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Ritika Kheda, Economist, teaches at Delhi IIT
Asha workers across the country have been on strike since last month. At the lowest level of health system in India are 'Asha Didi'. Their demand is that they get Rs. 10,000 monthly salary and PPE kit. ASHA workers have played a big role in the Battle of Corona as they are present in every village.
Deaths from the Corona epidemic and economic losses have raised questions over the policies of countries around the world. The major question in India should also be why government spending on health in the country is so low? While in countries like England and France, 7-10% of GDP is spent on health, in India it has been around 1%.
Why did this expenditure prioritize the top rung of the health infrastructure and ignore first aid? Why insurance is over-emphasized and first aid is bypassed. One example is enough to understand the stupidity of such a policy.
If the wound can be cured by dressing then why increase
Suppose you have a wound in your foot. If first aid is the strongest link in the health system then the wound can be cured by dressing immediately. If the health system rests on health insurance, then you will have to look for the severity of the wound because most of the insurance money is received only when there is a chance of hospitalization. There are two disadvantages to such an arrangement. One, the discomfort will be longer, the disease will last longer and the wounds may deteriorate and fracture. Two, the work that could have been done with just one dressing, now may have to bear the cost of the operation.
Prevention is better than cure
The basic principle of public health is that there is better prevention than cure. Do not let the disease take root, you can save both life and money. That is, the lowest level (first aid) must be strengthened. If you look at the National Health Service in England, there are large numbers of nurses (8 nurses per 1000 people), then general doctors (3/1000) and then specialist doctors.
If more emphasis is given to the nurse, then the expenditure on health is less (because the salary of the nurse is work from the doctor). On the other hand, early detection of the disease also costs less on treatment. In India, on the contrary, the structure costs more on the upper rung and less on the lower level. For example, there are less than 2 nurses per thousand people in the country, and about 1 doctor.
It is necessary to give proper training to the workers at the lower level
Proper training and good work environment is also necessary for the workers appointed at the lower level. Questions also arise on India's policies here. The doctor should have at least basic equipment available: seating area, toilet arrangements, blood and other testing services, availability of medicines, etc. The basic facilities of working for such nurses and other lower workers are as important as their timely salary.
Researchers, doctors and others have long demanded that the right of people to obtain health services in the country should be legally enforced. There is such a law in many countries of the world. The first step towards the goal of bringing legislation may be that the demands of the ASHA workers of the country are met.
She works closely with Anganwadi workers and ANMs (nurses). They get honorarium instead of salary and incentive per case for institutional delivery and other tasks. But their work is not just a few hours, as it is supposed to be at the time of appointment, but almost a full day's work like an Anganwadi worker or nurse. He is given Rs 2000 per month in honorarium. Delay in giving it is common.
Asha has long been demanding that she be appointed as a regular government employee and be paid her salary instead of honorarium. There is a chance to rectify the mistake of neglecting the health policy and expenditure in the 70 years of the epidemic. (These are the author's own views)