Around 6,000 Accredited Social Health Activists (ASHA) in Delhi have not been paid monthly incentives since April 2021. The incentives are due to them for visiting COVID-19 patients under home isolation and for carrying out surveys in containment zones.
ASHA workers do not get fixed salaries like regular workers . They are paid incentives by the government for their services as community health workers. Special incentives were promised to them during the Covid-19 pandemic. An ASHA worker is to be paid Rs.100 per visit to a COVID-19 patient under home isolation, along with Rs.100 per day for refreshment, as per government rules. For surveys done in containment zones, an ASHA worker is to be paid Rs.500 for surveying less than 50 houses in a day. Given all this, an ASHA worker could earn as low as Rs.3000-Rs.5000 a month.
ASHAs are one of the cadres of frontline health workers that has been mobilised for everything from door-to-door surveys, distributing medicine kits, measuring oxygen saturation, monitoring containment zones and spreading awareness about vaccines.
Since the pandemic, these workers have worked around the clock, sometimes responding to calls at 10 p.m. and visiting homes to give medicines to patients at their homes. The government did not provide them with PPE kits, and the workers have been buying sanitisers, gloves and masks with their own money.
In the wake of the pandemic, there was a dip in the ASHA workers’ routine work. Officials claim that the incentive is not being paid because routine work, from which ASHA workers used to earn incentives before the pandemic, have restarted from March. This is a lame excuse, because the second wave hit the country and ASHA’s were, once again, drawn into the thick of it. Delhi government had agreed to pay Rs.3,000 in response to demands from the workers, who protested in August last year at Jantar Mantar. But it had not paid the Rs.3,000 when the second wave of the pandemic struck this year.
ASHA workers have been repeatedly coming out on the streets to demand their rights. 70,000 of them went on strike in June 2021 in Maharashtra, demanding higher pay, regularisation of work and social protection. In August 2020 there was an all India strike by 6 lakh ASHA workers. Over the past year, ASHA workers have carried out many strikes and protests in many states, including Gujarat, Haryana, Karnataka, Kerala, Madhya Pradesh and Punjab.
The Delhi ASHA workers have also been given no clarification from the government regarding which office will be paying them the incentives for the duties that they have been called upon to carry out. They have written to the Chief Minister about the problems being faced by them, but there has been no response so far, from the government.
There is no justification for the Delhi government’ not to pay its workers. Denying payment to workers, especially those that have most readily responded to the call given to health workers to deal with the pandemic is a gross violation of workers’ rights
National Rural Health Mission
The government of India started deploying ASHA workers under the National Rural Health Mission (NRHM) in 2005.
Accredited Social Health Activists (ASHAs) are an all-women healthcare workforce that acts as the interface between communities and the public health system in India. Even though they are known as “health activists” according to the Ministry of Health and Family Welfare, their struggle to be recognised as frontline workers and receive access to basic necessities has been ongoing for a long time.
NRHM guidelines state that an ASHA would be an ‘honorary volunteer’, not receive any salary and her work would not interfere with her ‘normal livelihood’. The ASHA workers’ workload was supposed to be just two-three hours, four days a week, along with some extra events. This categorisation is based on the premise that the work of an ASHA is just a supplement to the worker’s main livelihood. However, it was seen that most ASHAs were working between 25-28 hours a week, and even beyond that. In 2020, it was found that because of additional pandemic duties, ASHA workers across India have been working an average of 8-14 hours a day in the field, including on weekends.
There are over 60 tasks under the NHM for which states can set incentives for ASHA workers. These range from Re.1 for distributing items to households such as ORS packets, condoms or sanitary napkins, to Rs. 5000 for facilitating treatment and support to a drug-resistant TB patient. In 2018, the Union Government doubled incentives for a certain set of routine and recurring ASHA activities from Rs. 1000 to Rs. 2000.
Not being classified as ‘employees’, ASHAs do not have access to any social protection (sick leave, maternity leave, pension, PF, etc). They instead have to rely on ad hoc, temporary welfare measures.