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Wednesday, December 01, 2021

ASHA workers: The backbone of India’s primary health care are demanding salary for their work

#GenderAnd Nation: Underpaid and undervalued, the system looks at ASHA workers as “voluntary, social workers” who should not demand wages

Written by Soumya Mathew | New Delhi |
Updated: January 4, 2018 12:01:10 pm

It’s a little past noon. At Sarita Vihar’s Madanpur Khadar village, new mothers and grandmothers are bringing babies and toddlers wrapped in blankets to the municipal dispensary. Sonu (42) has been standing at the entrance waiting for them. She has a phone in her hand, that hasn’t stopped ringing all morning. As they come in, Sonu directs them to Dr Ajeet Kaur, one of the head doctors at the dispensary. Her attention is diverted by the ringing phone. Sonu reminds the woman at the other end, Puja, that her niece is due to be vaccinated.

Sonu is an Accredited Social Health Acitivist (ASHA), enrolled under the National Rural Health Mission started by the Ministry of Health and Welfare in 2005. She, along with 11 other ASHA workers were taken in after three months of a basic training. Earlier this year, Sonu as the Executive President of Delhi Asha Workers’ Association took part in the ‘Mahapadav’, a 3-day protest that saw ASHA workers among others from across the country come together to ask for minimum wages from the Central government as well as other benefits like pension and gratuity.

ASHA workers=health activists=social workers

The National Health Mission website describes ASHA workers as “health activists”. These workers are normally chosen from within the community and are expected to work in areas they live in. The list of duties they are expected to perform is long–from “providing information on nutrition, basic sanitation & hygienic practices, healthy living and working conditions”, the ASHA workers also counsel women on birth preparedness, importance of safe delivery, breast-feeding and complementary feeding. Immunisation, contraception and prevention of Reproductive Tract Infection/Sexually Transmitted Infections (RTIs/STIs) are among other tasks ASHA workers are expected to counsel and work on. They do this, in addition to conducting regular surveys of population—all for an outcome-based income of about Rs 1,500 per month. There are incentives, for instance for every institutional delivery, Sonu would make Rs. 200-250 over a span of nine months. This amount is staggered and not a surety either.
“How am I supposed to look after my family with such little money? We do so much work without complaining and the government does not even want to acknowledge us by giving us respectable wages,” says Sonu.

ASHA workers demand salary, Delhi ASHA workers, Sarita Vihar ASHA workers, #GenderAnd

Rs 250 in nine months for an institutional delivery

Just as Sonu is waiting for more women to come to the dispensary, she is joined by Saroj, an ASHA worker at the Churia Mohalla. The dismal pay is all they talk about these days. “We get just Rs. 250 in total for registering a pregnancy, taking the mother for regular check-ups and for registering the birth of the child,” Saroj says. “Imagine, this is what we get paid for nine months of work. And in case the woman doesn’t inform us that she is expecting within three months of conception, the doctors at the clinic deduct Rs 50,” she adds.

In August this year, Delhi ASHA workers approached the government, for an increase in their honorarium to Rs 7,500 per month. Sonu and many ASHA workers tout the example of Telengana where ASHA workers receive five times their pay, they claim (Telangana State website though says Chief Minister K Chandrasekhar Rao increased their basic income to Rs 6,000 in May, 2017). While Delhi Chief Minister Arvind Kejriwal refused to concede to the demands on account of budgetary limitations, he assured them of a gradual increase, starting with doubling their honorarium amount and incentives from October, 2017. “Consider this our Diwali gift, they had told us at the time. But no, we did not get AAP’s ‘Diwali gift”, Sonu says.

In Kerala, ASHA workers reportedly get Rs 2,000, in Orissa, Rs 1819 and Rs 1000 in Karnataka. Krishnaveni Sharma, the general secretary of Kerala’s ASHA Workers’ Congress, explains the government has allocated Rs 1,500 as basic pay for the ASHA workers but adds, “any variation in the amount they receive is because of the additions made by respective state governments, which is not uniform in spite of the tedious labour involved.”

Dr. RS Mohil, senior General Surgeon at Safdarjung hospital, where a majority of ASHA workers in Delhi get trained calls ASHA workers, “very important contributors in the first level of health care delivery”. He adds that hiking their remuneration should be considered to sustain interest but points to how ASHA work is thought to be “part-time activity meant to boost one’s income from their main profession.”

The ASHA workers at Madanpur Khadar encounter this perception often. Sonu recalls how their co-ordinator and a health officer appointed with the Delhi State Health Services, who takes care of their incentives related payment once likened them to social workers, doing a service to society. “You shouldn’t be expecting wages in the first place,” she is believed to have told Sonu in one of the discussions.

Speaking to the Indianexpress.com Tahira Hasan, President of All India Progressive Women’s Association (AIPWA) responded to this perception. “They are skilled labour working tirelessly and don’t even get an off-day in a week. Referring to their contribution to public health care as social work is just bizarre,” she said.

While underling that the demand for better pay was justified many officials that Indianexpress.com spoke to say said that acknowledging community workers as government employees would open a pandora’s box. Further, this would contradict with the very nature of the ASHA scheme that looks at them as volunteers and community workers.

Dr A K Jain, consultant gynaecologist and obstetrician at Safdarjung Hospital agrees with Dr. Mohil on ASHA workers and their contribution to public health care, but adds “asking for Rs 18,000 is not justified. If the workers are asking for that kind of money with just the few months of training they received, their claims and demands must be carefully scrutinised, he said. For many ASHA workers, like Sonu, this is at the heart of their fight, a complete lack of understanding of how gruelling their job really is.

Urmila Sati, a 38-year-old ASHA worker who also works in the same area remembers how till a few years ago they were treated with indifference and anger. “When I started in 2008, elderly women would not let us meet their daughters-in-law. They feared we would ‘brainwash’ them,” she said. “Given how they were not used to seeing women work outside homes, they’d look down upon us,” she added. Gradually workers like Urmila and Sonu claim they forged bonds based on trust and friendship with the women in the village. It was the only way to talk about health problems, safe sex, family planning—all sensitive matters that are talked only in hushed tones, a fact completely ignored in all this conversation about wages.

Still at the dispensary, Sonu is squinting at her phone scrolling through her contacts. Just then, Pooja, the young mother Sonu had been speaking to earlier, arrives. As Sonu takes the baby inside to give her the vaccine, Pooja says she has to rush back because her own toddler was asleep. “I would have completely forgotten about the vaccination camp had Didi not reminded me,” Pooja says referring to Sonu. The child is getting a BCG vaccine and it is Sonu’s job, among other things to make sure every child in her area of 2300 people is vaccinated.

“We do all the work, and doctors take credit,” Sonu rues as she hands the baby back to Puja.

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