Healthcare Workforce Challenges in India
The recent indefinite strike by 16,000 National Health Mission (NHM) staff in Chhattisgarh and recurrent strikes by ASHA workers in Haryana and Kerala highlight significant issues within India's healthcare workforce. These challenges are particularly pressing in the context of providing comprehensive primary healthcare (CPHC).
Key Cadres Supporting CPHC
- Anganwadi Workers (AWWs)
- Part of the Integrated Child Development Services Scheme (ICDS) since 1975.
- Focus on nutritional education, supplementation for women and children, and facilitating maternal and child health services.
- Accredited Social Health Activists (ASHAs)
- Introduced under the National Rural Health Mission in 2005.
- Responsible for creating awareness and mobilizing beneficiaries to health facilities.
- Community Health Officers (CHOs)
- Initiated in 2018 to expand services through Health and Wellness Centres.
- Comprise dentists, nurses, or AYUSH practitioners working on a contractual basis.
Roles and Challenges of ASHAs and AWWs
- Responsibilities
- Both are link workers connecting healthcare systems to the community.
- Expected to work part-time for up to four hours daily, with ASHAs often extending beyond this due to emergencies.
- Compensation and Additional Responsibilities
- ASHAs earn Rs 5,000-10,000/month; AWWs around Rs 12,000, varying by state.
- Entrusted with additional tasks like population enumeration and NCD screening.
Issues and Grievances
- Increased workload and inadequate safety measures.
- Lack of proper and timely remuneration.
- Strikes and formation of unions due to unresolved issues.
Challenges of Regularization and Contractual Appointments
- Regularization would lead to significant salary payouts and promotion issues.
- High vacancy rates (10-15% ANM, 20-25% doctors) filled through contractual appointments for reduced financial and administrative burdens.
Conclusion
The reliance on contractual and volunteer-based staff for essential services needs re-evaluation. A balanced approach is necessary for effective recruitment, incentive structures, and cadre management to address the inherent challenges in India's public healthcare workforce.