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150,000 ASHAs – the backbone of rural healthcare – will go on strike in Maharashtra

Over a lakh and a half ASHAs (Accredited Social Health Activists) are going on a strike in Maharashtra from September 24. ASHA workers from Manipur are also expected to protest. They are protesting because of the incentive of Rs. 1,000 from the Central government for testing and contact tracing Covid-19 patients, which they are still waiting for.
In the midst of the COVID-19 pandemic, the government of India designated 9,00,000 ASHA workers to assist with healthcare management. In most of the States, ASHAs have been doing door-to-door surveys of infected Covid-19 patients for contact tracing of closed contacts. These Community Health Workers also visit villagers to maintain data of children with malnutrition and health updates of pregnant women. This often makes them vulnerable to contracting Covid on the field. Already 45 Asha workers have lost their lives to the novel coronavirus in Maharashtra.

Who is an ASHA?

ASHA stands for Accredited Social Health Activist. India’s National Rural Health Mission was launched in 2005, aiming is to provide every village in the country with a trained female ASHA. ASHAs serve as a link between their own community and the public health system. As community health activists, ASHAs provide prevention education on a range of health issues, including reproductive and sexual health, and healthy lifestyles to prevent diabetes and other non communicable diseases.
ASHAs depend on a system of task-based incentives for complementary income to their honorarium, which is a paltry sum in itself. This system has negative impacts on the workers and on the patients as activities with higher incentives become prioritised over other activities resulting in healthcare that may not be a priority for the individual or community.

Why you should care

ASHAs are the backbone of rural health programmes, including many CSR programmes being implemented in public-private partnership. They are an integral part of the institutional healthcare structure in India, but continue to be treated as subpar by the government. They have a direct relationship with officers of health system for their employment and are not contracted through third parties. They are supervised by officers of the health system that would be unable to carry out these activities without them. They are contributing significantly to the management of the COVID-19 pandemic yet they have reportedly not been provided with personal protective equipment.
The resources required to adequately remunerate them is only a fraction of the resources lost to tax evasion by corporations. Tax progressive reforms can greatly contribute to the gap in financing community health programmes in rural India.
ASHAs in India are not recognized as government employees and therefore are not provided any form of paid leave, uniform allowances, or compensation for occupational risks encountered. This is despite the fact that ASHAs perform services for the public healthcare system, that they depend on attending patients for their income, and are given instructions from the public health post on how the work is to be done.
ASHAs are reported to work at least 5 hours a day or 25 hours a week, but this is probably underestimated. They provide an essential linkage between vulnerable population in rural and poor communities and the formal health system. ASHAs collect information from the community through house-to-house visits and bring it back to the local health facility. They also carry basic health resources (vitamins, contraceptives, health education tools, etc) from the local health facilities into the community and distribute them as required.
The government has committed to ambitious health targets “universal access to sexual and reproductive healthcare services”. These commitments cannot be dependent on the maintenance and expansion of women’s unpaid and informal labour. This situation can be turned around. There is no justifiable reason to continue paying ASHAs mere incentives with which they cannot make ends meet. It violates their dignity as human beings and as workers.