The World Has Recognised ASHA Workers, But Has The Indian Govt?

DELHI- Rita Baradhwaj, 42, a community health worker, was on her way to a newborn's house when she got a call from her colleague. "We have won an award from the World Health Organisation," the excited caller told her.

A moment of delight was immediately followed by a question, "Will the government increase our wages now?" Her colleague had no answer.

The call ended and Rita kept walking in the scorching heat to finish her first visit of the day in Sangam Vihar, a densely populated locality in South Delhi.

On May 22, the WHO Director-General Dr Tedros Adhanom Ghebreyesus honored more than 1 million female volunteers in India, the ASHA (Accredited Social Health Activist) workers, for their crucial role in community health of rural India during the COVID-19 pandemic.

"ASHA means hope in Hindi. These health workers provide maternal care & immunization for children against vaccine-preventable diseases; community health care; treatment for hypertension & tuberculosis & core areas of health promotion for nutrition, sanitation & healthy living," the tweet by WHO read.

India's Prime Minister Narendra Modi congratulated them too. "Congratulations to all ASHA workers. They are at the forefront of ensuring a healthy India. Their dedication and determination is admirable," tweeted the Prime Minister.

The irony in the congratulatory messages could not be missed. The global award comes at a time when over a million ASHA workers have been demanding their rights and protesting against the working conditions.

They are struggling to make their ends meet; they do not have job security; their loan applications are not entertained; there's no minimum wage bar. All of this combined with often working in hostile environments.

In Delhi, on average, an ASHA worker earns Rs 3,000 a month. In Maharashtra, a volunteer may earn up to Rs 8,000 a month. ASHAs do not get fixed salaries like government employees. The states set the incentives for ASHAs, it can range from Re 1 for distributing ORS packets, condoms or sanitary napkins to Rs 5,000 for helping a drug-resitant TB patient.

READ | ASHA Workers: WHO Recognition Comes Amid Protest For Higher Wages

BOOM met some ASHA workers in Delhi to understand what the WHO award means to them. 

"My application for a home loan was rejected because my income is below Rs 18,000," said Rita. The 42-year-old health worker who lives in rented accommodation with three family members has been dreaming of a house of her own. But without being eligible for loans, that dream of hers remains that.

For the last three years, the ASHA workers have staged a number of protests demanding a hike in salaries or minimum wages. In 2020, Delhi police registered FIR against 100 workers for staging the protest at Delhi's Jantar Mantar.

Last year, Delhi's ASHA workers wrote to chief minister Arvind Kejriwal demanding Rs 15,000 a month as a fixed salary or to pay minimum wage. The minimum wage in Delhi currently varies between Rs 15,000 and Rs - 20,976, depending on skill and educational qualification. But ASHA workers do not get minimum wage as they are categorised as volunteers.

Days after the nationwide lockdown was imposed by the central government in April 2020, the government announced an additional Rs 1,000 to be given to every ASHA worker for Covid-related work. These payments were given for only one year even as the pandemic continued.

"Appreciation won't fetch ration at home"

Rita became an ASHA worker in 2008, three years after it was inducted into the health department by the Manmohan Singh government as a part of India's National Rural Health Mission (NRHM).

With limited medical education and training, these women have filled the health care gap in rural India where people were struggling with India's fragile, almost non-existent healthcare services.

"During Covid-19 we put our lives at risk. We were frontline warriors, we were the ones who provided basic health facilities to the people. We used to go door to door in our localities, motivating people for vaccinations and making them aware about the deadly pandemic," Rita recalled.

For Rita, the appreciation by the Prime Minister or the WHO does not mean much.

"Appreciation won't fetch ration to our homes. I will be given the same wages," she told BOOM.

She said that while ASHAs are 'underpaid', the incentives remain unpaid for months as well. 

"We were abused during the pandemic"

Shweta Raj, general secretary of Dilli ASHA Kamgar Union told BOOM that ASHA has played a pivotal role in strengthening the healthcare system of India. "They have connected people to healthcare units and especially played an important role during the deadly pandemic. There were huge crises in healthcare facilities during the pandemic in India and they worked hard to overcome that crisis," she explained.

During the devastating pandemic, which resulted in thousands of deaths in India, these frontline workers with limited resources available around, saved the lives of hundreds of thousands of coronavirus patients by helping in the early detection of cases, creating public awareness about the myths about the virus. They were instrumental in countering vaccine hesitancy and helping India carry out one of the largest vaccination drives in the world.

But even as they stepped up, they faced abuse in that moment of crisis.

"During the pandemic, we faced a lot of abuses and physical assaults from people when we tried to motivate them to get vaccinated," said Poonam who works at Mehrauli Public Health Center. "We received unwanted calls from strangers during late hours after we shared our contact numbers for a health emergency."

Even with more than one billion of India's population being vaccinated, these workers say that their workload has not slowed down. It stretches for more than 12 hours a day and sometimes even on weekends.

READ | Why The COVID-19 Pandemic Forced More Women Out of Jobs

Shweta said that many ASHA workers died while performing their duties after they got exposed to the coronavirus. One study of three Indian states by public health researchers at Oxfam in 2020 found that at least 25 percent of the health workers received no masks, and only 62 percent received gloves.

"Our family members used to maintain distance with us," Poonam recalled. She said that their neighbors would blame them for spreading the virus. "How will the award make a difference?" she asked.

In a cynical tone, Poonam said that neither the working conditions for ASHA workers will change nor will their wages be hiked. "If the government is hyping on WHO's award, why don't they accept our demands?" she asked.

"The world has recognised our efforts to bring a change in India's public health services but now it's time to change our lives. If PM Modi is sincere with his words, then we expect him to do something for us. He should announce a hike in our wages and give us job security," said Poonam.

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