Exploitation Of ASHA Workers Is Due To Patriarchal Idea Of Care Work Being ‘Lowly’

Overburdening of ASHA workers, not giving them fair payment, and calling them volunteers rather than employees, shows how our society takes work done by women so much for granted.

Shivangi (name changed) an ASHA (Accredited Social Health Activist) worker from a health care centre at Bowenpally, Hyderabad starts her day at 9 am in morning.

Since the pandemic began, she has been working in her area, going door to door, conducting COVID-19 surveys, tracking illness records of people, spreading awareness on sanitation and vaccination, doing the examination for common ailments, delivering health and nutrition supplements, tracking the health of pregnant women in the area, working for about 12-13 hours a day and even for 24 hours on some days, and doing much more for community health care.

“I used to work for 6-7 hours a day but due to the pandemic, I have worked even 24 hours some days… I travel 4 to 5 hours a day and just get around Rs 7000-8000 per month. I worked extra during the COVID-19 time and still, I was paid the same money… along with that we hardly get any respect in the community while conducting surveys,” said Shivangi.

She also told me that during the peak time of the 2nd wave this year, she and other members of the health staff did not even have proper stocks of N95 marks, PPE kits, gloves and sanitisers to keep them safe from the coronavirus.

What does the data about ASHA workers in Telangana say?

According to the Telangana Voluntary and Community Healthworkers Union (TVCHU) — the state association of ASHA workers led by the Centre of Indian Trade Unions (CITU) — at least 50 of them have died so far, and 500 have contracted the novel coronavirus. (As per a report published in TNM). 

Telangana has an incentive-based payment system for ASHA workers. They get around Rs 7,500 a month. Addressing this in March, the Chief Minister of Telangana K Chandrashekar Rao announced that the 11th Pay Revision Commission (PRC) would apply to the state’s contracted as well as the outsourced employees. Under this, ASHA workers and Anganwadi workers were entitled to a hike of 30%. However, activists argue that this hasn’t been implemented yet, and even in the guidelines, ASHA workers are not mentioned.

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C Lalitha, an office-bearer of the Telangana Voluntary and Community Healthworkers Union (TVCHU) in an interview to TNM said, “Even the 30% hike to us is a very nominal amount for the services we do, considering we earn only around Rs 7,000. We are made to do all the heavy lifting work — from data entry, vaccination, carring out fever surveys and other work — but left out when it comes to acknowledging our services.”

The plight of ASHA workers is the same all over India

This treatment towards ASHA workers is not just restricted to Telangana. Various news reports have shown that ASHA workers, Anganwadi Workers (AWWs) and Auxiliary Nurse Midwives (ANMs) all over the country have been risking their lives for community health care during COVID-19. Still, they are overburdened, underpaid, and not given adequate safety essentials.

According to a survey conducted by Behan Box in Assam, Bihar, Haryana, Jharkhand, Karnataka, Maharashtra, Madhya Pradesh, Delhi, Telangana, and Uttar Pradesh, work hours of ASHA workers have increased from 6-8 hours a day to almost 12-15 hours of work per day due to the pandemic. In simpler terms, this means that one ASHA worker is responsible for handling the healthcare activities for 1000 villagers in the area.

There are no fixed salaries for ASHA workers in most parts of the country and the work is incentive-based. They receive a minimum honorarium of 2000-4000 per month depending on the state/UT. Incentives according to the work they do are added to this. Activists have often raised their voices on how this is below the minimum wage policy.

Due to this, last year from August 7-8, ASHA workers went on a 2-day nationwide strike demanding minimum safety and fixed salary. Promises were made but nothing significant changed. On May 24 this year again they protested to make government officials recognise their issues. Since then ASHA workers have been protesting on and off to get their demands met. The organisations representing ASHA workers have been demanding a fixed pay of Rs 21000, but so far this request has not been considered.

Another issue that many ASHA workers (especially in Telangana) are facing is uncertainty in employment. Due to the COVID-19 pandemic, many women were employed on a contract basis at various PHCs (Public Health Care Centre).

Sudha, one such lady was hired for the Primary Health Care centre, Kandi, Sangareddy last year on a contract basis. Her contract ended in February this year but because of the second wave she is still working, and hasn’t received her paychecks after March.

“I was hired on a 6-month contract, but after my contract ended I was still asked to work because of the 2nd wave… I don’t have proper documents so my paychecks after March haven’t been released. I have informed the supervisors, but so far I don’t know what is happening… I have kids at home to feed and I don’t have any strength left to fight,” said Sudha. She also told me that many other workers have the same issues.

It can be said here that the work of ASHA workers is taken for granted. A lot of the attitude of both our society and our policymakers comes out of the patriarchal nature in which our society works.

The exploitation of ASHA workers proves the patriarchal nature of our society

ASHA workers have been a part of the National Health Mission since 2005. They have contributed immensely to the execution of health care policies. Even after working all these years for community health care, they don’t receive their due respect and pay. They are termed “volunteer workers.” This also stems from the patriarchal bias of our society. A huge chunk of the work that ASHA workers do requires emotional labour.

They often work with women, children, and care for the ill and elderly in the communities, tasks traditionally perceived as women’s duty, and often considered unpaid care work. By recruiting only women employees to do the community health care workers also propagates the idea of care work being something that only women are expected to do.

Overburdening of ASHA workers, not giving them fair payment, and calling them volunteers rather than employees shows how our society takes work done by women so much for granted. Unfair low payments for these women shows our patriarchal attitude of not considering care work as something that holds monetary value.

As economist Padmini Swaminathan argues, terming ASHA workers as volunteers “reiterates the view that these women implementing India’s health and nutrition goals at the grassroots level are merely honorary volunteers, and not actual workers.”.

All these women want is just fair and fixed pay, and the respect that they deserve for the work that they do. It’s high time we as a society start respecting ASHA workers, and our policymakers start taking the issues of ASHA workers seriously.

Image source: YouTube

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