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Business Standard
a day ago
- Health
- Business Standard
PM Surakshit Matritva Abhiyan marks 9 years, MRR declines by 50 points
India's Maternal Mortality Ratio (MMR) has declined by 50 points in the nine years of Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA). During that time, 6.19 crore women have been examined under the scheme. According to a press note, the government's combined efforts to provide antenatal care and ensure proper nutrition for pregnant women have led to a significant improvement in India's Maternal Mortality Ratio (MMR), which declined from 130 per lakh live births in 2014-16 to 80 per lakh live births in 2021-23, a reduction of 50 points. According to the note, 6813 volunteers have registered to assist pregnant women under the PMSMA. Maharashtra has topped the list of the most volunteers registered under the scheme till May 2025 with 1131 volunteers, followed by 1076 in Uttar Pradesh and 1015 in Rajasthan. Uttar Pradesh has the most pregnant women in the second or third trimester receiving antenatal care under the scheme, with 189534 women who have received the facilities. Launched in June 2016, the PMSMA is a flagship initiative of the Ministry of Health and Family Welfare, Government of India. It was designed to provide assured, comprehensive, and quality antenatal care (ANC) services free of cost to all pregnant women on the 9th of every month, particularly during the second and third trimesters. The core aim is to reduce maternal and neonatal mortality by facilitating early detection and prompt management of high-risk pregnancies. The press note says that the programme follows a systematic approach to engagement with the private sector, which includes motivating private practitioners to volunteer for the campaign, helping develop strategies for spreading awareness, and participating in the Abhiyan at government health facilities. The PMSMA aligns with the broader goals of the Reproductive, Maternal, Newborn, Child, and Adolescent Health plus Nutrition (RMNCAH+N) strategy under the National Health Mission (NHM). The main objectives of the scheme include ensuring that every pregnant woman receives at least one check-up by a physician/specialist during the second or third trimester, improve the quality of care during antenatal visits, identifying and managing high-risk pregnancies (HRP) at an early stage, appropriate birth planning and complication readiness for each pregnant woman, ensuring appropriate management of women with malnutrition and a special focus on adolescent and early pregnancies. The E-PMSMA strategy was rolled out in January 2022 to ensure the tracing and tracking of High-Risk Pregnant (HRP) women until a safe delivery is achieved by provisioning financial incentivisation for the identified HRP women and accompanying Accredited Social Health Activists (ASHA) for an extra three visits over and above the PMSMA visit, the press note said. Services offered under the scheme include routine antenatal care checkups, diagnostic services, identification and management of high-risk pregnant women, and counselling regarding nutrition, family planning, birth preparedness, and newborn and postnatal care. PMSMA complements other government programs, including the Janani Suraksha Yojana (JSY), which was launched to incentivise institutional deliveries through conditional cash transfers. This scheme has benefited over 11.07 crore women as of March 2025, the Janani Shishu Suraksha Karyakram (JSSK), launched to promote free institutional delivery and neonatal care. More than 16.60 crore beneficiaries have been served since 2014-15, LaQshya Initiative for improving quality of care in labour rooms, the Surakshit Matritva Aashwasan (SUMAN), launched to strengthen respectful and quality care for pregnant women. 90,015 SUMAN health facilities have been notified across the country by March 2025, the POSHAN Abhiyaan, started to target the most vulnerable--children, adolescent girls, pregnant women, and lactating mothers--by revamping the nutrition services and the Pradhan Mantri Matru Vandana Yojana (PMMVY), launched to promote institutional delivery and ensuring maternal health, the scheme provides direct cash benefits of Rs5,000 to pregnant and lactating women.
The Star
2 days ago
- Health
- The Star
Paid less than unskilled labourers, community health workers in India go on strike
BENGALURU: Thousands of community health workers in the south Indian state of Kerala have been on strike for more than 110 days. Their demands? Better pay, reduced workload, social security and dignity. This is not the first time they have protested against work conditions, nor are they the only state's health workers in India to do so. In Kerala's capital, Thiruvananthapuram, female community health workers known as Accredited Social Health Activists (Ashas) have been in a day-and-night protest opposite the state secretariat since Feb 10. Yet four meetings with state Health Ministry officials have been inconclusive. Under the national Asha programme, every village or urban ward has a resident health worker who helps ensure people's access to vaccination, safe childbirth and seasonal epidemic checks. In Kerala, these women were on the front line of the state's famously superb Covid-19 response that earned praise from the World Health Organisation. After the devastating 2018 floods in Kerala, they were also at the forefront of preventing rampant waterborne diseases. The health workers' grievances of poor pay and lack of respect stand at odds with Kerala's highly reputed public health system, which has achieved better disease control and maternal mortality and immunisation rates than most other states. Studies credit these healthcare triumphs to decentralised governance and the community engagement by more than 26,000 grassroots health workers. The Indian government defines Asha work under a national programme as voluntary, and the workers' payment an honorarium, not a wage. The workers are paid largely by the local state governments, with each state setting its own honorarium. When the Asha programme was launched in 2005, the honorarium nationwide was 500 rupees (US$5.83) a month. In Kerala, it has been gradually increased in response to protests every few years, up to 7,000 rupees a month since 2024. This still amounts to around 230 rupees a day, only a third of Kerala's legal minimum wage for unskilled labourers, which is 700 rupees. Ashas are also eligible for up to 3,000 rupees a month in performance-based incentives – this is paid by the state and national governments in a 60:40 ratio. 'I was shocked to discover how little the front-line workers of Kerala's proactive health system are paid. It's insulting,' said Dr Gopika Swarna Bai, a community health physician from Kerala who is now doing her residency in Mumbai, where Ashas are paid 13,000 rupees a month. 'Ashas know every household. For example, they spread awareness of a mass drug administration for filariasis for weeks, bring the 100 people, find chairs and shelter for them on a fixed date for doctors like me to just go and administer injections,' Dr Gopika added, noting that government nurses and doctors could be transferred, but Ashas have 'backyard knowledge' as they stay put in a region for decades. All states have raised the honorariums over the years in response to demands and protests. Neighbouring Karnataka increased the fixed honorarium from 5,000 to 10,000 rupees in January after an eight-year campaign by health workers. The north-eastern state of Sikkim has paid Ashas 10,000 rupees a month since 2022; Puducherry in the south pays them 18,000 rupees. In West Bengal, health workers retiring at 65 years old get a one-time payout of 500,000 rupees – the same amount Kerala's Ashas want. Striking health workers in Kerala are demanding minimum wages, which would amount to 21,000 rupees a month. Bindu B., a community health worker in the Kannammoola ward of Thiruvananthapuram city, points to 'the hypocrisy of the communist-led state government that enjoys the plaudits of being people- and worker-centric leaders, but treats women workers almost like slaves'. The 51-year-old, who has been an Asha for 18 years, spoke to The Straits Times on May 30 as she was headed to the protest site, even though there was an orange alert for rainstorms that week. At least 12,000 Ashas like her have endured extreme rain and heat for over 110 days, and held dramatic protests, including a 41-day hunger strike and cutting their hair off. Some of them are now on a statewide march, spending the night under bus shelters or on school verandas as they reach out to Ashas who may not have been able to travel to the Thiruvananthapuram protest site. 'The government's response is that they don't have funds, that the central government has not transferred the budget,' said S. Mini, state vice-president of the Kerala Asha Health Workers Association, which is helming the ongoing strike. Kerala is among several states, such as Tamil Nadu and Telangana, led by opposition parties demanding a greater share of taxes from Indian Prime Minister Narendra Modi's Bharatiya Janata Party government at the centre. India spends a mere 1.14 per cent of its budget on public health. 'Understanding Kerala's financial situation, we asked the (Kerala) Health Minister to increase the pay for now by 100 rupees a day, so that we can get 10,000 rupees a month at least,' said Rosy Mardra, 51, an Asha who was part of the delegation that met officials, of the last meeting. 'They refused even that.' Kerala's Health Ministry has yet to respond to ST's queries. A state official, who requested anonymity, pointed ST to a recent central government study that found the state's financial health poor, ranking 15th among 28 states owing to high social welfare spending and limited revenue growth. He also argued that Kerala paid the honorariums more regularly than other states that promised more, but Ashas have refuted this claim, saying they sometimes do not get paid for over three months. Rosy, struggling to repay loans she took to send her two daughters to college, was enraged by what she called 'the government's cruel excuses'. 'Amid this financial crunch, how come the Kerala government has 100 crore (one billion) rupees to celebrate its fourth anniversary, but does not give us 100 rupees more?' she asked. The cost of living in Kerala is higher than the national average. Some estimates put average monthly expenses excluding rent at more than 27,000 rupees per month. Almost all Ashas in Kerala are from low-income families, and three-quarters are sole breadwinners while a quarter are Dalits, who are at the bottom of India's caste hierarchy, said feminist scholar J. Devika, who conducted spot surveys of striking health workers. 'Families in Kerala are kept safe by these women's cheap labour. They've clearly had enough. Without committed, financially secure Ashas, the state's health indices and disease control will collapse,' she added. Since joining the service at the age of 32, Bindu's work hours have ballooned from two hours a day, per government guidelines, to at least 12 hours a day of fieldwork and report writing. She is responsible for 950 households, and performs 100 tasks each month assigned by the national health programme. These include registering pregnancies, ensuring child immunisations, doing leprosy checks, detecting sources of waterborne diseases, and monitoring fevers or other symptoms in vulnerable populations during epidemics. Kerala has assigned her ten other responsibilities, such as conducting surveys for the local government and digitising a lot of health data. Some days, she is chlorinating wells, and other days, she is collecting diabetes data from every household. The latest task, which many Ashas told ST was a trigger for the ongoing strike, was the Kerala government's app-based statewide screening for non-communicable diseases. Launched in 2023 to detect and prevent lifestyle diseases, the Shaili app's initial phases have shown 45 per cent of the population at risk for diabetes, cancer, tuberculosis and hypertension. But Ashas alleged that having to ask 60 questions a household within tight deadlines over a glitchy app, which does not work in areas with poor data networks, made the job so onerous that it affected other tasks. 'Even as the workload grew and took on a compulsory nature, the pay remains an honorarium fit for volunteers,' social activist Shradha S. said, also a co-founder of a menstruation awareness collective in Kerala. 'The current pay is too little and too erratic, and I keep having to take loans to get by,' said Bindu, who recently took on a second job to make ends meet. After dusk, she delivers medicine for a neighbourhood pharmacy. It pays her 10,000 rupees a month. 'After my husband died a decade ago, my son had to drop out of college to work, and I married my daughter off early at 20 years to have one less mouth to feed,' she told ST. To Bindu, the strike was 'the only step left to save me from dying of exhaustion'. The strike has had a few wins, with Kerala's Health Minister, Veena George, announcing that the Ashas' monthly pay is no longer tied to the fulfilment of ten state tasks, although the fine print reveals that it is still tied to the incentives. The state has also formed a committee to investigate the need for a pay hike. But Chief Minister Pinarayi Vijayan has stated that the government will not engage in further negotiations. As the monsoon sets in, the health workers will also have to begin awareness campaigns to prevent waterborne and mosquito-related diseases like dengue, filariasis and malaria. Cognisant of the impact of their absence on the community, and struggling without any income for three months, most Ashas have gone back to work now. But many are still making time to spend a few hours at the protest site. 'What began as a simple protest seeking fair compensation and lower workload has now turned into a cry for respect and parity,' said Rosy. Bindu has been going to the protest site and conducting her fieldwork despite requiring rest for a ligament tear. 'In my area, there is one palliative care patient with cancer; 13 senior citizens, of whom eight are on (intravenous drips); 150 children are under five years old; 14 kids are under one year (old). I know where mosquitoes breed regularly. This week, four people had a fever – I took them for testing, and two turned out positive for Covid-19.' She asked: 'Who will know people in this detail if I don't go to work? 'Why doesn't the government see us?' - The Straits Times/ANN
Straits Times
5 days ago
- Health
- Straits Times
Paid less than unskilled labourers, community health workers in India go on strike
Through intense rain and heat, over 26,000 community health workers in Kerala have demanded minimum wages, less workload and retirement benefits. PHOTO: COURTESY OF KAHWA, HARSH Paid less than unskilled labourers, community health workers in India go on strike – Thousands of community health workers in the south Indian state of Kerala have been on strike for more than 110 days. Their demands? Better pay, reduced workload, social security and dignity. This is not the first time they have protested, nor are they the only state's health workers in India to do so. In Kerala's capital, Thiruvananthapuram, female community health workers known as Accredited Social Health Activists (Ashas) have been on a day-and-night protest opposite the state secretariat since Feb 10. Yet, four meetings with state health ministry officials have been inconclusive. Under the national Asha programme, every village or urban ward has a resident health worker who helps ensure people's access to vaccination, safe childbirth and seasonal epidemic checks. In Kerala, these women were on the front line of the state's famously superb Covid-19 response that earned praise from the World Health Organisation. After the devastating 2018 floods in Kerala, they were also at the forefront of preventing rampant waterborne diseases. The health workers' grievances of poor pay and lack of respect stand at odds with Kerala's highly reputed public health system, which has achieved better disease control and maternal mortality and immunisation rates than most other states. Studies credit these healthcare triumphs to decentralised governance and the community engagement by more than 26,000 grassroot health workers. The Indian government defines Asha work under a national programme as voluntary, and their payment an honorarium, not a wage. T he workers are paid largely by the local state governments, with each state setting its own honorarium. Paid just 230 rupees (S$3.50) a day When the Asha programme was launched in 2005, the honorarium nationwide was 500 rupees (S$7.50) a month. In Kerala, it has been gradually increased in response to protests every few years, up to 7,000 rupees a month since 2024. This still amounts to around 230 rupees or S$3.50 a day, only a third of Kerala's legal minimum wage for unskilled labourers, which is 700 rupees. Ashas are also eligible for up to 3,000 rupees a month as performance-based incentives – this is paid by the state and national governments in a 60:40 ratio. 'I was shocked to discover how little the front-line workers of Kerala's proactive health system are paid. It's insulting,' said Dr Gopika Swarna Bai, a community health physician from Kerala who is now doing her residency in Mumbai, where Ashas are paid 13,000 rupees a month. 'Ashas know every household. For example, they spread awareness of a mass drug administration for filariasis for weeks, bring the 100 people, find chairs and shelter for them on a fixed date for doctors like me to just go and administer injections,' Dr Gopika added , noting that government nurses and doctors could be transferred, but Ashas have 'backyard knowledge' as they stay put in a region for decades. Striking health workers in Kerala are demanding minimum wages, which would amount to 21,000 rupees a month. PHOTO: COURTESY OF KAHWA, HARSH All states have raised the honorariums over the years in response to demands and protests. Neighbouring Karnataka increased the fixed honorarium from 5,000 to 10,000 rupees in January after an eight-year campaign by health workers. The north-eastern state of Sikkim has paid Ashas 10,000 rupees a month since 2022; Puducherry in the south pays them 18,000 rupees. In West Bengal, health workers retiring at 65 years old get a one-time payout of 500,000 rupees – the same amount Kerala's Ashas want. 'Government's cruel excuses' Striking health workers in Kerala are demanding minimum wages, which would amount to 21,000 rupees a month. Ms Bindu B ., a community health worker in the Kannammoola ward of Thiruvananthapuram city, points to 'the hypocrisy of the communist-led state government that enjoys the plaudits of being people- and worker-centric leaders, but treats women workers almost like slaves'. The 51-year-old, who has been an Asha for 18 years, spoke to The Straits Times on May 30 as she was headed to the protest site, even though there was an orange alert for rainstorms that week. At least 12,000 Ashas like her have endured extreme rain and heat for over 110 days, and held dramatic protests, including a 41-day hunger strike and cutting their hair off. Some of them are now on a statewide march , spending the night under bus shelters or in school verandas as they reach out to Ashas who may not have been able to travel to the Thiruvananthapuram protest site . 'The government's response is that they don't have funds, that the central government has not transferred the budget,' said Ms S. Mini, state vice-president of the Kerala Asha Health Workers Association that helms the ongoing strike. Kerala is among several states, such as Tamil Nadu and Telangana, led by opposition parties demanding a greater share of taxes from Prime Minister Narendra Modi's Bharatiya Janata Party government at the centre. India spends a mere 1.14 per cent of its budget on public health. 'Understanding Kerala's financial situation, we asked the (Kerala) health minister to increase the pay for now by 10 rupees a day, so that we can get 10,000 rupees a month at least,' said Ms Rosy Mardra, 51, an Asha who was part of the delegation that met officials, of the last meeting. 'They refused even that.' Kerala's health ministry has yet to respond to ST's queries. Ms Bindu B., 51, has been a community health worker in Kerala for 18 years. PHOTO: COURTESY OF BINDU A state official, who requested anonymity, pointed ST to a recent central government study that found that the state's financial health poor, ranking 15 among 28 states due to high social welfare spending and limited revenue growth. He also argued that Kerala paid the honorariums more regularly than other states that promised more , but Ashas have refuted this claim, saying they sometimes do not get paid for over three months. Ms Rosy, struggling to repay debts she took to send her two daughters to college, was enraged by what she called 'the government's cruel excuses'. 'Amid this financial crunch, how come the Kerala government has 100 crore (one billion) rupees to celebrate its fourth anniversary, but not give us 10 rupees more?' she asked. The cost of living in Kerala is higher than the national average. Some estimates put average monthly expenses excluding rent at more than 27,000 rupees per month. Almost all Ashas in Kerala are from low-income families, while three-quarters are sole breadwinners, and a quarter are Dalits, who are at the bottom of India's caste hierarchy, said feminist scholar J. Devika, who conducted spot surveys of striking health workers. ' Families in Kerala are kept safe by these women's cheap labour. They've clearly had enough. Without committed, financially secure Ashas, the state's health indices and disease control will collapse,' she added. Ever-increasing workloads Since joining the service at the age of 32, Ms Bindu ' s work hours have ballooned from two hours a day, as per government guidelines, to at least 12 hours of fieldwork and report writing. She is responsible for 950 households, and performs 100 tasks each month assigned by the national health programme. These include registering pregnancies, ensuring child immunisations, doing leprosy checks, detecting sources of waterborne diseases, and monitoring fevers or other symptoms in vulnerable populations during epidemics. Kerala has assigned her 10 other responsibilities, like conducting surveys for the local government and digitising a lot of health data. Some days, she is chlorinating wells, and other days, she is collecting diabetes data from every household. The latest task, which many Ashas told ST was a trigger for the ongoing strike, was the Kerala government's app-based state-wide screening for non-communicable diseases. Launched in 2023 to detect and prevent lifestyle diseases, the Shaili app's initial phases have shown 45 per cent of the population at risk for diabetes, cancer, tuberculosis and hypertension. But Ashas alleged that having to ask 60 questions per household within tight deadlines over a glitchy app that does not work in areas with poor data networks made the job so onerous that it affected other tasks. 'Even as the workload grew and took on a compulsory nature, the pay remains an honorarium fit for volunteers,' said social activist Ms Shradha S. , also a co-founder of a menstruation awareness collective in Kerala . 'The current pay is too little and too erratic, and I keep having to take loans to get by,' said Ms Bindu , who recently took on a second job to make ends meet. After dusk, she delivers medicines for a neighbourhood pharmacy. It pays her 10,000 rupees a month. 'After my husband died a decade ago, my son had to drop out of college to work, and I married my daughter off early at 20 years to have one less mouth to feed,' she told ST. The cost of living in Kerala is higher than the national average. Some estimates put average monthly expenses excluding rent at more than 27,000 rupees per month. PHOTO: COURTESY OF KAHWA, HARSH To Ms Bindu, the strike was 'the only step left to save me from dying of exhaustion'. The strike has had a few wins, with Kerala's state health minister, Ms Veena George, announcing that their monthly pay is no longer tied to the fulfilment of 10 state tasks, although the fine print reveals that it is still tied to the incentives. The state has also formed a committee to investigate the need for a pay hike. But Chief Minister Pinarayi Vijayan has stated that the government will not engage in further negotiations. A heart for the people As the monsoon sets in, the health workers will also have to begin awareness campaigns to prevent waterborne and mosquito-related diseases like dengue, filariasis and malaria. Cognisant of the impact of their absence on the community, and struggling without any income for three months, most Ashas have gone back to work now. But many are still making time to spend a few hours at the protest site. 'What began as a simple protest seeking fair compensation and lower workload, has now turned into a cry for respect and parity,' said Ms Rosy. Ms Bindu has been going to the protest site and doing her field work her despite requiring rest for a ligament tear. 'In my area, there is one palliative care patient with cancer. Thirteen senior citizens, of whom eight are on IVs, 150 children are under five years old, 14 kids are under one year. I know where mosquitoes breed regularly. This week, four people had a fever – I took them for testing, and two turned out positive for Covid-19. 'Who will know people in this detail if I don't go to work?' she asked. 'Why doesn't the government see us?' Rohini Mohan is The Straits Times' India correspondent based in Bengaluru. She covers politics, business and human rights in the South Asian region. Join ST's Telegram channel and get the latest breaking news delivered to you.
The Hindu
15-05-2025
- Health
- The Hindu
Kerala govt forms panel to look into demands of striking ASHA workers
The Kerala government has constituted a five-member committee to study the demands of protesting Accredited Social Health Activists (ASHAs) and submit a report within three months. The order forming the committee was issued only this week, though it had been announced last month following talks with the striking ASHA wokers. The five-member committee will be chaired by Haritha V. Kumar, director, Women and Child Development department. R. Subhash, Health additional secretary, will be its convener. Two additional secretaries from the Finance and Labour departments will be nominated to the committee as members. K.M. Seena, head of Social Development at the National Health Mission, will be the third member. The committee will meet representatives of ASHAs organisations and trade union representatives and submit its report. ASHAs, under the banner of Kerala ASHA Health Workers' Association (KAHWA), have been protesting since February 2025 seeking an increase in their remuneration and retirement benefits.
Time of India
10-05-2025
- Health
- Time of India
Maradu municipality approves Rs 3,000 monthly honorarium for ASHAs
Kochi: In a significant move to address long-standing demands, Maradu municipality approved a monthly honorarium of Rs 3,000 for Accredited Social Health Activists (ASHAs). The decision was taken during an emergency council meeting convened on Friday and marks a crucial step towards recognizing the contributions of grassroots health move follows persistent protests and formal appeals by ASHAs, who sent letters to local self-government minister, principal director, district planning committee and other officials, demanding a hike in monthly pay. The proposal was passed unanimously, except for one abstention by division 1 councillor and ASHA worker Shalini Anil Raj, who opted out of the the municipality earmarked an additional Rs 2,000 in its annual budget as a special allocation for ASHAs. However, implementing this provision required both council approval and state govt sanction. The recent council meeting not only endorsed the proposal but also agreed to increase the amount to Rs 3,000 per worker per month."Ashas play a key role in Maradu's health services. When there is a collective struggle by them, we found it important to take an initiative to support them," said municipality chairperson Antony Ashanparambil. Earlier, Ashanparambil donated his monthly honorarium to ASHAs in solidarity with their protest in added that the resolution has now been forwarded to state govt for final approval and requested that necessary steps be taken to ensure immediate implementation of the decision.
