The Covid-19 pandemic highlighted the crucial role that community healthcare workers play in India's rural and semi-rural regions. Working for long hours, backed by a performance-based pay system, they bolstered the health care system and helped increase the rate of quarantines and vaccinations. Over one million Accredited Social Health Activists (ASHA) workers and other female frontline health workers conducted field surveys related to contact tracing, door-to-door vaccine awareness, and managing quarantine centres. Whilst an ASHA worker was putting her life at constant risk of the pandemic, she was reimbursed with an amount of ₹1000 per month (not more than $14USD a month).
INDEPENDENCE FROM INJUSTICES
Waking from the deadliest second wave of Covid-19 in 2021, India commemorated its 75th Independence Year in 2022. The first quarter witnessed elections in five major states: Uttar Pradesh (UP), Uttarakhand, Punjab, Manipur, and Goa. ASHA employees were also tasked to assist in maintaining hygiene and sanitation at polling booths in the country's most populous state.
Meanwhile in Ludhiana, on 21 February 2022, many ASHAs voiced against harassment outside the office of deputy commissioner-cum-district election officer Varinder Sharma. The protesting workers claimed that they were assigned to distribute masks, gloves, and other items at the polling station, and were told to stay until the bio-medical waste was collected. This further emphasises the significant hindrance these helpers face on the daily basis of their underpaid and uninsured jobs. Meanwhile, the President of an association of ASHA workers, Balbir Kaur, shed light on the injustices that these undermined workers had to face; “we were not even given our wages of ₹500, meant for every worker deputed on election duty. Many other workers could not cast their vote as they were deputed away from their respective constituency and had to leave their houses at 5 am. The lives of the workers were also put at risk … we had to return to our houses late at night in private transport”. A subsequent march was organised at Jantar Mantar, in New Dehli, by over 1000 ASHA, Anganwadi, and Mid-Day Meal workers to lodge for a much-awaited increase in budget allocation for basic services schemes, minimum wages, and pensions to frontline community workers. Unfortunately, the demands were stuck between the central government shifting responsibility onto state governments. The General Secretary of Haryana’s ASHA Workers' Union, Ms Surekha, also shed light on major human rights violations posed by the recent Haryana government’s actions.
A DEMORALISED LABOUR FORCE
“If there are two pregnant women who I help with deliveries, I will have to share that with another ASHA worker… which means getting paid only for one,” said Vaghela, a 42-year-old ASHA worker in a remote village about 150km from Ahmedabad, in Gujarat. This accentuates how performance-based incentive gives rise to immoral work behaviour of ASHAs. While these workers continue to get exploited in terms of heavy labour and minimal social security, thousands of such workers continue to serve their communities. One worker from Mangaluru, Sujatha Shetty, carried out her duties by working 15 hours a day combating outbreaks in her village. For 12 years, Sujatha has been devoting her life to the welfare of her locals, calling it her bhagya (fate) to serve people, recalling how her job leaves no room for her own family’s care.
THE NEEDED PILLARS FOR A HEALTHY INDIA
As “essential” workers, ASHAs need to have insurance, fixed wages, unemployment benefits, and the retirement that other Indian government employees enjoy. The lack of security and equipment at work for these “honourary volunteers” was widely evident during Covid-19. Despite these frontline health workers being at the forefront of the pandemic response, the 2022-23 Budget failed to address the above allocations to strengthen their social security. Ultimately, negligence over fixed payments to these workers rusts their hard work as no less than “free labour”. Providing fixed honorariums of ₹10000 to ₹18000 for ASHA workers and at least ₹24000 for ASHA facilitators should be effectively implemented. The economic and social threats faced by these foot-soldiers are agitating and call for immediate action on all of the above-aforementioned problem areas.
Khushi is an Economics major from Jesus and Mary College, University of Delhi. With an affinity for writing, her core interests lie in research, economic policy, and entrepreneurship aimed at sustainability.