Recognition very often goes to those at the top of the pecking order, and stays there. Credit seldom trickles down to the worker at the bottom. The World Health Organization’s act of recognising India’s ASHA (accredited social health activists) and the polio workers of Afghanistan is an attempt to right that wrong. It is a rare, and commendable doffing of the hat for workers at the very bottom of the rung, and gives credit where it is due. When WHO Director General Tedros Adhanom Ghebreyesus announced the names of six Global Health Leader awardees at the opening session of the World Health Assembly, over one million ASHAs and eight volunteer polio workers found themselves being counted amidst people leading from the front. The other awardees are Paul Farmer, co-founder of the NGO Partners in Health, Ahmed Hankir, a British-Lebanese psychiatrist, Ludmila Sofia Oliveira Varela, a youth sports advocate, and Yōhei Sasakawa, WHO’s Goodwill Ambassador for Leprosy Elimination. Dr. Tedros who picks the awardees himself, said that the award recognises those who have made an outstanding contribution to protecting and promoting health around the world, at a time when the world is facing an unprecedented convergence of inequity, conflict, food insecurity, climate crisis and a pandemic.
The ASHAs were honoured for their “crucial role in linking the community with the health system, to ensure those living in rural poverty can access primary health care services....” These workers, all women, faced harassment and violence for their work during the pandemic, well documented in the media. While the pandemic rewrote the rules, creating danger where mere routine existed, it must be stressed that in general, their job, which takes them into difficult-to-reach places and hostile communities, confers a measure of privations. Even as they contribute to better health outcomes, this workforce continues to protest across the country, for better remuneration, health benefits and permanent posts. The eight volunteer polio workers of Afghanistan (four of them women) were shot and killed by gunmen in Takhar and Kunduz provinces in February 2022. Their work was crucial in a country where wild polio virus type 1 is still circulating, WHO recorded. Clearly, certain kinds of basic public health work are fraught with perils in several continents across the world. It is the duty of the governmental agencies that employ them to ensure their welfare, safety and security. While cheerleading about the award is rightfully reaching a crescendo, what matters is how the Indian government serves its last mile health workers who are its feet on the ground, once the dust raised by their unexpected recognition has settled down.