For the last 21 months starting April 2020, Neeta Awanghade, an Accredited Social Health Activist (ASHA) in Atali village, located in Maharashtra's Satara district, started her work day at 7 am in the morning.
She would do door-to-door survey of the 300-odd people living in her village, to trace symptoms of COVID-19. She would advise them on isolation, and medicines needed. From April 2021, she started talking to people and advising them about the benefits of vaccination – along with surveys – clocking 12-14 hours of work, during the height of the second wave.
Risking her life, she made sure everyone in her village got inoculated and followed it up with the secondary dose. All for a monthly salary of Rs 5,000 – the only source of income for her four-member family.
Constituted in 2006 under the National Rural Health Mission (NRHM), the ASHAs act as an interface between community and health system. These women 'volunteers' became the foot soldiers during the COVID-19 pandemic – leading the fight against coronavirus in India's villages, saving millions of lives.
"I got a WhatsApp message about the award. I am very happy and proud of what I have achieved in the last two years. But awards don't pay for food. Awards cannot make sure that my children get good education. I want my ASHA sisters and me to be paid for the work we do. That will make us happier than any award," Awanghade tells The Quint.
ASHAs from across India – be it a remote village like Atali or the national capital Delhi – mirror Awanghade's words. As they fought the pandemic from the frontlines – the ASHAs brought to light how their compensation is a pittance for the work they do, and their abysmal working conditions, through protests across the country.
'Got Paid Rs 10 Per House For Survey in Containment Zone'
For the last 10 years, Kavita Singh, a secretariat member of the Scheme Workers Federation of India, has devoted her time to being an ASHA worker in Delhi.
"The award is a matter of pride for us and we are very thankful. It means that our work has been acknowledged on an international platform. However, this will not fill our stomachs. We have been demanding a regular salary but we are still considered incentive-based volunteer workers," Singh tells The Quint.
"During COVID, we would conduct 50 surveys in containment zones, for which we would get paid Rs 500 per day (Rs 10 per house). Similarly, for home isolation, we would be paid Rs 100 per patient. The tasks would include getting them tested, and delivering medicines, and oximeters. When nobody else was stepping out of their homes during the pandemic, we were the only people out there."Kavita Singh
On an average, an ASHA worker’s monthly income varies from Rs 2,000 per month to Rs 5,000 per month, depending on the state they are based out of. In some states like Maharashtra, they can earn up to Rs 8,000 – along with incentives, which again depend on the tasks available in the region.
'End Incentive-Based Pay'
COVID or not, the ASHAs are the first point of call for health concerns in most Indian villages – especially with regard to women's health issues. They get Rs 75 for full immunisation, Rs 40 for reporting child death, and Rs 300-600 for accompanying a pregnant woman to hospital.
ASHAs like both Singh and Awanghade say that most of their income is in the form of incentives rom these tasks – with their basic salary being 'unliveable.'
"For instance, we are paid a certain amount for certain tasks. We are assigned areas and we have to look into all the health-related issues in the specified areas, starting from immunisation of children to taking care of pregnant mothers. There are 12 core jobs. If we deliver on six of them, we get an incentive of Rs 3000. Based on our tasks, our salary can range from Rs 3000 to Rs 8,000."Kavita Singh
Need More Than Just the 'Volunteer' Tag
This is because they are called volunteers, but not healthcare workers, says Dharamvati, a ASHA worker from Meerut’s Gagol village. She started working in 2019, and like many others does not like the label "volunteer attached to it."
“We are paid Rs 600 when a pregnant woman we took to a government hospital, gives birth to a baby. It’s contractual labour. But if something unfortunate happens during the birth, this money is snatched from us. How is that fair? We have been with the mother-to-be and taking care of her all these months."
“Even a daily wager around here earns approximately Rs 400-500 per day. We get Rs 1,000 per month for our COVID-related services. That amounts to Rs 30-35 a day. You tell me, is that enough?" she had told us in May 2021 as well.
'Welcome the Award, Tired of Fighting'
The Karnataka ASHA Karyakarthara Sangha D Nagalakshmi tells The Quint that the women work for 8-10 hours every day, but the volunteer tag prevents them from earning 'respectable' wages – that too for the work they do.
"Sometimes, we accompany patients for deliveries in the middle of the night, stretching our working hours from 24 to 48 hours. We travel at least 2 km every day and 5-15 in coastal and holly areas. Till date, we do not receive any allowance for travel. How do we go from one place to another? The last time we received uniforms was before the pandemic. We do not get any healthcare benefits ourselves, or retirement ones. Why are we doing all this? During COVID, we even had to fight for basic thing like masks. Welcome the award, but tired of fighting."
When The Quint reached out to her after the WHO announcement – she repeated the words she had told us in April 2020.
She said that while 'little has changed', she hopes that the award brings ASHAs the monetary rewards they deserve. But that hope too, is a "very small one," she adds.