ASHA workers and their neglected state

ASHA workers and their neglected state

ASHA workers and their neglected state – Today Current Affairs

Over 10 lakh rural and urban “ASHA” (accredited social health activists) workers whose role in the pandemic has been acknowledged from all quarters, locally and internationally, continue to be sidelined. Their demand for the recognition of their work in their role as community health workers is deliberately pushed aside by a state system that appears to be thriving on the free labour of women workers, be it in the Integrated Child Development Scheme (ICDS), the Midday Meal Scheme or the National Health Mission. It is therefore not surprising that ASHA workers are now on a warpath, continuously organizing several protest programmes in different states even as the pandemic rages around them, because they continue to face an indifferent administration and a callous government that does not care to remunerate them properly for their labour.

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The pandemic is far from over, and nobody can hazard a guess about when it will eventually phase out. The Epidemic Diseases Act, 1897 and the Disaster Management Act, 2005 continue to be in operation and are being invoked to justify all kinds of government decisions as well as restrict public behavior. Yet, in September 2021, the government in all its wisdom chose to withdraw the meager COVID-19 risk allowance of `1,000 that was announced as a compensation for ASHA workers.1 It was restored, albeit for another six months (up to March 2022) only when they protested about it on Human Rights Day on 10 December 2021.2

Case of Neglect : The Hindu Analysis

It was stated in Parliament that till January 2021, 44 ASHA workers died due to the virus (Rajya Sabha 2021); however, the numbers could be higher. In September 2020, of the 155 settled COVID-19 claims for the `50 lakh compensation on account of death announced by the government, only 14 were of ASHA workers (Rajya Sabha 2020). But even those who simply needed medical attention got none, like the case in Bihar, where many ASHA workers who tested COVID-19 positive got no treatment from the state government’s public health services (Madhav and Gurmat 2021). Worse, many have reported that they did not even get the mandatory protective equipment of masks and sanitisers for doing their duty or even if they did that it was a one-off gesture—this while the same authorities imposed stringent fines for lapses in respect to COVID-19 safety protocols.

In many places the trade unions of ASHA workers have had to step in to demand priority vaccinations for them, even though they are a critical link in the entire pandemic control strategy of the governments at both the central and state levels. At best, since 2018 they are reimbursed for any premium that is deducted from their bank accounts for the Pradhan Mantri Jeevan Jyoti Bima Yojana (death benefit of `2 lakh) and the Pradhan Mantri Suraksha Bima Yojana (accidental death/disability benefit of up to `2 lakh).

Full-time Disguised as ‘Voluntary’ : The Hindu Analysis

The answer obviously lies in the gendered nature of the work done by ASHA workers coupled with the tendency of the neo-liberal state to reduce its expenditure, especially social sector spending, as we have witnessed in our country for the last several years. The ASHA workers are essentially a part of the care work sector, providing a crucial link between the community and the public health system in both rural and urban areas.

The guidelines issued when the National Rural Health Mission (NRHM) was first set up in 2005 describe the role and responsibility of an ASHA worker—the ASHA will be a health activist in the community who will create awareness on health and its social determinants and mobilize the community towards local health planning and increased utilization and accountability of the existing health services; creating awareness, counseling women and escorting them to the nearest health facility for treatment; providing primary medical care and first aid and acting as a depot for a basic drug kit; mobilizing the community and facilitating their access to local health and related services; providing information on births, deaths and unusual diseases; and, helping to develop a village-based comprehensive health plan are the primary responsibilities laid out for them in the document.

There are some fundamentally con­tentious issues in these arrangements that are now emerging with greater severity with the expansion of the scope and outreach of the NHM across the country. Counseling, creating awareness and even facilitating access to local health facilities may be tasks that could be done by any citizen helping their fellow citizens and could be counted as “voluntary.” But the actual task list and the coordination expected with other health staff is quite specific and requires the ASHA worker to not just devote a considerable amount of time, but also adhere to a particular timetable that goes far beyond the framework of voluntary services.

Continued Precarity : The Hindu Analysis

Class, caste (a majority are from underprivileged caste backgrounds) and patriarchy combine to produce a unique hierarchy where ASHA workers are at the bottom of the heap. It is not just that they are not paid or poorly paid for their 24×7 services. They are not even extended common courtesy such as a place to sit in the PHC or local hospital; they are often asked to do menial tasks, face physical and mental abuse and are at times forced to part with their meager earnings with corrupt health staff members. The lack of status and indignities they face are a direct product of the “nature” of their work and the fact that they are “poor women” workers with few options. 

Working struggle : The Hindu analysis

It is therefore to the credit of the ASHA workers, that despite these systemic odds, they have launched a determined struggle for recognition of their work as productive labour worthy of proper wages and status as workers. The last few years have seen struggles of ASHA workers to draw attention to the sheer neglect and discrimination faced by them, despite their stellar role in improving the delivery of health services to some of the poorest and deprived sections of our society. However, the Congress-led United Progressive Alliance-I government reneged on its promise made in 2009 to pay a fixed honorarium (Nirula 2015). Several ground level protest actions combined with the initiative of the central trade unions resulted in the tripartite 45th Indian Labour Conference convened in May 2013 to recommend that workers in different central and state government schemes, including ASHA workers, The Hindu Analysis.

This positive direction is sought to be turned around by the labour codes being pushed by the Bharatiya Janata Party (BJP) government that do not even mention them as a category of employees; something that requires consideration for the application of protective labour legislation such as minimum wages and social security.

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They are organizing into trade unions and pushing demands for minimum wages, social security, and dignity. The inherent insecurity of their job and its precarious nature poses challenges to organizing, as also their lack of resources due to their poor and marginalized socio-economic background. Efforts to mobilise and organise are met with threats of privatisation or dismissal. But the “worker consciousness” that is being built through the process of organising has led to an understanding that it is only the recognition of their work as productive care “work” and the status of workers that will lead to an improvement in their conditions.

The ASHA workers’ unions are today one of the most militant organisations of women and form a substantial part of the trade union movement in the country. They have supported the farmers’ struggle and have supported the demand for the withdrawal of the intolerable labour codes brought by the BJP government. Some of their major actions have been two national strikes, in August 2020 and September 2021 (along with other scheme workers5), and consistent participation from all states in the general strike calls of the central trade unions. In another national strike scheduled for 28–29 March 2022, they have called for a permanency of their mission and a universal legislation guaranteeing the right to healthcare, a minimum wage of `21,000, pension of `10,000 per month, an additional COVID-19 risk allowance of `10,000 per month, and continued insurance coverage (All India Coordination Committee of ASHA Workers [CITU] 2021). Even in this third wave of COVID-19 they are determined to bring their struggle to the streets. Nobody can stop their march forward.


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