India’s unsung healthcare heroes, the ASHA workers, received the world’s recognition when the Director General of the World Health Organization conferred the Global Health Leaderships award for the year 2022 to India’s ‘Accredited Social Health Activists’, popularly known as ASHAs. The ASHAs were among the six awardees announced at the Assembly, to recognize their outstanding contributions to advancing global health, demonstrated leadership and commitment to regional health issues.

Conceptualized as part of the National Rural Health Mission, ASHAs drawn from the communities they serve, became the critical bridge between the complex health system and the people. The major credit for India achieving its millennium development goals (MDG) in reducing maternal and child mortality is given to these frontline workers. ASHAs played an important role in responding to the Covid-19 pandemic and in driving the vaccination program under most challenging conditions.

As India pivots its focus onto non-communicable diseases (NCDs) that have become the leading cause of death across every state, the burden on ASHAs is increasing beyond the conventional responsibility of mother & child care. They are being called upon to participate in various screening and treatment programs aimed at slowing the incidence of NCDs as part of Strategic Development Goals (SDGs). There will be a growing emphasis on robust disease surveillance as a part of the pandemic prevention and preparedness program given the traumatic experience with Covid-19 pandemic. Ayushman Bharat Digital Mission (ABDM) will be driving digital personal health records of everyone to transform our health systems.

Given these expanding responsibilities of ASHAs, there is a need to redesign the cadre in terms of the knowledge and skills they should have, revisiting the ‘ASHA to population’ ratio, inducting male ASHA workers as the scope of work now extends beyond mother and child to men as well, redefining the workload that each ASHA worker can satisfactorily handle, addressing the last mile challenges involved in adopting digital health, extending adequate financial and social protection, providing career growth opportunities and revisiting the current compensation system to make it appropriate to the responsibility that is likely to be entrusted on them. 

ASHAs are not as evident in the urban settings as in the rural settings. And yet, community engagement in urban settings is as important as that in rural settings. However, the profile of urban ASHAs has to be in alignment with the expectations of the urban communities. The healthcare needs of urban communities are different and their health seeking behavior is differs from rural communities. Point of care diagnostic and monitoring devices, selfcare applications, direct to home healthcare services, telemedicine etc., are disrupting the way primary healthcare is accessed in urban areas. Social media permits direct engagement of communities. Hence, there is a need to revisit ASHAs in urban locations.  Given the proven effectiveness of community engagement and community health worker strategy, health policy should address redefining ASHA cadre.    

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