Rural COVID-19 warriors up in arms; fixed wage less than Rs 100 a day

A female ASHA (accredited social health activist) volunteer carrying portable vaccine case (Source: ShutterStock)

At the core of the battle against COVID-19 in rural areas is an army of barefoot women who earn less than Rs 100 a day as fixed wage, but end up shelling out up to Rs 20 from their pockets to photocopy documents for record-keeping and to visit distant public health centres for bi-monthly meetings.

These overworked, underpaid women are Accredited Social Health Activists (ASHA) who are the backbone of healthcare in remote hamlets across the length and breadth of the hinterland.

They are vulnerable to infection as they don’t have protective gear, and their stellar work as frontline warriors combating COVID-19 at the grassroots has been largely ignored.

They are now beginning to stand up for their rights.

These women workers were initially roped in under the central National Health Mission plan for working as an interface between the community and the public health system. An ASHA worker was seen as the first port of call for health-related demands of deprived sections of the population, especially women and children, who otherwise find it difficult to access health services on their own.

Role of ASHA workers 

ASHA workers are local health activists who inform the community about nutrition, sanitation and hygiene and inform people about existing health services. They also counsel pregnant women on birth preparedness, the importance of safe delivery, breastfeeding, immunisation, contraception and prevention of common infections.

The pandemic has heaped more responsibilities on them. They track cases, urge household to get tested if a member has any symptom, and even try to persuade naysayers to get vaccinated.

In all of these tasks, the ASHA workers are left to protect themselves, with no PPE kits or gloves being provided and only rarely are they even given sanitisers.

Why are they unhappy?

Now, ASHAs across the country are up in arms, seeking better wages and improved working conditions. Their representative bodies in several states have either ensured that members cease work or are in active negotiations with respective state governments over wage revision. In Maharashtra, an estimated 70,000 ASHAs are on strike; discontent is brewing elsewhere too.

Vijaya Shivprasad Mantri, an ASHA supervisor in Jaulka village of Malegaon district of Maharashtra, told Moneycontrol that last fiscal, the state government had agreed to pay Rs 2,000 to ASHA workers, over and above the Rs 1,500 they were getting from the central government as an incentive for specific tasks.

But this order has not been renewed for 2021-22. This means, till March this year, ASHA workers in Maharashtra were getting just Rs 2,000 as fixed income but even that has stopped. Representatives of ASHAs are now negotiating a steep increase in fixed pay for workers with the state health minister.

After the pandemic hit India, ASHAs have been conducting contact tracing for infections in their respective areas and monitoring patients.

In some districts of Rajasthan, where the state government has started door-to-door vaccination programmes, ASHA workers are accompanying the vaccination teams to each household in their respective areas of work.

Jaipur Grameen is one such district where ASHA workers have been collecting information on age-wise eligibility before accompanying teams for door-to-door vaccination drives.

In the Bhilwara district of Rajasthan, 1,137 ASHA workers are registered. Prabas Choudhury, Coordinator for ASHA and Aaganwadi workers, said ASHAs report to two separate departments: ICDS (for malnutrition or the POSHAN Abhiyan) and health. The state government pays slightly more than Maharashtra – Rs 2700 – as fixed pay to these workers (over and above the Rs 1500 Central incentive) but this amount is just about a third of the minimum wage prescribed by the state government.

What are their demands?

“ASHA workers are demanding that they be counted as government employees – right now they are merely paid an honorarium and have no regular jobs. Secondly, they want fixed monthly income of Rs 18,000. All over the country, COVID-19 warriors were feted but even here, ASHA workers were not recognised for their fight against the virus,” Choudhury said.

They also want to report to a single government department instead of having two reporting lines. The ASHAs are also seeking health insurance which has been provided to other frontline workers.

ASHAs were initially envisaged as part-time workers doing their job for 3-4 hours for some days a week. But the workload has doubled without extra compensation.

Durgabai Chandrashekhar, an ASHA worker in Malegaon, said she has to be available almost 24x7 since phone calls can come anytime. She looks after 300 households, keeping meticulous records of blood pressure, inoculation of children, needs of pregnant and lactating mothers and now, whether anyone in her area has any COVID-19 symptoms.

She said a few people had been persuaded to get the COVID-19 vaccine but her work has increased manifold since the pandemic started because not everyone is easily convinced. “We have demanded Rs 18,000 fixed salary per month but the government should at least provide Rs 10,000. It is a tough job.”