The National Rural Health Mission began a decade ago in India and was rechristened as the National Health Mission when it began covering urban parts of India as well. This Mission is responsible for the health care of the nation but the entire work force is under contract.Today NHM looks after the health of the nation's poor and unserved population on villages and slums on behalf of the government. The Mission has accomplished a mamoth task of training around 900000 village women as Community Health Workers ASHAs and then facilitating them to work in their own villages, under regular supervision and guidance.
A number of states in India have recently proposed the regularisation of contracted workers under the National Health Mission. This is a welcome move, and brings hope to the workers' associations.
These proposals can be brought to reality only when the Central Government issues guidelines to the states.It has a fine opportunity to do so in the upcoming New National Health Policy.
It is notable that none of the states have included the women Community Health Workers ASHAs in their proposals for regularisation. ASHAs can be exploited by their seniors, ridiculed by the community and pressurised by their families even as their work is appreciated by these stakeholders because their post and payment are both not regularised. Several countries like Brazil and Iran have retained CHWs as paid employees of the government and these CHWs are performing well.
Regularisation protects the rights of the workers and also facilitatesgood performance. Accountability is best expected from stable employees, not workers living with job insecurity. Therefore let us support the regularisation of contracted health workers in our individual capacities. Let us campaign for the regularisation of the services of volunteer CHWs like ASHAs. A stable work force is the backbone of a stable health care system.