The ASHA workers conducting a door-to-door survey Credit: EastMojo Image

The Word ‘Asha’ means ‘hope’, and in India’s battle against COVID-19, that’s what the Accredited Social Health Activists have symbolized.

Day or night, through flood and drought, these workers lead from the front, ensuring the community is aware and ready to fight the virus. However, currently, ASHA workers are undergoing hopelessness and misery.

“This is extremely urgent. Can you give me a lift till the bus stand?”, said Dulumoni Sahu, an ASHA worker from Kachariline, a small village near Dergaon, Golaghat district. She was giving an interview to EastMojo, when she got a phone call from a person whose wife had a miscarriage. The family was panicking and feared for the life of the mother.

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Sahu had to rush to Jorhat Medical College & Hospital. Before she got the bus to Jorhat, she added, “If the case would have been opposite and a baby would have been born healthy, the parents would have surely gifted me something; This is when I become happy. It isn’t easy to run my family with the little money that we get. The fare to Jorhat is Rs 80, but we do not get any travelling allowance. Many ASHA workers do not know that such allowances exist.”

Dulumoni Sahu is not alone in her struggle; over 33,000 ASHA workers from the state render relentless service to the community, ready to serve 24×7.

A village hospital in Golaghat District

“We received Rs 1000 as an incentive per month for working during COVID-19. However, I do not know if the government thinks that corona is gone. Now, our COVID-19 incentive is gone too. When people were in lockdown inside their homes, our duties did not end, but almost doubled. We used to get calls to maintain patient database, take care of everyone in-home quarantine, conduct door to door surveys, explain the importance of handwashing, wearing a mask or using hand sanitiser. All that we used to get as COVID-19 incentive could never really add to our savings,” said Parboti an ASHA worker from Tekelaline.

Parboti, like any other ASHA worker, gets Rs 2000-3000 per month. She struggles to make ends meet. With the pandemic there are extra costs of carrying a hand sanitiser and a mask.

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Despite being health workers and hence, bound to expose themselves to getting infected by the virus, they rarely get masks or sanitizers for free. However, Parboti is afraid of raising these issues; she fears that her supervisors will taunt her, saying that it is only she who has problems every time.

The Ministry of Health and Family Welfare in 2005, instituted ‘Community Health Workers’ namely Accredited Social Health Activist (ASHA) for promoting universal immunization, community counselling, referral and escort services for Reproductive and Child Health (RCH) and other healthcare initiatives under NRHM, now NHM. With the COVID-19 pandemic, they were pushed to the frontline collecting data, monitoring people in quarantine and spreading awareness.

Health workers at the sub divisional civil hospital at Bajali in Barpeta district

“Wherever we see a group of women talking, we feel like reaching out, making them aware of their health. Before COVID-19, we used to actively encourage women to take part in different awareness drives by the National Health Mission. Some of our sisters come from char chapari areas, affected by floods every year. But they never ask for an off-day, because they love their job and if ASHA stays inside, who will work outside?” she added.

The volunteers are always active. They are responsible for health awareness in their communities. Therefore during the epidemic, ASHAs played an important role. An ASHA added, “We do not know which is worse – being underpaid or getting directly exposed to any disease. I think both are equally dangerous.”

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ASHA workers, at the community level, work closely with auxiliary nurse midwife (ANM) and the Anganwadi worker (AWW). However, they get almost one-third of the salary of an ANM. Their primary concern is that they are not even addressed as an employee to have fixed remuneration or employee benefits.

Although the Eleventh Parliamentary Committee Report on Empowerment of Women had recommended a fixed remuneration for ASHA Workers almost a decade ago in 2010, but they see it or receive any employee benefits. Many ASHA workers are bound to make out-of-pocket expenses for even stationery and other related purchases.

During the initial period, ASHA workers were primarily involved in antenatal and post-natal care, immunization etc. But with time, their responsibilities have increased to add community awareness on issues like lifestyle changes in several non-communicable diseases, distributing medicines, managing diseases like dengue, chikungunya, malaria, filaria and so on. ASHA today are the first responders of the Indian Healthcare system.

Poster released by National Health Mission saluting the Covid-19 Warriors

Ranjana Nirula, the convener of Centre of Indian Trade Union (CITU), said that they have been demanding an additional incentive of Rs 25,000 per month for all the contract and scheme workers engaged in COVID-19 duty. They demand immediate payment of all the pending dues of ASHA workers working throughout the country.

The government launched ASHA Kiran Scheme in 2010 to provide Rs 25,000 annually in case of illness of ASHA Workers. Even an insurance scheme of Rs one lakh was announced in case of their death. But, as Bijan Das, a member from CITU Assam said, most of these schemes are yet to materialise.

Interacting with social media users in recent Sunday Samvad, Health Minister Dr Harshvardhan said regarding ASHA workers and other frontline health brigades that they shall get the topmost priority in COVID-19 immunisation. The ASHA workers at the same time anticipate a better standard of life, erasing of the stigmas associated and proper representation as a health worker so that they can avail the employee benefits by the government.

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