Lok Sabha Question No. 12 (STARRED), answered on 2024-02-02
Subject: ASHA Workers
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Gajanan Chandrakant Kirtikar

## GOVERNMENT OFINDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENTOFHEALTH AND FAMILYWELFARE

## LOKSABHA STARRED QUESTION NO. 12 TO BE ANSWERED ON THE 2 ND FEBRUARY, 2024

## ASHAWORKERS

## †*12. SHRI GAJANAN KIRTIKAR:

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

- (a) the total number of ASHA workers in the country, State/UT-wise;
- (b) the total amount paid as remuneration/ honorarium to ASHA workers in various districts of the country including Maharashtra during the last five years;
- (c) whether the salary paid to ASHA workers is much lower than the minimum salary of peons as per the recommendation of the 7th Pay Commission;
- (d) the steps taken by the Government to increase the minimum salary of ASHA workers;
- (e) whether any amount of honorarium to be paid to ASHA workers is pending with Government and if so, the details thereof, State/UT-wise including Maharashtra; and
- (f) the total increase in the compensation paid to ASHA workers during the said period?

## ANSWER THE MINISTER OF HEALTH AND FAMILY WELFARE (DR MANSUKH MANDAVIYA)

- (a) to (f) A Statement is laid on the Table of the House.

## STATEMENT REFERRED TO IN REPLY TO LOK SABHA STARRED QUESTION NO. 12 FOR 2 ND FEBRUARY, 2024

(a) As per NHM-MIS report (as on 30.09.2023), State-wise details of total number of ASHAs under National Health Mission (NHM), except Goa & Chandigarh, is placed at Annexure-I .

(b) to (d): ASHAs are envisaged to be community health volunteer and are given performance-based incentives after completion of specific activities under various National Health Programmes.

The activities for which incentives are paid to ASHAs are expanded from time to time. ASHAs incentive can be divided into two parts;

-  Monetary Incentives -ASHAs receive a monthly incentive of Rs. 2000/month for routine and recurring activities from the Central Government. Additionally, ASHAs are provided with performance-based incentives for a varied set of activities under various National Health Programmes. Further, States/UTs in their Programme Implementation Plans (PIPs) have also been given flexibility to provide a range of monetary incentives to the ASHAs. The details of these ASHA incentives are available on the following Uniform Resource Locator (URL):

## https://nhsrcindia.org/sites/default/files/2024-01/ASHA%20Incentives.pdf

After the launch of Ayushman Arogya Mandir, ASHAs are eligible additionally for Team Based Incentives (TBIs) along with ANMs based on monitored performance indicators (up to Rs. 1000 per month).

 Non-Monetary Incentives -ASHAs are also entitled to non-monetary incentives like - ASHA Uniform, Identity Card, Cycle, Mobile, CUG Sim, ASHA Diary, Drug Kit, ASHA Award, ASHA rest room etc.

Further, in the year 2018, the ASHA Benefit Package was introduced by the Govt. of India acknowledging the significant contribution and commitment of ASHAs. It included the following components- a) Doubling of routine and recurring incentives amount from Rs. 1000 per month to Rs. 2000 per month.

b) Extending social security benefits of Life insurance, accident insurance and pension to all eligible ASHAs through enrolment in following schemes -

-  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. 3,000/- pm after age of 60 years (50% contribution of premium by GOI and 50% by beneficiaries) is also available for ASHA workers. ASHAs across the States/UTs have been enrolled in all the above mentioned Social Security Schemes as per the defined eligibility norms.

In addition to the above incentives, as an acknowledgement of her service, significant contribution and commitment, a cash incentive of Rs. 20,000/under NHM and a citation by the State/UT is given to ASHAs, who leave or opt to leave the programme after a minimum of 10 years of service.

The expenditure for ASHA incentive under National Health Mission for the Financial Years during the last five years viz. from 2018-19 to 2022-23 against Central release, State release & unspent balances (at the beginning of the year) as per Financial Monitoring Reports (FMRs) submitted by all States/UTs including Maharashtra is at Annexure-II .

(e) Under the National Health Mission, financial and technical support is provided to the States/UTs for strengthening the healthcare systems including incentives to ASHA workers, based on the proposals received from the States/UTs in their Annual Programme Implementation Plan (PIP) and subject to the Resource Envelope (RE). Further, the funds are released to States/UTs on a lump sum basis as per the request from the State/UTs.

(f) The details of increase of performance-based incentives for a varied set of activities under various National Health Programmes since 2019 to ASHA workers is at Annexure-III .

## Annexure-I

| ASHAs in position underNHM   | ASHAs in position underNHM         | ASHAs in position underNHM   | ASHAs in position underNHM   | ASHAs in position underNHM   |
|------------------------------|------------------------------------|------------------------------|------------------------------|------------------------------|
| Sl. No.                      | State                              | NRHM                         | NUHM                         | Total                        |
| 1                            | Bihar                              | 94337                        | 639                          | 94976                        |
| 2                            | Chhattisgarh                       | 68251                        | 3295                         | 71546                        |
| 3                            | Himachal Pradesh                   | 7893                         | 31                           | 7924                         |
| 4                            | Jammu &Kashmir                     | 13133                        | 136                          | 13269                        |
| 5                            | Jharkhand                          | 39964                        | 2325                         | 42289                        |
| 6                            | Madhya Pradesh                     | 64885                        | 4288                         | 69173                        |
| 7                            | Odisha                             | 47082                        | 2112                         | 49194                        |
| 8                            | Rajasthan                          | 49295                        | 4347                         | 53642                        |
| 9                            | Uttar Pradesh                      | 160575                       | 9515                         | 170090                       |
| 10                           | Uttarakhand                        | 10813                        | 1205                         | 12018                        |
| 11                           | Arunachal Pradesh                  | 4068                         | 102                          | 4170                         |
| 12                           | Assam                              | 31334                        | 1166                         | 32500                        |
| 13                           | Manipur                            | 3928                         | 81                           | 4009                         |
| 14                           | Meghalaya                          | 6811                         | 260                          | 7071                         |
| 15                           | Mizoram                            | 1004                         | 87                           | 1091                         |
| 16                           | Nagaland                           | 1949                         | 220                          | 2169                         |
| 17                           | Sikkim                             | 641                          | 35                           | 676                          |
| 18                           | Tripura                            | 7135                         | 528                          | 7663                         |
| 19                           | Andhra Pradesh                     | 36915                        | 5643                         | 42558                        |
| 20                           | Gujarat                            | 39079                        | 5245                         | 44324                        |
| 21                           | Haryana                            | 17696                        | 2631                         | 20327                        |
| 22                           | Karnataka                          | 38135                        | 3198                         | 41333                        |
| 23                           | Kerala                             | 22243                        | 4205                         | 26448                        |
| 24                           | Maharashtra                        | 62092                        | 10320                        | 72412                        |
| 25                           | Punjab                             | 17416                        | 2684                         | 20100                        |
| 26                           | Tamil Nadu                         | 2608                         | 2256                         | 4864                         |
| 27                           | Telangana                          | 23000                        | 5160                         | 28160                        |
| 28                           | West Bengal                        | 61565                        | 6237                         | 67802                        |
| 29                           | Andaman and Nicobar Islands        | 412                          | 10                           | 422                          |
| 30                           | Dadra &Nagar Haveli and Daman &Diu | 365                          | 75                           | 440                          |
| 31                           | Delhi                              | 0                            | 6200                         | 6200                         |
| 32                           | Ladakh                             | 605                          | 0                            | 605                          |
| 33                           | Lakshadweep                        | 110                          | 0                            | 110                          |
| 34                           | Puducherry                         | 0                            | 332                          | 332                          |
| Total                        | Total                              | 935339                       | 84568                        | 1019907                      |

Note: ASHAs exists in all State/UTs except Goa and Chandigarh

Source: NHM-MIS as on September 2023

## Annexure-II

## Expenditure for ASHA incentive under National Health Mission for FY-2018-19 to 2022-23

(Rs. in Lakh)

| Sl. No.   | State/UT                    | 2018-19     | 2019-20    | 2020-21          | 2021-22         | 2022-23         |
|-----------|-----------------------------|-------------|------------|------------------|-----------------|-----------------|
| 1         | Andaman and Nicobar Islands | 91.67       | 61.95      | 130.20           | 210.07          | 103.04          |
| 2         | Andhra Pradesh              | 6,557.82    | 10,623.54  | 11,225.51        | 9,629.63        | 1,660.65        |
| 3         | Arunachal Pradesh           | 663.28      | 866.50     | 1,235.15         | 1,132.58        | 1,600.91        |
| 4         | Assam                       | 12,539.66   | 13,528.31  | 9,619.47         | 6,941.57        | 11,106.50       |
| 5         | Bihar                       | 16,961.02   | 21,303.36  | 22,540.24        | 4,644.26        | 33,139.23       |
| 6         | Chattisgarh                 | 13,123.47   | 24,518.77  | 24,813.51        | 4,330.25        | 23,077.21       |
| 7         | Daman &Diu                  | 32.66       | 36.10      | 104.86           | 93.47           | 104.08          |
|           | Dadra &Nagar Haveli         | 82.58       | 101.72     |                  |                 |                 |
| 8         | Delhi                       | 11.31       | 3.23       | 1.65             | 1.86            | 2,068.94        |
| 9         | Gujarat                     | 17,032.87   | 19,489.58  | 20,925.19        | 8,237.40        | 14,757.27       |
| 10        | Haryana                     | 3,989.21    | 5,789.35   | 5,615.51         | 5,087.83        | 6,399.52        |
| 11        | Himachal Pradesh            | 3,305.51    | 3,584.41   | 4,307.32         | 6,345.45        | 6,668.99        |
| 12        | Jammu &Kashmir              | 2,347.75    | 3,698.54   | 3,772.44         | 4,936.44        | 3,766.83        |
| 13        | Jharkhand                   | 9,791.32    | 13,058.16  | 14,056.28        | 13,991.61       | 16,501.60       |
| 14        | Karnataka                   | 8,246.98    | 12,563.79  | 11,848.62        | 7,127.02        | 10,706.61       |
| 15        | Kerala                      | 1,150.16    | 4,281.02   | 8,215.03         | 1,501.01        | 7,868.19        |
| 16        | Lakshadweep                 | 0.12        | 12.55      | 22.16            | 19.76           | 27.40           |
| 17        | Madhya Pradesh              | 17,947.42   | 28,749.40  | 30,051.32        | 27,106.79       | 23,526.57       |
| 18        | Maharashtra                 | 22,551.47   | 26,305.10  | 29,453.97        | 19,326.48       | 23,078.27       |
| 19        | Manipur                     | 537.65      | 1,042.73   | 1,021.26         | 925.18          | 1,017.29        |
| 20        | Meghalaya                   | 1,444.46    | 1,609.31   | 2,209.93         | 2,103.33        | 2,013.19        |
| 21        | Mizoram                     | 280.69      | 339.82     | 234.17           | 302.25          | 273.32          |
| 22        | Nagaland                    | 262.54      | 365.43     | 434.96           | 587.38          | 382.01          |
| 23        | Odisha                      | 11,309.45   | 17,732.39  | 20,307.07        | 16,637.43       | 18,855.24       |
| 24        | Puducherry                  | 5.36        | 53.29      | 45.85            | -               | 114.30          |
| 25        | Punjab                      | 4,719.52    | 6,430.65   | 5,251.67         | 3,378.06        | 6,962.56        |
| 26        | Rajasthan                   | 9,382.38    | 12,524.14  | 14,266.97        | 10,390.31       | 10,872.31       |
| 27        | Sikkim                      | 125.58      | 81.15      | 170.38           | 139.51          | 217.41          |
| 28        | Tamil Nadu                  | 1,144.55    | 764.33     | 1,324.53         | 1,692.44        | 1,004.85        |
| 29        | Tripura                     | 1,809.68    | 2,400.93   | 2,477.67         | 1,290.85        | 2,844.86        |
| 30        | Uttar Pradesh               | 48,863.72   | 59,141.17  | 58,653.14        | 51,259.26       | 51,591.86       |
| 31        | Uttarakhand                 | 1,938.63    | 2,908.60   | 3,804.39         | 4,115.20        | 3,743.46        |
| 32        | West Bengal                 | 15,353.89   | 15,799.30  | 16,243.07        | 2,463.77        | 15,030.66       |
| 33 34     | Telangana Ladakh            | 11,814.23 - | 5,487.42 - | 20,799.91 175.72 | 9,029.61 182.87 | 7,423.22 342.33 |

## Note:

1. ASHAs exists in all State/UTs except Goa and Chandigarh.
2. Expenditure includes expenditure against Central Release, State release & unspent balances at the beginning of the year.
3. Expenditure is as per FMRs submitted by States/ UTs.

## The details of increase of performance-based incentives for a varied set of activities under various National Health Programmes since 2019 to ASHA workers

| Sl. No.                                            | Activities                                                                                                                                                                                        | Previous Incentive                                                  | Current Incentive in Rs. /Case                                                                                                                                                                                                                                                                                                                                                       |
|----------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
|                                                    | Child Health                                                                                                                                                                                      | Child Health                                                        | Child Health                                                                                                                                                                                                                                                                                                                                                                         |
| 1                                                  | Revision of ASHA incentive for referral of SAM children to NRC and follow up of SAM children after discharge from facility, NRC or Severe Acute Malnutrition (SAM) management centre .            | Rs. 150/- per follow up visits of SAM children (introduced in 2014) | Rs. 100/- per referring SAM child with medical complication to NRCs.(Revised in 2022) Rs. 150/- per follow up visits of SAM children discharged from NRC (Rs 50/visit for 1st and 4th visit and Rs 25 per visit for 2nd and 3rd visit) (.(Revised in 2022) Rs. 50/- per SAM child in case child is declared free of SAM status after completion of all follow-ups..(Revised in 2022) |
| Maternal Health                                    | Maternal Health                                                                                                                                                                                   | Maternal Health                                                     | Maternal Health                                                                                                                                                                                                                                                                                                                                                                      |
| 1                                                  | Mobilization under E-PMSMA                                                                                                                                                                        | -                                                                   | Rs 300 per ASHA to mobilize high risk pregnant woman to facility for follow up @Rs 100/-per visit for maximum up to 3 visits (Introduced in 2022)                                                                                                                                                                                                                                    |
| 2                                                  | Health Outcome under E-PMSMA                                                                                                                                                                      | -                                                                   | Rs 500 after ensuring survival of baby and mother duo after 42 days of Delivery. (Introduced in 2022)                                                                                                                                                                                                                                                                                |
| 3                                                  | ASHA incentive for identification of HRP during Post Natal Period                                                                                                                                 | -                                                                   | Rs 250 (Introduced in 2023)                                                                                                                                                                                                                                                                                                                                                          |
| National Tuberculosis Elimination Programme (NTEP) | National Tuberculosis Elimination Programme (NTEP)                                                                                                                                                | National Tuberculosis Elimination Programme (NTEP)                  | National Tuberculosis Elimination Programme (NTEP)                                                                                                                                                                                                                                                                                                                                   |
| 1                                                  | Incentive to ASHA/Community Volunteers for ensuring seeding of bank account details of TB patients in Ni-kshay portal within 15 days of treatment initiation for enabling DBT Payments under NTEP | -                                                                   | Rs 50/notified TB patient for seedlng of bank account details on the Nikshay portal. (Introduced in 2022)                                                                                                                                                                                                                                                                            |

| 2                                                                  | 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 (Introduced in 2022)                                                                                                                                                                                                                         |
|--------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| 3                                                                  | Mobilization of beneficiary through ASHA or other mobilizers for additional adult BCG beneficiaries                                                                                                 | - Rs 150 session                                                                                                                                             | ((Introduced in 2023)- per                                                                                                                                                                                                                                                                                                 |
| 4                                                                  | ASHA incentive for due list preparation (For monthly updating of due list of beneficiaries for adult BCG Vaccination)                                                                               | - Rs 100*3 months (if mop-up required) ((Introduced in 2023)                                                                                                 | is                                                                                                                                                                                                                                                                                                                         |
| 5                                                                  | ASHA incentive for house-to-house survey, before the campaign. -                                                                                                                                    | Rs 100 once during the campaign (Introduced in 2023)                                                                                                         |                                                                                                                                                                                                                                                                                                                            |
| 1 2                                                                | National Malaria Control Program Providing complete treatment for RDT positive Pf cases Providing complete radical treatment to positive Pf and Pv case detected by blood slide, as per drug regime | Rs. 20 for RDT positive Pf cases and Rs. 50 for complete radical treatment to positive Pf and Pv case detected by blood slide. It was revised to Rs 75 in Rs | 200/ confirmed case for ensuring complete treatment. (Revised in 2022)                                                                                                                                                                                                                                                     |
|                                                                    | Kala Azar elimination                                                                                                                                                                               | Kala Azar elimination                                                                                                                                        | Kala Azar elimination                                                                                                                                                                                                                                                                                                      |
| 1                                                                  | Incentive to ASHAs for referring Post Kala-Azar Dermal Leishmaniasis (PKDL) case                                                                                                                    | - Rs. 500/- per time of after treatment                                                                                                                      | case (Rs. 200/- at the diagnosis and Rs. 300/- completion) (Introduced in 2022)                                                                                                                                                                                                                                            |
| ASHA Certification                                                 | ASHA Certification                                                                                                                                                                                  | ASHA Certification                                                                                                                                           | ASHA Certification                                                                                                                                                                                                                                                                                                         |
| 1                                                                  | Incentive award in cash for ASHAs and ASHA Facilitators who have certified in two independent certificates: 1- RMNCHA+N 2- Expanded Service Package from NCDs to Palliative Care                    | -                                                                                                                                                            | Rs. 5000 for all ASHAs and ASHA Facilitators who successfully receive certification by NIOS in two independent certificates: A. RMNCHA+N B. Expanded package of new services from Non-Communicable Diseases to Palliative Care Total incentive: Rs 5000*2 (two independent certificates)= Rs 10,000/- (Introduced in 2022) |
| Facilitating creation and seeding of ABHA ID in various IT Portals | Facilitating creation and seeding of ABHA ID in various IT Portals                                                                                                                                  | Facilitating creation and seeding of ABHA ID in various IT Portals                                                                                           | Facilitating creation and seeding of ABHA ID in various IT Portals                                                                                                                                                                                                                                                         |
| 1                                                                  | Incentive for ASHAs for each ABHA account created and seeded in various IT portals of MoHFW                                                                                                         | -                                                                                                                                                            | Rs 10 for ASHAs for each ABHA account created/seeded. (Introduced in 2022)                                                                                                                                                                                                                                                 |

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