ASHA, Nirasha

Overworked and underpaid ASHA workers, braving pulls and pressures, receive Rs 67 per day as stipend.
"Their outstanding contribution to reducing maternal mortality and Vaccination was hailed by the Hon’ble Prime Minister Narendar Modi in one of his speeches."
"Their outstanding contribution to reducing maternal mortality and Vaccination was hailed by the Hon’ble Prime Minister Narendar Modi in one of his speeches."Special arrangement

On March 29, 2022 a swarm of ASHA workers traveled from length and breadth of Kashmir and converged at Srinagar’s press enclave to voice their demands.

Shakeela from Baramulla’s sleepy hamlet was one among the thousand protesters. Her long and jaded journey of 13 years is full of twists and twirls.

She did not receive a single penny for her work for all those years.

However, From April 2019, she gets Rs 2000 as a monthly honorarium.

Braving poverty and other complications, Kashmir’s ASHA volunteers like Shakeela tirelessly worked during Covid Crisis.

India’s celebrated Accredited Social Health Activists (ASHA) are credited for making dramatic reductions in maternal and infant mortality, which has contributed to India’s life expectancy.

At a time, when patients from Syria, Iraq, Iran and other countries come to India for special treatment to their patients, “why are frontline health workersdeprived of their basic rights in India,” is the question ASHA’s unanimously asked during 4th state conference held in Srinagar on June 25, 2022.

Jammu and Kashmir registered impressive COVID-19 vaccination drives successfully and that was made possible by ASHA workers.

“Without the untiring efforts of community health workers, it would not have been possible,” Mubeena Akhtar, General Secretary of ASHA Union told me.

“Amidst the raging pandemic, I visited Covid positive patients during the dead of the night. I never stopped. We were paid Rs 3000 for those six months. We are being made to suffer,” Akhtar expressed her anguish.

The Genesis

WHO’s 1975 monograph ‘health by the people’ emphasized for countries to strengthen people-centric primary healthcare services. India responded a little late.

However, In May 2002, Chhattisgarh became the first state in India to adopt a similar initiative called Mitanin meaning ‘a female friend’.

India launched the ASHA program in 2005 as part of the National Rural Health Mission. It was extended to Cityscapes in 2013.

These women-only volunteers work with usually 1000 heads in villages and 2000 people in urban settings. The key intention was to take good care of their own family and other community members.

As one professor at Harvard Medical School commented, “the ASHA program is a template for building a community-based workforce to support the diverse health and social care needs.”

Public health specialists and community health workers after thorough deliberations designed the ASHA program. Familiarity, community connection, and acceptance by the womenfolk of the village is aimed from ASHA.

It all zeroes down to ensure sound health and well-being of female folk at the grassroots. As Shakeela puts it, “Teenage girls from my village come to me and secretly complain about white discharge, they are not comfortable talking about this taboo talk to male doctors. In the absence of gynecologists, I help them.”

Hope against Hope

ASHA translates to Hope in Hindi. And Hope sustains life. They are the only hope for women living in backward areas. Their contributions to maternal and child health including immunization and reaching out to poor rural women have been duly acknowledged.

Their outstanding contribution to reducing maternal mortality and Vaccination was hailed by the Hon’ble Prime Minister Narendar Modi in one of his speeches.

“ASHA warriors have played an important role in running a successful COVID-19 vaccination drive in India.”

A few months back, India’s one million ASHA workers received the biggest acknowledgment from WHO’s Global Health Leaders Award 2022 at the 75thWorld Health Assembly in Geneva.

ASHA volunteers have become a backbone of healthcare systems in the erstwhile state of J&K.

Mubeena, one of the disgruntled ASHA workers believes that only appreciation doesn’t make ends meet.

She said that it is true they are not lower-rung government functionaries. But they are playing a pivotal role in every health initiative at the community level.

To ensure greater internal accountability and transparency, they work with Anganwadi Workers (AWW) and Auxiliary Nurse Midwife (ANM).

Mubeena laments that their plight is overlooked. They demand enhancement in incentives and social security.

Another ASHA chips in to narrate her story of vulnerability. “During COVID-19 Pandemic, I was shivering. Three attendants helped me to stand up.

I was unwell and tears were rolling down my cheeks. We were discharged from the hospital the next day. In the afternoon, I got a call from the patient and I accompanied her to Lal Ded Hospital and stayed awake for the night on the floor. I didn’t eat anything.”

Ifshana Jan, another ASHA, added, “It was really difficult for us. I toiled hard during Covid Crisis and ensured full vaccination in my jurisdiction” Jan continued that there is no career growth and no fixed remuneration which pushes them to hit the streets to register their peaceful protests and demand their rights. “WHO has recognized our work but the local government has ignored us.”

Overburdened?

Several ASHA workers I talked to complained of being overburdened with work.

An ASHA worker from South Kashmir’s Pulwama told me during a protest rally that they are being exploited in the name of work and paid peanuts in the name of salary.

The foot soldiers said that they are underpaid for the huge workload they are assigned to complete with tight deadlines. How much is too much? Let’s find out.

From registration of Ayushman Bharat (Golden cards) to Antenatal care for pregnant ladies, from leprosy survey to checking eligible couples to monitoring HBNC (Home Based Newborn Care) weekly visits to homes under HBYC (Home Based Care of Young Child), from a process evaluation of VHND (Village Health and Nutrition Day Observation) to attending meetings with panchayat representatives under VHSNC (Village Health Sanitation and Nutrition Committee)program.

“We are always on toes against the paltry sum of USD 25/month.” Shakeela quipped.

In the growing protests by ASHA’s against working conditions and unfair pay, Communist Party of India (M) state representative of J&K Mohammad Yousuf Tarigami was the only ex-lawmaker joining them and demanding Minimum Wages Act to be implemented for ASHA’s.

I asked Mr. Tarigami the reason for joining the protest. He responded in his signature style. “They earn a pittance but risk life and limb to perform their duty. ASHA is a beacon of hope but flashing a distress signal. They deserve a decent honorarium of INR 15,000 and maternity and medical benefits. They can be promoted and regularized after reviewing their performance.”

Meanwhile, Shakeela is finding it difficult to join the protest, “Our grievances have gone unheard. I don’t have money to travel now.”

The author is one of the 3 awardees of the inaugural Narendar Revelli Media Fellowship and this story is funded by Turaga Foundation and University of Hyderabad.

Disclaimer: The views and opinions expressed in this article are the personal opinions of the author.

The facts, analysis, assumptions and perspective appearing in the article do not reflect the views of GK.

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