Prachi Kadam (33) is one of the frontline soldiers in the fight against Covid-19 as she goes about visiting 40-50 households in Ratnagiri, contract-tracing and identifying patients. For putting her life at risk every day, all that Kadam, an Accredited Social Health Activist (ASHA), receives as incentive is Rs 33.3 a day (Rs 1,000 per month), way less than wages promised in Maharashtra’s minimum wages Act.
Sitting in isolation in her brick hut, Kadam, who is Covid positive after catching the infection during her daily visits, is now in doubt if she would return to her old work. “What if I bring the infection home to kids? Government promised us Rs 1,000 per month as Covid incentive. I got that after a four-month delay. What’s the point of doing so much work for this meagre amount,” says Kadam, as her children, not allowed to go near her, cry from outside.
Kadam is one of 319 ASHAs in 21 districts infected with Covid. After the Covid outbreak and surge in cases in rural areas, the state government had deployed ASHAs on screening duty and refer those symptomatic to quarantine centres. Apart from 71 health programmes for which they receive varying incentives, the government promised Rs 1,000 every month for Covid screening.
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With less than adequate safeguards, these workers have become prone to infection. Two workers have succumbed so far, one each in Pune and Solapur.
ExplainedPaid less than urban counterparts
ASHAs are one of the key components of the National Rural Health Mission and were trained to work as an interface between the community and public health system. The government needs them for 71 health programmes. But for hours of legwork they are paid much less than their urban counterparts. Their demands for better pay have been long-pending, and the pandemic seems to have tested their patience. The decision of the labour commissioner in favour of urban CHVs may pave the way for wage hike for ASHAs.
As cases in rural Maharashtra increases, the Maharashtra Rajya ASHA Karmchari Kruti Samiti wrote to the government on September 10, warning of a strike from October 5-7, if their demand for higher wage and safety gear is not resolved. This will be their second protest post August 7 when ASHAs across India had protested for better remuneration.
The difference in remuneration given to a rural community health worker (CHV) and ones working in urban areas like Mumbai, Navi Mumbai, Ulhasnagar and Thane, where there are municipal corporations, are 10-fold. CHVs in urban areas receive as much as Rs 300 per day compared to Rs 33.3 that an ASHA worker gets. Recently CHVs associated with the Brihanmumbai Municipal Corporation achieved a major victory when the labour commissioner on September 7 directed BMC to pay its 4,000 health workers Rs 15,000 per month as per minimum wages Act instead of the existing Rs 9,000. “There is huge disparity in salaries of rural and urban workforce,” Raju Desle, who works with ASHAs, said.
In Kadam’s case all that she received from the state to protest herself from possible infection were eight cotton masks and a one-litre sanitiser bottle from the public health department in March. Since the last six months, none of these items have been replenished. Kadam has to rely on her own money to buy masks for door-to-door screening in Khed in Ratnagiri district.
Netradeepa Patil, an ASHA in Kolhapur where 33 ASHAs have tested positive, said an ASHA earns Rs 2,000-5,000 per month based on incentives from various health programmes. On July 17, a long-pending demand of ASHAs to get fixed salary, apart from programme-based incentives, was fulfilled. Maharashtra passed a government resolution approving monthly salary of Rs 2,000 in addition to incentives for 70,000 ASHAs and Rs 3,000 for 6,000 block facilitators. That amount, however, has not been released since August.
The state heavily relies on ASHAs for 71 routine health programmes and now Covid screening. Once under isolation, ASHAs cannot participate in any health drive in those 14 days of isolation, thereby losing monetary incentives.
Sneha Adsule (50) in Kolhapur, who was infected with Covid in August, infected eight of her family members. Since then her husband and brother-in-law have lost jobs in a factory in MIDC. “They sit at home. I’m the only earning member. The money government pays us is not enough to run a house,” Adsule said.
ASHAs not only face delayed payments and meagre income, they also face stiff resistance in villages during Covid screening. In Ratnagiri, as Dakshata Jadhav (40) wraps a dupatta around her face and sets off every morning to look for cough, fever and body ache cases, she says when she knocks, most people refuse to inform if they have symptoms, and high-risk contacts remain unwilling to go for testing. “Sometimes they shut the door on my face.” Her only armour is three feet distance from each resident, but sometimes she breaks that distance to counsel them and gain their confidence for testing.
Snehal Mane works in Kotawade village, 15 km away outside Ratnagiri city. She contracted Covid in June. Her monthly income is Rs 2,000-2,500. Her husband Santosh, a farmer, has been hit hard when work slowed during the lockdown. “I’m scared about her and our three children. This infection is everywhere. But we need whatever money we can earn so I let her go for screening,” he says.
Mane says if they had N-95 masks, sanitiser and gloves, they can work more confidently. With care workers battling to help the vulnerable, many like Mane are renewing demands for a rethink of their pay and improved equipment to tackle the crisis.
Prachi Kadam is under home isolation after she tested positive in the first week of September. (Express Photo) 
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