The National Rural Health Mission (NRHM) was flagged off in the year 2005 to facilitate the delivery of high quality affordable healthcare to the citizens of rural sectors in 18 states. Haryana is one of the large non-high focus states and yet the benefit received by the state's rural population from the NRHM is considerable. One of the highlights of the NRHM activities in the state is the training and positioning of a female community health worker from the village itself. This worker, called ASHA, is the first point of contact for all health and medication related needs in many villages of Haryana.
Despite the importance of NRHM in ensuring health and wellness in rural sectors, the employees of the mission have been facing adverse working conditions and unfavourable terms. The key concern here is the continuation of contractual staff for prolonged tenures, often running into decades. Across the country, the NHRM has engaged lakhs of employees in various capacities all on short or long term contracts that are renewed as and when needed. In Haryana alone, thousands of such contractual employees continue to function for periods as long as 14-15 years on renewable contracts.
Not being absorbed into the payrolls of the NRHM or the state health agencies deprives these employees of a number of benefits and of the minimum wage scales as ascertained by the central and state governments. The contractual staff lacks insurance coverage, equitable service conditions, and most often the right to protest without hurting the prospects of renewing their contracts. Contractual employees are hired to almost all positions from peons and village health workers to doctors, nurses, and administrative officers. This leads to a major concern about the quality of healthcare, the prevention of corruption and malpractices in rural healthcare.
Long and inhospitable work hours are common among the contractual workers at the NRHM. In other states these contractual employees of NRHM have gone on long strikes and protests, bringing the public medical and healthcare systems in the state to a virtual standstill. Over 62,000 NRHM contractual employees went on a strike in Jharkhand earlier this year to protest their service conditions.
A look at similar scenarios in the roadways or sanitation domains shows us why regularisation of many contractual NRHM employees is an urgent need. Earlier this month about 8,843 contractual employees of Haryana Roadways were granted regular employment following a massive protest that had derailed public road transport in the state for a while. In the same breath, the state cabinet approved the absorption of 10,530 contractual sanitation employees of civic bodies in the state. At a time when contractual employees of NRHM across the state have been breaking out on prolonged strikes and agitations, it is important that Haryana review its employment and engagement contracts and service conditions to keep the health mission activities up and running.
Healthcare, especially rural healthcare, is an important aspect of social security and administration. Unless the employees of NRHM are accorded equitable work conditions and absorbed into the permanent employment as and when necessary, one of the key programs for healthcare in the state may remain compromised.