ASHA workers struggle for survival

New Delhi: Come rain, sun, hail or indeed a contagion, the band of women who form the bedrock of India's rural healthcare system slog on, anonymous, underpaid and mostly unsung until last week when the WHO honoured them for their efforts in controlling Covid.

For the 10 lakh Accredited Social Health Activists (ASHA) volunteers who administer medicines, vaccines, first aid, offer health advice and a myriad other services across the length and breadth of India, the WHO recognition is just the global spotlight they need.

But their battle against low payments, no facilities and erratic schedules continues. And because they are women, so does the tightrope walk between their homes and their jobs.

Like for Sailendri, 42, an ASHA worker from Basti in Uttar Pradesh who wakes up at 3 am every morning, finishes her chores at home and then joins her colleagues in going home to home. Her primary worry is how to make ends meet.

"The government must give us a fixed income. There is so much work Do authorities see the work we put in? We have served the people so faithfully but got only empty praise, she said, unaware that ASHA workers like her have been honoured at an international platform.

"We get Rs 10,000 per month at most. How are we expected to support ourselves in that money with prices going up every day. Also, the personal sacrifice we make by keeping our work before our family Who values that?" Sailendri, who has been an ASHA volunteer for 16 years, added in a phone interview from her home in Basti.

Sunita Sinha, an ASHA worker from Sabour block of Bhagalpur district in Bihar, agreed.

Echoing Sailendri's resentment, she said there are days when they even have to take a patient to hospital.

"There is no conveyance and we have to manage everything on our own. Also, we work under so much pressure. There have been days when we spend the whole day walking and don't sit for five minutes. But this is not acknowledged.

During the long months of lockdown, she went from house to house to tend to patients without any concern for herself, Sunita said.

"I remember one instance... we were running low on masks so we sanitised clothes and made masks to ensure protection for everyone possible. Even now we are encouraging people to get vaccinated. We have helped raise awareness on vaccination since the day the vaccination drive started," she said from Sabour.

ASHA workers are the first and sometimes only point of contact for millions of villagers and the healthcare system. They earn money through task-based incentives under the National Health Mission (NHM), which is funded in a 60:40 ratio between the Centre and state government. All the ASHA workers spoke to said they don't earn more than Rs 10,000 per month.

Poonam Muttreja, executive director, Population Foundation of India, noted that there are major differences between the pay scales of regular frontline workers and those recruited on a contractual basis under the National Health Mission.

"During the COVID-19 pandemic, ASHAs continued to work in fragile settings despite receiving resistance from communities. A study conducted by the Population Foundation of India during this period showed that the fear of getting infected by COVID-19 among people kept many away from accessing services at health facilities," she said.