“We don’t get a monthly salary, the payment is based on tasks, like a task wage. For example, When the baby is born, we visit the home and take care of both the baby and the mother for 42 days, and visit them 7 times and when 42 days are complete, we’re paid a meagre amount of Rs 250,” says Usha (name changed), one of the Accredited Social Health Activist (ASHA) workers from Chaukhutia in Uttarakhand.
Launched in 2005, ASHA workers, are in charge of creating awareness on health and its social determinants and mobilize the community towards local health planning and increased utilization and accountability of the existing health services.
There are over a million ASHA workers in India now.
During the surge of COVID-19, ASHA workers have become the most vulnerable group, who has to risk their lives going door to door to keep a check on the community. one ASHA worker is supposed to cater to 1,500 people in her area but real numbers are usually very high.
“We live in mountainous regions and the village is very vast, we have to go from place to place to do the survey. And there is no schedule, if they call us, we have to follow their commands, we go no matter what”.
According to government guidelines, ASHA will be the first port of call for any health-related demands of deprived sections of the population, especially women and children, who find it difficult to access health services.
During COVID-19, workers are taking surveys to collect the names of the people who came back from the cities to the village.
They collected their names and numbers, names of those who were yet to come back, according to the information given by the families. ASHA workers guided such people to stay at their homes and not to roam unnecessarily.
Usha told Maktoob how difficult it is to work so much with no salary plus take care of the house. She wakes up at 6 am, cuts off the grass, feeds the cow they have in their house, then goes off to farming and works there till 11 am. But when she has to take a pregnant woman for an ultrasound she wakes up much early. The nearest Ultrasound centre in their village is 100 kilometres away.
“When it comes to Ultrasounds, Blood tests and other required consultations, we have to run after them and tell them how important it is, otherwise they don’t care. And they will only call you when either the baby or the pregnant mother is ill”.
Underpaid and overlooked
In many states, ASHA workers have staged protests to increase their wages. In June, more than 68,000 ASHA workers and community health activists in Maharashtra went on a week-long strike till the state agreed to fulfil their demands, which included a salary hike, among other things.
Usha tells Maktoob that the ASHA workers are paid Rs 100 if a pregnant woman has safely completed nine months of her pregnancy. When the vaccine formalities of the child are completed for 12 months to 17 months, then they are paid Rs 75.
“We request the Government a monthly salary, be at Rs 2,000 or Rs 5,000; we demand a monthly salary. We are paid in pieces. The money goes directly to our bank accounts, and when we check out our accounts, someone’s received Rs 50, either Rs 100 or Rs 250, that’s it”.
ASHA workers collect the database of the total number of deaths, births and the number of vaccinations done and then submit a report, from which they receive Rs 1,650 only. It’s not paid to them regularly, plus if there’s information missing for even one day then Rs 100 is deducted from the payment.
Usha says that many works hard but aren’t paid at all.
“We are ready to work as much as the government wants us to but please pay us money, we need a monthly salary. The Anganwadis are monthly salaried employees”.
“We were told that from April we will be paid Rs 1,000 for the work we did during the surge of COVID-19, but now I guess the information has evaporated in the air”.
Same situation in all states
Shazia, the ASHA worker from Jammu, complains how earlier they had only two things to do, that is, to look after pregnant women and their children. ‘But now the burden is too heavy to bear.
“Since Covid-19, our work burden has increased multiple folds. During the first wave, the situation in Kashmir was extremely grave, there were no nurses available, we would get calls to reach particular places where Covid-19 patients were admitted and we have complied new duties too, full duties, day and night,” Shazia told Maktoob.
As of January, 44 ASHAs across India have died battling Covid-19, according to the central government.
“Only married females are a part of ASHA, and in our homes when we go out we have to inform our family about wherever we go, it also gives a call to problems at home. We are repeatedly taunted at our homes for doing so much work with such low incentives. There are constant arguments at home, so many of my friends had to go through divorce because the families weren’t supportive. Some widows are the only breadwinners, so just think can they support their families, their children with such little money?” she added.