Chandigarh: Demanding a “respectable” salary and better work conditions, over 20,000 Accredited Social Health Activists, or ASHAs — grassroots workers responsible for connecting marginalised communities with the healthcare system — have been on strike in Haryana for over a month.
The ASHAs currently get a monthly honorarium of Rs 4,000, which, along with some incentives, adds up to Rs 7,000-Rs 9,000 (depending on the amount of incentive-based work they get in a month).
“We are demanding a respectable salary, Rs 26,000 per month, regularisation of our services with all benefits of pension, gratuity and provident fund,” said Surekha (who only uses her first name), president of ASHA Workers Union, Haryana, which is affiliated to the Centre for Indian Trade Unions (CITU) and Sarv Karamchari Sangh, Haryana.
“Quality healthcare facilities for all at reasonable rates. Filling of the vacant posts of doctors and nurses at the district and primary health centre (PHC) levels, and setting up ultrasound and X-ray machines with the posting of radiographers at PHC level,” she added.
Sunita Rani, general secretary of the ASHA Workers Union, told ThePrint Saturday that, until February 2018, the ASHA workers were getting just Rs 1,000 per month as honorarium.
“After our prolonged struggle, it was increased to Rs 4,000 per month. The government has not given any hike since 2018,” she said. “Our members have been on strike since 8 August, but the government has not even bothered to talk to us. When our members decided to hold a protest at Chandigarh on 28 August, when the monsoon session of the state assembly was in progress, the state government used oppressive measures to stop us from going to Chandigarh,” she said.
As part of the strike, the workers are holding protests in different districts.
One of the main grievances the ASHAs have is that their brief is being widened without any increase in compensation.
Initially, Rani said, they were given 40 basic duties in healthcare aimed at maternal and neonatal care. But, she added, the government has been adding several new duties, “including an online survey for non-communicable diseases like cancer, diabetes, hypertension, obesity etc, completing KYC (know your customer) documentation for Ayushman Bharat cards, a survey of tuberculosis patients and drug addicts etc”.
“When we demand a respectable salary like other government employees, we are told that we are voluntary workers, but when we refuse to take the additional duties, we are threatened that we will be removed from service,” she added. “The government adopts double standards. It is different when they have to decide our wages, and different when they have to decide our job conditions,” she said.
Reached for comment, Haryana Health Minister Anil Vij said he has called a meeting of the representatives of ASHA workers on 13 September. “All officers of the health department will be present during that meeting. We will listen to their grievances,” said Vij.
Confirming the communication, Surekha said that although the meeting has been called to discuss health programmes, the letter from the minister also directs the officers to discuss the issues of ASHA workers and submit a proposal to him.
“Going by the contents of the letter, the officers concerned should have discussed our issues with us, but no one has contacted us so far,” she added, speaking to ThePrint Saturday. “As we are on strike, we wouldn’t have attended a meeting called for discussing health programmes. Still, since the minister has taken the initiative, we will definitely go to attend the meeting,” she added.
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Who are ASHA workers?
The scheme to employ ASHAs as community health workers was started by the government at the national level in 2005, under the National Rural Health Mission (NRHM) — since renamed the National Health Mission (NHM).
“One of the key components of the National Rural Health Mission is to provide every village in the country with a trained female community health activist, ASHA or Accredited Social Health Activist,” the NHM website says. “Selected from the village itself and accountable to it, the ASHA will be trained to work as an interface between the community and the public health system.”
The website says the ASHAs are at the base of the NHM pyramid, and have been envisaged as “change agents” in health-sector reform.
They are expected to play a vital role in improving health indicators in the grassroots, especially infant mortality rate (IMR) and maternal mortality rate (MMR).
According to the Haryana NHM website, the current IMR of Haryana is 28 per 1,000 live births (data from the Sample Registration System Statistical Report 2020, released by the Registrar General of India), which has decreased by 13 points since 2013 from 41.
The Under-Five Mortality Rate has declined by 12 points, from 45 (SRS 2013) to 33 (SRS 2020).
The NHM website shows that the current MMR of Haryana is 110 (SRS 2018-20). The ASHAs say this was down to 95 in 2022.
Another of their roles is promotion of institutional deliveries by operationalising 24×7 delivery facilities. Institutional deliveries increased to 97.5 percent in 2022-23 (data sourced from the Union govt’s Health Management Information System), from 90.37 percent in 2017, the NHM website says.
Under the Union government’s Janani Suraksha Yojana (maternity safety scheme), ASHAs are paid incentives for bringing pregnant women to government hospitals for checks to promote institutional deliveries. Similarly, incentives are paid for facilitating the vaccination of kids at different stages.
Jagmati Sangwan, national vice-president of the All-India Democratic Women’s Association (AIDWA), said the ASHA workers have been performing their duties on the ground “so beautifully that even the World Health Organization (WHO) lauded their work during the Covid-19 pandemic”.
“It is because of their excellent work that we have witnessed improvement in maternal mortality rate (MMR), infant mortality rate (IMR) and vaccination in the past nearly two decades,” she added. “However, when it comes to providing them with suitable remuneration for their work, the government is seen dragging its feet.”
(Edited by Sunanda Ranjan)
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