ASHA Workers: The Unpaid, Unprotected Frontline Warriors of India

Sukanya Maity

Speaking to India’s neglected Frontline ASHA workers, why they’re striking and what they demand. 

The Accredited Social Health Activist (ASHA) is an all-women community of health workers launched in 2005 as a part of the National Rural Health Mission (NRHM). Since then, it has been functioning under the Government of India’s Ministry of Health and Family Welfare (MoHFW) programme. In India, proper healthcare services remain largely inaccessible and the rural sectors are deprived of the basic necessities. ASHA workers, clad in pink sarees, have been instrumental in bridging the gap between the rural population and effective healthcare services. 

“Since 2005, ASHA workers have helped sensitize rural women by raising awareness and educating people on basic healthcare facilities, sanitation and hygiene”

Since 2005, ASHA workers have helped sensitize rural women by raising awareness and educating people on basic healthcare facilities, sanitation and hygiene. They have carefully taken note of the determinants of health such as proper nutrition, living conditions, sanitation, hygiene, number of family members, income and the working conditions of rural families. This, in turn, has tremendously helped the government in its implementation of family welfare and healthcare services. 

ASHA workers encourage and educate rural women on the importance of childbirth at hospitals, rather than at homes. They regularly distribute medicine kits to every rural household. They act as providers of direct observatory short-course treatment under the revised Tuberculosis Control Programme. They also accompany pregnant women to the nearest hospitals, even at odd hours. Most of these workers are women who come from economically disadvantaged backgrounds. In order to be an ASHA worker, they must have a formal education of up to the eighth standard and must be between the ages of 25 and 45. After being selected, they are trained through awareness sessions and health welfare programmes. 

The Frontline Workers Battling Covid-19

When the Covid-19 pandemic spread across India, ASHA workers were asked to work as contact tracers, collect data and identify patients who showed mild symptoms through door-to-door screening and report these to state authorities. They were expected to do this without any protective gear or PPE kits and with an added remuneration of 1,000 rupees (13 USD) a month to their regular salary of 4000 rupees a month. 

“Realising that it was a national emergency, they stepped up to the task with no complaints. In fact, all the accurate data that is televised, printed and reported, is a direct result of the commitment of these frontline warriors to their work and responsibilities”

Realising that it was a national emergency, they stepped up to the task with no complaints. In fact, all the accurate data that is televised, printed and reported, is a direct result of the commitment of these frontline warriors to their work and responsibilities. Speaking to Bol Magazine, Kamlesh Hindustani, an ASHA worker from Haryana who has been working since 2005, says: “Had we not been there, it would have been impossible to control the spread of coronavirus as well as keep a track on the number of confirmed cases each day.” 

“They were not paid for months and scores of ASHA workers suffered from high rates of infection of Covid due to the lack of protective gear and PPE kits.”

The situation worsened when they were asked to work for ten hours a day instead of the usual four hours. They were not paid for months and scores of ASHA workers suffered from high rates of infection of Covid due to the lack of protective gear and PPE kits. Hindustani says: “We have been working tirelessly since April. I, myself, have identified a lot of patients who were infected. We did all that we could, without a question but we do care for our lives and our families. Many of my colleagues got infected and lost their lives. Who is responsible for it?” 

Reportedly, 1 million ASHA workers in the country have been working as contact tracers. They have not been paid since March. The families of the workers who died due to the callousness and the ignorance of the governmental authorities have not received any compensation or insurance.

“On the 10th of July, the ASHA workers in Karnataka proposed to strike against the unjust nature and measures of the ruling party by boycotting their work.”

On the 10th of July, the ASHA workers in Karnataka proposed to strike against the unjust nature and measures of the ruling party by boycotting their work. The movement gained momentum as ASHA workers from other states such as Delhi, Haryana, Maharashtra and Himachal Pradesh united to protest against the government’s inaction. These workers are being supported by organisations such as the All India Democratic Women’s Association (AIDWA), Centre of Indian Trade Unions (CITU) and Indian National Trade Union Congress (INTUC).

Their Demands

“The ASHA workers are pressing for provision of protective gear, PPE kits and a legal status that ensures minimum wages with better and timely pay.”

The ASHA workers are pressing for provision of protective gear, PPE kits and a legal status that ensures minimum wages with better and timely pay. Hindustani says: “Before 2005, the condition of the health sectors was much worse than what it is now. People in the remotest areas had zero to no access to health facilities. For every thousand people in the villages, one ASHA worker was appointed. We have often functioned as midwives, escorting the pregnant women to nearest hospitals and taking care of them and their children for a prolonged period of 16 years by providing them with drug kits, vaccinations, nutritional supplements and so on. Look at how the government is treating us now! Is it the price that we pay for our humanitarian work?”

The authorities have also curtailed the due incentives of ASHA workers. On the 21st of July, they had placed their demands in front of the Haryana State Authority. Instead of paying their due remuneration, the state government curtailed 50% of the total incentives (provision of 1,000 INR for a door-to-door visit) that they were initially paid. Hindustani comments: “The ruling Janata Party’s national slogan and initiative of ‘Beti Bachao, Beti Padhao’ (save the girl child and educate her) is an utter scam when in reality, it fails to recognise the contribution of all-women ASHA workers and exploit our unpaid labour!” 

“In India, prior to Covid, ASHA workers have been instrumental in mitigating the risks of diseases like Polio, Tuberculosis, AIDS and the like through regular sensitization, awareness sessions and distribution of medical kits and supplements.”

In India, prior to Covid, ASHA workers have been instrumental in mitigating the risks of diseases like Polio, Tuberculosis, AIDS and the like through regular sensitization, awareness sessions and distribution of medical kits and supplements. As a result of the government’s inability and failure to implement labour laws and their dilution through repeated amendments the Trade Unions and Workers organisation that are solely driven towards alleviating the sufferings of these workers have been relegated to a secondary position.

Hindustani explains: “The ruling Janata Party’s fetish for privatising the government sectors will not work when it comes to privatising our labour. We feel ashamed to disclose our salaries to our relatives and families. When a saviour (referring to the government) turns into a monster, people do not see a ray of hope. But, we will keep fighting for our rights until we get what we deserve.”

“Hindustani’s husband is an auto-driver who was rendered jobless overnight due to the sudden declaration of the countrywide lockdown. She has a 21-year-old son who is pursuing his Bachelor’s in Engineering. She is also the only earning member in her family and hence, cannot afford to lose her job at any cost.”

Hindustani’s husband is an auto-driver who was rendered jobless overnight due to the sudden declaration of the countrywide lockdown. She has a 21-year-old son who is pursuing his Bachelor’s in Engineering. She is also the only earning member in her family and hence, cannot afford to lose her job at any cost. She says: “We do not care if the government labels us as ‘anti-national’ for pressing for our own rights. I’m the daughter of an Indian soldier and I would rather call myself ‘anti-national’ instead of succumbing to unemployment, poverty and hunger. They have also sent a legal notice and I might as well be arrested today, but no matter what, I will participate in the sit-in demonstration as I have been.” 

The Ongoing Strike

“Despite the threat of losing their jobs and getting arrested, 600,000 ASHA workers and scheme workers from 21 states, working under various central government programmes like National Health Mission (NHM), took to the streets.”

Image sourced by Kamlesh Hindustani

The protests first broke out in Karnataka on the 21st of July. ASHA workers from other states gradually joined the movement and 20,000 workers in Haryana have been on a strike since the 7th of August. CITU called for a countrywide strike on the 7th and 8th of August. Despite the threat of losing their jobs and getting arrested, 600,000 ASHA workers and scheme workers from 21 states, working under various central government programmes like National Health Mission (NHM), took to the streets. 

Meanwhile, in March, announcing a nationwide lockdown, Prime Minister Narendra Modi requested people to recognise and validate the contribution of the frontline workers by lighting candles, banging utensils and clapping for them. People even went to the extent of bursting crackers and chanting spiritual hymns to end the pandemic. 

“Speaking to Bol Magazine, the Haryana State Secretary of All India Democratic Women’s Association (AIDWA), Savita says: ‘the show of gratitude that the PM had put up which included banging utensils, lighting candles and clapping for the frontline workers would neither satiate their hunger nor save their lives. The ASHA workers were not even provided with masks and sanitizers. Some of them used their dupattas (scarfs) and handkerchiefs to cover their mouth.’”

Speaking to Bol Magazine, the Haryana State Secretary of All India Democratic Women’s Association (AIDWA), Savita says: “The show of gratitude that the PM had put up which included banging utensils, lighting candles and clapping for the frontline workers would neither satiate their hunger nor save their lives. The ASHA workers were not even provided with masks and sanitizers. Some of them used their dupattas (scarfs) and handkerchiefs to cover their mouth. The workers do not need to be showered with flowers, instead, they want their monthly wages so that they can run their households. Flowers won’t fill their empty stomach. They are tired of the government’s caricatures and mockery.”

The Government Response

Since 2005, the ASHA workers have been functioning as volunteers and not as (formal) workers. They do not have legal backing, protective laws and government-funded insurance policies. Jay Bhagawan, Haryana State General Secretary of Centre for Indian Trade Unions (CITU), explains: “The ASHA workers are sometimes paid 1,000 rupees, sometimes 3,000 and sometimes 4,000. They do not get a fixed salary. The workers who stay in the field for more than 8 hours a day face undue discrimination, harassment and abuse from the local people. One such worker was chased away by the villagers because they thought she would misinform the authority and all of them would be taken to the quarantine centres, despite not being infected with the virus.” 

“The ASHA workers are mostly women from marginalized caste and class. Many of them live in slums and congested areas. Their neighbours have boycotted them believing that they might be infected since they came in close contact with the patients and other local people.”

The ASHA workers are mostly women from marginalized caste and class. Many of them live in slums and congested areas. Their neighbours have boycotted them believing that they might be infected since they came in close contact with the patients and other local people. The Delhi Police has launched an FIR against 100 protesting workers on grounds of breaking rules related to physical distancing by gathering in large numbers at Jantar Mantar.

Bhagawan says: “The movement has not yet become widespread. Only 6,00,000 out of 10,00,000 workers have participated in the countrywide protest and some thousand of them in few states are on a strike. The government has no sympathy for the people living in the margins. The workers will not back off until and unless the government fulfils their demands. The government must realise that it can never tackle a pandemic without the cooperation of its ASHA workers. The strike has been extended till the 17th of August. If the government fails to take any necessary action, the strike will go on even after the 17th.”

“ASHA workers are essential in India’s fight against Covid. They are needed now more than ever.”

ASHA workers are essential in India’s fight against Covid. They are needed now more than ever. Without them, it will be impossible to contain the spread of the virus. Activities related to immunization and tuberculosis control will also be affected. While speaking to Kamlesh Hindustani, I felt the heaviness of the situation and the hardships and humiliation that these frontline workers have faced and continue to face every day. All they demand are regular wages so that they can fulfil their basic needs and ensure their safety on the job. If we fail the ASHA workers, we will not only lose the fight against Covid but also be remembered as a nation that failed to protect it’s frontline workers. 

Sukanya is pursuing a Bachelor’s degree in Sociology from Jadavpur University, Kolkata. She is a feminist, anti-fascist and anti-capitalist and hopes to document the lives of remarkable women so that their stories don’t vanish into anonymity.

Design by Hemashri Dhavala

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