Few incentives, ASHA workers indifferent to certification course; enrolments continue to decline

The course is aimed at upskilling ASHA workers.

The number of ASHA workers taking up the voluntary certification course aimed at upskilling them has seen a continuous year-on-year fall since 2019, data shared by the Ministry of Education in the Lok Sabha shows.

ASHA, or Accredited Social Health Activists, workers are women community health volunteers under the National Rural Health Mission, who work as an interface between the community and public health system and help in the implementation of central health schemes.

While no consolidated number of ASHA workers who have been certified under the programme was provided, the data shared for five years – 2017-18 to 2021-22 – showed that only 50,968 workers were certified during the five-year period.

The numbers are in stark contrast to the target of certifying 9 lakh ASHA workers under the course.

The course seeks to ensure that the workers gain competencies in a package of skills that ensure positive health outcomes for the communities and higher skill levels for progress across other career paths.

In 2017-18, only about 2,256 appeared for the certification program in the country, this number saw a huge boost the next year in 2018-19 when 24,540 ASHA workers appeared for the certification.

However, this number has since shown a steady fall with 13,862 opting for the certification in 2019-20, 10,991 in 2020-21 and 6,148 in 2021-22.

The government response also reveals that while the total funds received by the National Institute of Open Schooling (NIOS) during 2014-19 for certification of ASHA workers was Rs 7.64 crore, an expenditure of Rs 5.73 crore was made. An amount of Rs 1.91 crore continues to remain with NIOS as an unspent balance.

For the certification course, a memorandum of understanding was signed between the Ministry of Health and Family Welfare, National Health System Resource Centre and NIOS for skill development, assessment and certification of 9 lakh ASHA health workers.

The duration of the project was 2014–2019 but was extended to 2024 when the target of certification was not met.

What is the objective of the course?

The project aims to enhance the competency and professional credibility of ASHA workers in providing quality health care services in the community and to certify approximately 9 lakh ASHAs covering all districts of 35 states & Union Territories

It assesses the skills and competencies of ASHAs and recognises the learning through certification.

The course was started to “inspire ASHAs to fulfil their work responsibility to the optimum level and to establish a mechanism to improve knowledge, skill and competencies among ASHAs across the country,” the official website says.

How does the project function?

The project runs in a distance education mode and is based on a cascade model, in which state trainers train the district trainers and district trainers further train the ASHAs.

At the state level, the trainers are required to have an educational background in nursing/clinical/social work with 7 to 10 years of work experience. Here, the assessment and certification of trainers too are required to enhance their skills and competencies as per the program.

Why has the project not been able to accomplish its objectives?

A low number of trainers and lack of awareness among the ASHA workers can be cited as prime reasons for the dismal numbers of workers applying for certification.

As per the official website, only 232 state trainers in 24 states and 1,006 district trainers in 15 states have been certified by NIOS to work on the certification of ASHAs.

The low number of trainers is in contrast to around 10.4 lakh ASHA workers spread across the country, as per the latest National Health Mission data available from September 2019.

Moneycontrol spoke with several ASHA workers, most of whom had little to no idea about the project.

Neelam (43), an ASHA worker from Haryana’s Panchkula, says while certifications are provided to ASHAs, she is not sure if they are the ones being given by NIOS.

“I am a school graduate and did not need to undergo such training,” she says.

Vandana (34), an ASHA worker from Uttar Pradesh’s Bareilly says, “I have never given any exam or undertaken any training other than the initial training we get. I have never heard of any certification course either.”

No incentives to undertake the certification

Kavita Yadav, Delhi State coordinator for ASHA workers, points out several issues with the project. “I took the certification course a few years back. While the training and getting the certificate was hassle-free, the issue remains about its importance and awareness among workers,” she says.

“ASHA workers are mostly women who come from low-income groups. They are sometimes illiterate or school graduates. The course is useless to them as it does not give them the option to earn more. There are no incentives attached and it is an exercise in vain for them,” she says.

Moreover, the scheme is not prevalent in most states, Yadav points out. “It was undertaken in Delhi a few years back and is currently being conducted in J&K. But that is how it is, they are focusing on only one state at a time.”