(This was first published on 24 April 2020. It has been republished from The Quint's archives after India's ASHA workers were honoured with the Global Health Leaders Award-2022 by the WHO.)
ASHA workers – considered as ‘low-cost resources’ – have come to the rescue of state governments during the ongoing coronavirus crisis. They carry out community-level activities, including tracking positive cases, identifying symptomatic cases, monitoring people with travel history, and much more.
ASHAs – or Accredited Social Health Activists – are leading the COVID-19 fight in their community by risking their lives. However they are having to continuously deal with the unruly behaviour of community members, with several media reports recording instances of attacks on ASHA workers across states.
It should not be forgotten that these female volunteers are facing difficulties in their domestic life as well, as the nationwide lockdown since 22 March has made ‘normal life’ difficult for millions of people.
In these tough times, these underpaid heroes need not just acknowledgement, through banging ‘thalis’ and ‘taalis’, but the means to end their financial hardships.
No Recognition For Community Health Workers
Even while acknowledging the role of health workers in fight against coronavirus, words are limited to doctors and nurses, without the explicit mention of community health workers.
ASHA workers are voluntary community health workers present across states since the launch of the National Rural Health Mission (NRHM) in 2005.
The ASHA programme in India is now more than a decade old – and employs nearly one million voluntary women workers.
The success of the programme in achieving better health outcomes, especially for rural areas, is well documented but so are the issues of attrition and sub-optimal performance. The voluntary nature and incentive structure of these workers is the most debated aspect of the programme.
ASHA workers are in a continuous struggle with the government to gain the status of formal employees of the health system, and receive better remuneration.
ASHAs On Frontline But No Assured Financial Support
However, they have failed in their negotiations, and continue to serve the society as volunteers with minimum payment for their services – and that too in the form of performance-linked incentives.
As a response to their long-standing demands and political mobilisation, the government has responded by introducing ‘symbolic’ policies in the form of offering life-insurance, accidental insurance cover and maternity benefits.
It is disheartening to note that even during this time of the COVID-19 crisis, when these women are risking their lives to help government contain the spread of coronavirus, they have not been assured of any financial payments.
Once again, symbolic policies, like accident and life insurance of Rs 50 lakhs, have been offered to them but we need policies to motivate them to remain in the workforce.
Does a life insurance policy matter to a woman struggling to feed her family? Perhaps the answer to this question lies in the figure of low penetration of life insurance policies in India, especially among poor people.
As per the Handbook on Indian Insurance Statistics, 2016-17, only about 25 percent of the Indian population has some form of life insurance.
When it comes to assigning tasks to ASHA workers the list is never-ending but when it comes to their payment system, policy documents don’t shy away from saying they are “honorarium workers” and their payment will be incentive-based.
As the NRHM document on ASHA policy mentions: “The compensation to ASHA based on measurable outputs would be given under the overall supervision and control by Panchayat.”
The incentives paid to ASHA workers are implemented in a very controlled environment. ASHA workers are mainly from poor and marginalized families and they may face discrimination from people in power. All these features of the ASHA program add to the difficulties of ASHA workers.
Let Us Support Those Risking Lives & Fighting Coronavirus
Even after facing so many difficult conditions, these voluntary female soldiers are standing with the government against the coronavirus. Like always, there’s a list of tasks assigned to ASHA workers under new guidelines released for community health workers to fight against the coronavirus.
As per the Ministry of Health and Family Welfare document on COVID-19 and training of community workers, ASHA workers have been assigned the task of door-to-door house visits to ensure early identification of cases, ascertain travel history details, ensure home-quarantine is being followed, and ensure supplies of essentials to quarantined people. They are also supposed to help prevent and control stigma and discrimination in the community.
It’s time to stop relying on the unpaid work of these brave women and properly acknowledge their efforts by explicitly mentioning their role in fight against the coronavirus, and ensuring they get paid as per their efforts.
It’s also time to act against people who attack these vital healthcare personnel.
On 22 April, 2020 Union Cabinet announced an essential step to safeguard our health workers, making any act of violence against health workers a cognizable and non-bailable offence. It is hoped that ASHA workers will be seen as within the ambit of health workers as defined in the passed ordinance, as the wording has been drafted to ensure it covers all such personnel.
This ordinance will come as a major relief for these voluntary workers, who are working day and night risking their lives without any assurance of financial incentives for these additional duties.
Apart from this, however, the fact remains that ASHA workers need economic security as well. India’s fight against COVID-19 is made possible with support from ASHA workers – let’s support them as well.
(This is an opinion piece and the views expressed above are the author’s own. The Quint neither endorses nor is responsible for the same. Vanita Singh is a PhD scholar at IIM Ahmedabad. Her research work focuses on health policy analysis, universal health coverage, women and development.)