Ashas, who make about Rs 1,000 a month, are required to undergo a 23-day training spread across 12 months, but a third of the Ashas in a block in north Bihar were not trained at induction. Nearly a million workers–forming the frontline of India’s faltering public health system–are inadequately trained and are underpaid, according to an IndiaSpend analysis of health ministry data, imperilling the country’s progress in healthcare efforts. Accredited Social Health Activists (Ashas)–considered to be voluntary workers–are paid a honorarium by the government and most make about Rs 1,000 a month–less than the cost of a bottle of single malt or a branded shirt. Ashas are required to undergo a 23-day training spread across 12 months, but a third of the Ashas in a block in north Bihar were not trained at induction, and the rest received seven days of training and learnt the rest by reading the manual, according to this 2015 study conducted in 187 villages.

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