Recurrent strikes by National Health Mission (NHM) staff and state-level protests by ASHA and Anganwadi workers have revealed deep-rooted structural weaknesses in the primary healthcare system of India.
Key Cadres Supporting Primary Healthcare
Key Challenges
- Expanding Responsibilities: Added duties like population enumeration, Non-Communicable Disease and palliative care, without matching pay or support.
- Poor Remuneration & Protection: Low, irregular payments; no social security; limited safety during fieldwork (still recognised as volunteers).
- Unionisation and Strikes: Growing union presence reflects discontent, Kerala and Haryana ASHAs, and Anganwadi unions nationwide, are demanding regularisation and fair pay.
- Vacant Regular Posts: ~10–15% Auxiliary Nurse Midwife posts and 20–25% doctor posts remain vacant.
- Contractualisation trend: Rising contractual hiring reflects cost-cutting and ease of administration but lacks clear career growth or cadre structure.
Conclusion
A balanced workforce model, coupled with transparent recruitment, fair incentives, and continuous capacity building, is essential to strengthen India’s health system.
