Pay attention to Asha workers' strike

Accredited Social Health Activists (or Ashas) are women community health workers under the National Health Mission (2005). Ashas are the link between the community and the healthcare infrastructure in rural India, and in disadvantaged communities in urban slums. They have diverse responsibilities that include spreading awareness on diseases, promoting government schemes, delivering basic medicare like first aid, conducting door to door health surveys and assisting other primary healthcare workers. They play a significant role in maternal and child health, particularly in immunisation programmes. They also play a key role in Disease Control Programs like the National Tuberculosis Control Programme, the National Leprosy Eradication Programme and the National Vector Borne Disease Control Programme for malaria, dengue. The work profile of Ashas is diverse, and they play a crucial role in achieving positive health outcomes for the marginalised and disadvantaged communities.

Despite the essential and risky nature of their work, Ashas are not a part of the salaried and formal workforce. They are ‘volunteer’ workers who receive honorariums and performance-based incentives. Most states pay around Rs 2000-4000 monthly, along with incentives upon completion of specific tasks. In the Guidelines on ASHAs, it was suggested that Asha’s work would be flexible, that us, 2-3 hours per day around 4-5 days a week. The rationale behind the honorarium was that it would be an additional source of income for the women, and therefore would not interfere in her routine source of livelihood. However, we now know that it is the only and primary source of income for many of them and that they work for much longer hours.

In the course of their work, they also face many challenges like travelling long distances between villages in remote areas (often paying from their own pockets), and working in the understaffed and sub-par primary health infrastructure ( i.e the sub-centers and Primary Health Centres). They also have to work alone in risky and unsafe work environments of largely male-dominated communities. During the Covid-19 pandemic, Ashas were given the high risk and herculean task of contact tracing and community surveillance. This was to be an additional duty alongside their usual work without additional incentive initially. In the initial months when a lot was not known about Covid-19, Ashas were going door to door to carry out their duty without protection, often using only their dupattas for a face cover. They often worked without protective gear and security, and there were many reported cases of Ashas getting attacked due to the Covid-19 stigma and panic. We do not have a centralised database to identify how many ASHAs were infected, and how many have succumbed to the infection. However, it has been reported that around 100 Ashas had died till August 2020.

In April 2020, a Rs 1000 incentive to perform Covid-19 related duties was announced. However, many Ashas were not even given their honorarium, let alone the incentives. This resulted in protests for their basic rights of livelihood and safety, with the latest protest in November 2020. Ashas have been demanding that they be given the status of a government employee with a minimum wage of Rs 21,000 along with benefits.

Even before Covid-19, Ashas were working for prevention, tracking and ensuring treatment for high-risk diseases like Drug-Resistant Tuberculosis, etc. They have also been the reason behind the success of India’s immunisation program. Our healthcare infrastructure is still poor in many rural areas, and remains out of reach for many even in the urban disadvantaged communities. In such a scenario, Ashas can play a significant role in dispensing information, facilitating accessibility, enabling preventive healthcare and if trained properly, providing primary medical care.

Moreover, we have a shortage of trained healthcare workers in rural areas. By improving the training given to ASHAs, fixing their work hours and effectively utilising them, we can better the quality of preventive and primary health care provided in rural India. Currently, many ASHAs drop out as they are not able to cope with the heavy workload for meagre pay. Formalising the job would incentivise women to apply and help retain them.

(The writer is a public policy student at Takshashila Institution)