Lok Sabha Question No. 674 (UNSTARRED), answered on 2022-12-09
Subject: Enhancing Honorarium of ASHA Workers
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Rajmohan Unnithan

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

## LOK SABHA UNSTARRED QUESTION NO. 674 TO BE ANSWERED ON THE 9 th  DECEMBER, 2022

## ENHANCING HONORARIUM TO ASHA WORKERS

## 674: SHRI RAJMOHAN UNNITHAN:

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

- (a) the details of the schemes implemented by the Government to support ASHA workers;
- (b) whether the Government proposes to increase the honorarium/incentives of ASHA workers, keeping in view their job profile;
- (c) if so, the details thereof and the time by which the increased honorarium/incentives are likely to be granted; and
- (d) if not, the reasons therefor?

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

## (DR. BHARATI PRAVIN PAWAR)

- (a) to  (d)      In  the  year  2018,  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 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 contributed by GOI).

In Addition, 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) is also available for ASHA workers.

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.

Further,  it  is  intimated  that  the  Central  Government  has  announced  the  'Padhan  Mantri Garib  Kalyan  Package,  under  which,  Insurance  Scheme  has  been  introduced  for  all  health workers,  including  ASHAs.  This  insurance  scheme  provided  an  insurance  cover  of  Rs.  50.00 Lakhs in-case of loss of life on account of COVID-19 related duty from March, 2020 to April, 2022.

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 operationalization 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  approved  additional  incentives  for  ASHAs  the  details  of  which is placed at Annexure IV .

*****

## 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                                                                                                                                      |
|--------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------|
| Details of performance-based incentives for a varied set of activities under various National Health Programmes                                  | Details of performance-based incentives for a varied set of activities under various National Health Programmes                                  | 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                                                                                                                                     | 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                                                                                                                                  | 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

|   SN | Name of States    | State Specific Incentives for ASHAs from State Funds                                                                                                                                 |
|------|-------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
|    1 | Andhra Pradesh    | Provides balance amount to match the total incentive of Rs.10, 000/PM/ASHA                                                                                                           |
|    2 | Arunachal Pradesh | 100% top-up, frequency of disbursement quarterly                                                                                                                                     |
|    3 | Assam             | Rs.1000/PM/ASHA from FY 2018-2019                                                                                                                                                    |
|    4 | Bihar             | Rs. 1000/PM/ASHA for defined indicators related to Immunization, Child Health, Maternal Health, and Family Planning, etc. (for achieving any four out of the six defined indicators) |
|    5 | Chhattisgarh      | 75% of matching- amount of incentives over the above incentives earned by an ASHA as a top- up onan annual                                                                           |
|    6 | Delhi             | Rs.3000/PM/ASHA for functional ASHA (against the 12 core activities performed by ASHA)                                                                                               |
|    7 | Gujarat           | Provides 50% top-up - frequency of disbursement quarterly                                                                                                                            |
|    8 | Haryana           | Rs.4000/PM/ASHA and 50% top-up (Excluding Routine recurring incentive) and Rs. 450/- additionallinked with performance of 05 Major RCH activities                                    |
|    9 | Himachal Pradesh  | Rs.2750/PM/ASHA                                                                                                                                                                      |
|   10 | Kerala            | Rs.6000/PM/ASHA                                                                                                                                                                      |
|   11 | Karnataka         | Rs.5000/PM/ASHA                                                                                                                                                                      |
|   12 | Manipur           | Rs. 1000/PM/ASHA recently declared by state FY 2021-22- modalities of payment still to be finalized                                                                                  |
|   13 | Madhya Pradesh    | 100% against 07 specified activities (JSY, HBNC, LBW&SNCUFollow-ups, Iron Sucrose follow-ups ofanaemic PW, Early Registration of PW, Full Immunization and Complete Immunization)    |
|   14 | Meghalaya         | Rs.2000/PM/ASHA                                                                                                                                                                      |
|   15 | Maharashtra       | Rs.3500/PM/ASHA from FY 2021-22                                                                                                                                                      |
|   16 | Odisha            | Rs.1000 /PM/ASHA from state fund launched on April 1st, 2018                                                                                                                         |
|   17 | Punjab            | Rs. 2500/PM/ASHA                                                                                                                                                                     |
|   18 | Rajasthan         | Rs. 3564/PM/ASHA                                                                                                                                                                     |
|   19 | Sikkim            | Rs. 6000/PM/ASHA                                                                                                                                                                     |
|   20 | Tripura           | Provides 100% top-up against 08 specified activities and 33.33% top-up based on other activities.                                                                                    |
|   21 | Telangana         | Provides balance amount to match the total incentive of Rs. 7500/month                                                                                                               |
|   22 | Uttarakhand       | Rs.5000/year and Rs. 3000/PM/ASHA with 10% top-up                                                                                                                                    |
|   23 | Uttar Pradesh     | Rs.1500/PM/ASHA linked with proportion of routine incentives to be paid to the ASHAs in the month                                                                                    |
|   24 | West Bengal       | Rs.4500/PM/ASHA                                                                                                                                                                      |

| Annexure-IV                                                                             | Annexure-IV                                                                                                                                                                                                                                                                    | Annexure-IV                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             |
|-----------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Additional incentives approved by the Government Under NHM held on 7 th September,2022. | Additional incentives approved by the Government Under NHM held on 7 th September,2022.                                                                                                                                                                                        | Additional incentives approved by the Government Under NHM held on 7 th September,2022.                                                                                                                                                                                                                                                                                                                                                                                                                 |
| S No                                                                                    | Activities                                                                                                                                                                                                                                                                     | Amount in Rs/case                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       |
| A.                                                                                      | Provision of a cash award to ASHAs and ASHA Facilitators who have successfully been certified in two independent certificates. i. RMNCHA+N ii. Expanded package of new services from Non- Communicable Diseases to Palliative Care                                             | Rs. 5000/- for each certification                                                                                                                                                                                                                                                                                                                                                                                                                                                                       |
| B.                                                                                      | Provision of incentives for ASHAs for facilitating creation and seeding of ABHA ID in various IT Portals of MoHFW such as CPHC NCD Portal and RCH Portal etc                                                                                                                   | Rs. 10/- for each ABHA account created and seeded                                                                                                                                                                                                                                                                                                                                                                                                                                                       |
| C.                                                                                      | Provision of Incentive to ASHAs or Community Volunteers for ensuring seeding of bank account details of notified TB patients in Ni-kshay portal within 15 days of treatment initiation for enabling DBT Payments under the National Tuberculosis Elimination Programme (NTEP). | Rs. 50/- per patient                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    |
| D.                                                                                      | Provision to incentive to ASHA / Community Health Volunteer for supporting treatment adherence and completion of TB Preventive Treatment among eligible individuals                                                                                                            | Rs. 250/- per individual for successful completion of TB Preventive Treatment.                                                                                                                                                                                                                                                                                                                                                                                                                          |
| E.                                                                                      | Revision of ASHA incentive for referral of SAM children to NRC and follow up of SAM children after discharge from NRC to from current norms of Rs. 50/- to Rs. 300/- per SAM child.                                                                                            |  For referring SAM child with medical complication to NRCs, ASHA incentive enhanced from Rs. 50/- per child to Rs. 100/- per child.  For follow up visits of SAM children discharged from NRC, ASHA incentive enhanced from Rs. 100/- per child to Rs. 150/- per child. (Rs 50 per visit for 1st and 4th visit and Rs 25 per visit for 2nd and 3rd visit).  Additional incentive of Rs. 50/- per SAM child for ASHA in case child is declared free of SAM status after completion of all follow ups. |
| F.                                                                                      | Provision of incentive to ASHAs for referring Post Kali-Azar Dermal Leishmaniasis (PKDL) case detection and complete treatment in all 4 Kala- azar endemic states.                                                                                                             | Rs. 500/. per case (Rs. 200/- at the time of diagnosis and Rs. 300/- after treatment completion)                                                                                                                                                                                                                                                                                                                                                                                                        |
| G.                                                                                      | Revision of ASHA incentives under National                                                                                                                                                                                                                                     | Page 8 of 9 Enhancing ASHA incentive from Rs 75/- to                                                                                                                                                                                                                                                                                                                                                                                                                                                    |

| Malaria Control Programme for enhancing ASHA incentive for ensuring complete treatment.   | Rs. 200/- per confirmed case of Malaria   |
|-------------------------------------------------------------------------------------------|-------------------------------------------|