Lok Sabha Question No. 1118 (UNSTARRED), answered on 2022-07-22
Subject: Honorarium to ASHA Workers
Ministry: HEALTH AND FAMILY WELFARE
Asked by: M. K. Raghavan

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

## LOK SABHA UNSTARRED QUESTION NO. 1118 TO BE ANSWERED ON THE 22 nd  JULY, 2022

## HONORARIUM TO ASHA WORKERS

## 1118.  SHRI  M.K.RAGHAVAN:

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

- (a) whether any survey has been conducted to understand the issues being faced by ASHA and Anganwadi workers while discharging duties and if so, the details thereof;
- (b) whether  the  Government  has  any  data  regarding  the  State/UT-wise  honorarium  being provided to ASHA and Anganwadi Workers, if so, the details thereof; and
- (c) whether the Government proposes to increase the honorarium being provided to these health workers and if so, the details thereof?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (DR. BHARATI PRAVIN PAWAR)

(a) to (c) The ASHA programme is vital to achieve the goals of community engagement with the health system and is one of the key components of the National Health Mission (NHM). Under NHM, the performance of various health programmes, including ASHA programme, is assessed, through  review  meetings,  video  conferences  &  field  visits  of  senior  officials,  promoting performance  by  setting  up  benchmarks  for  service  delivery  &  rewarding  achievements  etc. Further, under NHM, Common Review Missions (CRM) are conducted annually to assess and monitor  the  progress  and  implementation  status  of  various  schemes.  The  key  strategies  and priority  areas  of  CRM  is  to  analyze  challenges  with  respect  to  strengthening  health  systems, identify  trends  in  progress  of  key  indicators,  evaluate  the  readiness  of  the  state  to  take  up implementation of new initiatives, and review the progress and coordination mechanisms with

various partners. ASHA programme is one of the key elements of the CRM. Since inception of NHM, 14 CRMs have been carried out on an annual basis.

An  evaluation  of  ASHA  programme  was  conducted  by  NHSRC  to  understand  the characteristics of the ASHA, her beneficiaries and her support structures, her roles  and to use findings and recommendations of the evaluation to provide feedback to programme managers, ASHAs  and  other  key  stakeholders and enable modifications  to  strengthen  the  ASHA programme. The evaluation was done in 16 states in three rounds as under:

| Round one (2010-11)   | Assam, Bihar, Odisha, Rajasthan, Jharkhand, Andhra Pradesh, Kerala and West Bengal   |
|-----------------------|--------------------------------------------------------------------------------------|
| Round two (2011-2012) | Madhya Pradesh, Uttar Pradesh and Uttarakhand                                        |
| Round three (2013-14) | Delhi, Gujarat, Haryana, Punjab and Maharashtra                                      |

The key findings of the evaluation report with regard to issues faced by ASHAs while discharging their duties are the need for better training, monetary support, replenishment of the drug kit and stability in senior leadership.

ASHAs are envisaged to be community health volunteer and only 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 details are placed at Annexure-II. States/UTs in their Programme Implementation  Plans  (PIPs)  have  also  been  given  flexibility  to  provide  a  range  of  monetary incentives to the ASHAs and the details are placed at Annexure-III.

After the launch of the Ayushman Bharat scheme with operationalisation of Ayushman Bharat-  Health  and  Wellness  Centres  (AB-HWCs),  ASHAs  are  now  additionally  eligible  for Team Based Incentives (TBIs) along with ANMs based on monitored performance indicators (up to Rs. 1000 per month).

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.

As regards Anganwadi workers, as per the information received from Ministry of Women and Child Development (MoWCD):

-  Union Government issues guidelines to the State Governments/ UT Administrations to improve  the  functioning  of  Anganwadi  workers  and  whenever  any  shortcomings  are noticed during the course of visits of the States, they are addressed through letters and review  meetings  to  remove  the  deficiencies  and  to  improve  the  implementation  of  the Scheme. Recently, Development Monitoring and Evaluation Office (DMEO) under NITI Aayog  conducted  Sectoral  Evaluation  of  Schemes  of  MoWCD  including  Anganwadi Services.
-  Anganwadi Worker (AWW)/ Anganwadi Helper (AWH) are honorary workers and are paid a monthly honorarium as decided by the Government at the prescribed cost sharing ratio  between  Central  and  State  Governments.  Government  of  India  on  01.10.2018 enhanced the honorarium of AWWs at main- Anganwadi Centres (AWCs) from ₹3,000/to ₹ 4,500/-  per  month;  AWWs  at  mini-  Anganwadi  Centres  (AWCs)  from ₹ 2,250/to ₹ 3,500/- per month; AWHs from ₹ 1,500/- to ₹ 2,250/- per month.
-  Also, performance linked incentive of ₹ 250/- per month is  paid to AWHs and  ₹500/per month to AWWs. In addition, States/UTs  also pay additional monetary incentives/ honorarium to these functionaries from their own resources.

*****

## 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                                                                                                                                      | Annexure-II                                                                                                                                      | Annexure-II                                                                                                                                      |
|--------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------|
|                                                                                                                                                  | Activities                                                                                                                                       | Amount in Rs/case                                                                                                                                |
| I                                                                                                                                                | 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                                                                                                   | Page 5 of 7 Rs.150/ASHA/Quarterly round                                                                                                          |

| V    | 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                                                                    |

## 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.