Attending monthly meeting at Block PHC/UPHC                                                                                          | Rs. 150                             |
| 4        | a. Line listing of households done at beginning of the year and updated every six months                                             | Rs. 300                             |
| 4        | b. Maintaining village health register and supporting universal registration of births and deaths to be updated on the monthly basis | Rs. 300                             |
| 4        | c. Preparation of due list of children to be immunized on monthly basis                                                              | Rs. 300                             |
| 4        | d. Preparation of list of ANC beneficiaries to be updated on monthly basis                                                           | Rs. 300                             |
| 4        | e. Preparation of list of eligible couple on monthly basis                                                                           | Rs. 300                             |
|          | Total                                                                                                                                | Rs. 2000/-                          |

| Annexure-II Details of performance-based incentives for a varied set of activities under various National                                        | Annexure-II Details of performance-based incentives for a varied set of activities under various National                                        | Annexure-II Details of performance-based incentives for a varied set of activities under various National                                        |
|--------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------|
|                                                                                                                                                  | Health Programmes Activities                                                                                                                     | Amount in Rs/case                                                                                                                                |
| I                                                                                                                                                | Maternal Health                                                                                                                                  | Maternal Health                                                                                                                                  |
| 1                                                                                                                                                | JSY financial package                                                                                                                            |                                                                                                                                                  |
| a.                                                                                                                                               | For ensuring antenatal care for the woman                                                                                                        | Rs.300/Rs.200 (Rural/Urban areas)                                                                                                                |
| b.                                                                                                                                               | For facilitating institutional delivery                                                                                                          | Rs. 300/Rs.200 (Rural/Urban areas)                                                                                                               |
| 2                                                                                                                                                | Reporting Death of women                                                                                                                         | Rs. 200 (reporting within 24 hours)                                                                                                              |
| II                                                                                                                                               | Child Health                                                                                                                                     |                                                                                                                                                  |
| 1                                                                                                                                                | Home Visit-care of the New Born and Post-Partum mother etc. / Young Child / follow up                                                            | Rs. 250 /Rs. 50 per visit / Rs.150 only after MUAC is equal to nor- more than 125mm                                                              |
| 2                                                                                                                                                | Intensified Diarrhoea Control Fortnight                                                                                                          | Intensified Diarrhoea Control Fortnight                                                                                                          |
| a.                                                                                                                                               | Week-1-ASHA incentive for prophylactic distribution of ORS to families with under-five children                                                  | Rs. 1 per ORS packet for 100 under five children                                                                                                 |
| b.                                                                                                                                               | Week-2- ASHA incentive for facilitating growth monitoring of all children in village                                                             | Rs. 100 per ASHA for completing at least 80% of household                                                                                        |
| c.                                                                                                                                               | MAA(Mother's Absolute Affection) Programme                                                                                                       | Rs. 100/ASHA/ Quarterly meeting                                                                                                                  |
| III                                                                                                                                              | Immunization                                                                                                                                     |                                                                                                                                                  |
| 1                                                                                                                                                | Full immunization for a child under one year/ up-to two years age                                                                                | Rs. 100 /Rs. 75                                                                                                                                  |
| 2                                                                                                                                                | Mobilizing children for OPV immunization / DPT Booster                                                                                           | Rs. 100 per day / Rs. 50                                                                                                                         |
| IV                                                                                                                                               | Family Planning                                                                                                                                  |                                                                                                                                                  |
| 1                                                                                                                                                | Ensuring spacing of 2 years/ 3 years after birth of 1st child / permanent limiting method after 2 children after marriage                        | Rs. 500 / Rs. 500 / Rs. 1000                                                                                                                     |
| 2                                                                                                                                                | Counselling, motivating and follow up of the cases for Tubectomy                                                                                 | Rs. 200 in 11 with high fertility rates states,Rs.300 in 146 MPV districts, Rs. 150/Rs200 in remaining states                                    |
| 3                                                                                                                                                | Counselling, motivating and follow up of the cases for Vasectomy and NSV and Female Postpartum sterilization                                     | Rs. 300 in 11 states with high fertility rates and Rs. 400 in 146 MPV districts and Rs. 200 in remaining states                                  |
| Mission ParivarVikas- 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 ParivarVikas- 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 ParivarVikas- 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) |
| 4                                                                                                                                                | Injectable Contraceptive MPA (Antara Program) and a non-hormonal weekly centchroman pill (Chhaya) - Incentive to ASHA                            | Rs. 100 per dose                                                                                                                                 |
| 5                                                                                                                                                | Mission ParivarVikas Campaigns Block level activities                                                                                            | Rs. 150/ ASHA/round                                                                                                                              |
| 6                                                                                                                                                | NayiPahel - an FP kit for newly weds                                                                                                             | Rs. 100/ASHA/NayiPahel kit distribution                                                                                                          |

| 7    | SaasBahuSammelan- mobilize SaasBahu for the Sammelan- maximum four rounds                                                      | Rs. 100/ per meeting                                                                    |
|------|--------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------|
| 8    | Updating of EC survey before each MPV campaign                                                                                 | Rs.150/ASHA/Quarterly round                                                             |
| V    | Adolescent Health                                                                                                              | Adolescent Health                                                                       |
| 1    | 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    | Conducting PLA meetings- 2 meetings per month                                                                                  | Rs. 100/ASHA/per meeting                                                                |
| VI   | Revised National Tuberculosis Control Programme                                                                                | Revised National Tuberculosis Control Programme                                         |
| 1    | For Category I/ Category II of TB patients (New cases/ previously treated of Tuberculosis)                                     | Rs. 1000 for 42 contacts / Rs. 1500 for 57 contacts                                     |
| 2    | For treatment and support to drug resistant TB patients                                                                        | Rs. 5000 for completed course of treatment                                              |
| 3    | For notification if suspect referred is diagnosed to be TB patient by MO/Lab                                                   | Rs.100                                                                                  |
| VII  | National Leprosy Eradication Programme                                                                                         | National Leprosy Eradication Programme                                                  |
| 1    | Treatment in pauci-bacillary cases /multi-bacillary cases of Leprosy - for 33 states (except Goa, Chandigarh &Puducherry).     | Rs. 250 (for diagnosis) + Rs. 400/Rs.600 (for follow up)                                |
| VIII | National Vector Borne Disease Control Programme                                                                                | National Vector Borne Disease Control Programme                                         |
| 1    | Malaria-Preparing Blood Slides/complete treatment for RDT or radical treatment of positive Pf cases                            | Rs. 15 per slide/ Rs. 75 per positive cases                                             |
| 2    | Lymphatic Filariasis-Listing of cases                                                                                          | Rs. 200                                                                                 |
| 3    | Acute Encephalitis Syndrome/Japanese Encephalitis                                                                              | Acute Encephalitis Syndrome/Japanese Encephalitis                                       |
|      | Referral of AES/JE cases to the nearest CHC/DH/Medical College                                                                 | Rs. 300 per case                                                                        |
| 4    | Kala Azar elimination                                                                                                          | Kala Azar elimination                                                                   |
|      | Involvement of ASHAs during the spray rounds (IRS) / for referring a suspected case                                            | Rs. 100/- per round / Rs. 500/per notified case                                         |
| 5    | Dengue and Chikungunya                                                                                                         | Dengue and Chikungunya                                                                  |
|      | Incentive for source reduction &IEC activities for prevention and control of Dengue and Chikungunya in 12 High endemic States. | Rs. 200/- (1 Rupee /House for maximum 200 houses PM for 05 months- during peak season). |
| 6    | National Iodine Deficiency Disorders Control Programme                                                                         | National Iodine Deficiency Disorders Control Programme                                  |
|      | ASHA incentive for salt testing                                                                                                | Rs.25/ month (for 50 salt samples)                                                      |
| IX   | Incentives under (CPHC) and Universal NCDs Screening                                                                           | Incentives under (CPHC) and Universal NCDs Screening                                    |
| 1    | Maintaining data validation and collection of additional information                                                           | Rs. 5/form/family                                                                       |
| 2    | Filling up of CBAC forms of every individual                                                                                   | Rs. 10/per form/per individual                                                          |
| 3    | Follow up of patients                                                                                                          | Rs. 50/per case/Bi-Annual                                                               |
| 4    | Delivery of new service packages under CPHC                                                                                    | Rs.1000/ASHA/PM                                                                         |
| X    | Drinking water and sanitation                                                                                                  | Drinking water and sanitation                                                           |
| 1    | Motivating Households to construct toilet and promote the use of toilets and for individual tap connections                    | Rs. 75 per household                                                                    |

## Annexure-III

## State-wise details of monetary incentives provided to the ASHAs

1. Andhra Pradesh provides balance amount to match the total incentive of Rs.10,000/month;
2. Arunachal Pradesh-provides 100% top up;
3. Bihar- Rs.1000/- per ASHA per month linked with functionality of five specified 06 activities (started in FY 2019-20);
4. Chhattisgarh-75% of matching amount of the incentives over and above the incentives earned by an ASHA as a top up on an annual basis;
5. Delhi- Rs. 3000/- PM for functional ASHA (against the 12 core activities perform by ASHA);
6. Gujarat provides 50% top up;
7. Haryana- Rs. 4000/month from June-2018 and 50% top-up;
8. Himachal Pradesh- Rs. 2000/month;
9. Karnataka-Rs. 4000/month - recently introduced replacing the top up incentive;
10. Kerala-Rs.5000/month in FY 2020-21;
11. Odisha-Rs. 1000 /month from state fund launched on April 1st, 2018;
12. Rajasthan- Rs. 2700/month through ICDS;
13. Sikkim -Rs. 6000/month;
14. Telangana provides balance amount to match the total incentive of Rs. 6000/- pm;
15. Tripura provides 100% top up against 08 specified activities and 33% top-up based on other activities;
16. Uttarakhand- Rs.5000/year and Rs. 1000/month;
17. Uttar Pradesh- Rs.750/- per ASHA per month linked with functionality of five specified activities (started from March 2019); and
18. West Bengal-Rs. 3000/month.