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 healthcare efforts. Accredited Social Health Activists (ASHAs) — considered to be voluntary workers — are paid a honorarium by the government and most make about a measly Rs 1,000 a month. ASHAs are required to undergo a 23-day training spread across 12 months, but a third of them 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 a 2015 study conducted in 187 villages.

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