Articles by Mathew George

Originally envisioned to offer preventive, promotive, curative and rehabilitative services as per the needs of people at affordable costs, the health services in India are currently grappling with varied forms of fragmentation, at the macro-level institutions as well as at the level of primary healthcare. To arrest this crisis, it is necessary to revive referral services needed for primary-level curative care, by focusing on strengthening community health centres and developing a strong public health workforce at the grassroots level. The only way forward is to strengthen institutions of primary healthcare by effectively balancing people’s public health with their curative care needs.

Maharashtra’s policies for AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy) professionals are discriminatory, allowing them to engage in “mixed practice” and recruiting them either as paramedics or as administrators in the general health services system, without ensuring equal status with their allopathic counterparts. It is in this context that the nature of engagement of AYUSH professionals with the state health system is examined.

This study of the operation of the Accredited Social Health Activist programme of the National Rural Health Mission in one of the tribal blocks of Thane district in Maharashtra fi nds that incentives given to ASHAs generate a bias in their work activities and shift the attention of these community health workers from the community to the health services system. Moreover, the poor socio-economic background of ASHAs makes them depend on the incentives offered since this is their main source of income. Additionally, due to the excessive focus of ASHAs on curative care, the community considers them more an extended arm of the health service system, not as change agents as envisaged in the programme.