Overworked and underpaid: There's no hope for ASHA workers

These women provide information to people in rural areas about health, sanitation and nutrition; conduct ante-natal and post-natal check-ups; assist women during their deliveries, deliver polio vaccines and conduct health surveys.

This pink army -- as it's popularly known -- is the backbone of the primary healthcare in our 600,000 villages, building a bridge between the poor and the inadequate public health system. For many Indian villages where medical facilities aren't accessible easily, 860,000 ASHAs working across the country -- according to the Ministry of Health and Family Welfare, 2014 -- are the only ray of hope.

However, these backbone of healthcare in rural India is not a happy lot. Dismally low salaries, erratic work schedule and long working hours are just some of the issues that they face. They often have to toil from morning to night, have to do the night shifts, get no weekly offs and yet are paid Rs 2,000 per month.

One of the core strategies suggested under the National Rural Health Mission (NRHM), launched in 2005, was the creation of ASHA. According to the NRHM, these ASHAs were instrumental in bringing down the infant mortality rate from over 50 deaths per 1,000 live births in 2005 -- when ASHA was launched -- to 34 deaths in 2016.

They all feel they definitely deserve a lot more than they get.

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Suman Shukla, an ASHA, works in Harchandpur block in Raebareli. She works from dawn to dusk, and, at times, reaches back home really late. We caught up with her when she was visiting Gunavar village in Harchandpur block to pay a visit to a six-month pregnant lady. The entire village was in awe of Suman.

"The health department would crumble in the absence of ASHA workers; they are the departments' backbone. An ASHA worker visits villages and spreads awareness about family planning. When a lady is expecting, we have to administer two injections to them. After the kid is born, we have to look after them. We have to pay them seven visits in a span of 42 days," said Suman.

In 2005, Janani Suraksha Yojana -- a safe motherhood intervention under the National Health Mission -- identified ASHA as an effective link between the government and pregnant women. They are between the ages of 24 and 45, with a minimum level of eight years of formal education. They are also given regular and periodic training.

These ASHA workers get to sleep for just five-six hours. Every single day, they finish their household tasks and visit villages. They have to coordinate with those who deal with malnutrition, vaccinations and hygiene. They have to stay back at hospitals for many days and walk long distances.

"It feels at times that we are akin to Army soldiers. We have to be on our toes all the time, we don't have fixed timings or schedule. We get distresses calls at any time of the day. We have to go, and we go. Despite putting in so many efforts we feel we don't get enough credit," added Suman.

Each ASHA works on a volunteer basis and gets reimbursed on the basis of tasks that they perform. For instance, for each woman who delivers a child in a hospital, the ASHA is reimbursed Rs 600, the mother who delivers at a hospital is reimbursed Rs 1,400. There are also incentives for getting children timely and complete immunization.

As per the guidelines framed when the workforce of ASHA was conceptualised under the NRHM, a total of 43 different functions are assigned to them along with specific remuneration for each of them. The maximum they can get for an activity is Rs 5,000 for administering medicines to drug-resistant tuberculosis patients to just Re 1 for distributing an ORS (oral rehydration solution) packet. What they get is just the money for a particular activity, but it does not cover travelling and other costs.

Aarti Singh, block programme manager, Harchandpur block, said: "We work all day long, but we don't get paid enough. The officials working in the health department have fixed timings. Some earn Rs 40-50,000 and some even earn up to Rs 60,000. We get Rs 1,000-2,000. That's way too less. We deserve at least Rs 10-15,000. The government makes us slog and pays us very little."

"Some of us protested a few days back. We want the government to recognise us as health care workers. The ASHAs are part-timers as of now. If we are recognised as workers, there would be a hope that we would get our salaries by 3^rd or 4^th of every month. We should get a salary for Rs 10,000, but if they could give us Rs 5,000 that would also do," she added.

This year, on February 1, finance minister Piyush Goyal, in his Budget speech, announced increasing honorarium of ASHA workers by 50% -- a repeat of what the Prime Minister had said in September 2018. So, the news did not enthuse them enough and they are still waiting for their dues.

"The ASHAs follow through the vaccination programme for nine months but get a measly Rs 150. This is exactly what we are trying to tell the government. We are ladies, we take so many risks on a daily basis, our self-respect is at stake, the government should do something for us," said Suman.

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