For the last one year, ASHA workers in blocks Katehri and Bhiti blocks in Ambedkar Nagar district have been working without any pay from the district administration. The workers, who have been at the core of healthcare delivery in the region, complained that they have not received payment inspite of being involved with numerous services during the period.
ASHA workers Suman Sharma, Poonam Verma and Indravati who work in the blocks were distraught as they spoke of erratic pay for the wide range of work they do. 'It has been a year and ASHA workers here have not been paid for delivery, formatting and booster services. They expect all sorts of services from us, but when it comes to payment, we get nothing,' the women said.
Involved with multiple tasks at the block, district and state level, ASHA workers are enrolled on performance-based incentives and a monthly honorarium. The women who are engaged in immunization drives, maternal and child care services, and other healthcare programmes complained that lack of remuneration had severely affected them.
'Our children are starving … How will we survive? We are always at work – be it delivery, operation, or immunization, but we are not getting any payment. We demand the government to pay our withheld salaries immediately,' the workers said.
For these frontline workers considered to be the pulse of rural healthcare system, this is not the first instance where their plight has come to light. Over the last one year, ASHA workers in states like Karnataka, Meghalaya, Jammu and Kashmir have gone on strike to protest against erratic payments and insensitivity. Bihar is the latest to join the row as one lakh health workers, including hundreds of ASHAs, went on an indefinite strike earlier in June.
The Accredited Social Health Activists (ASHA) were enrolled on a contractual basis under the National Rural Health Mission in 2005 to improve delivery of basic health services. Selected from the village itself, the ASHA is trained to work as an interface between the community and the public health system. These workers have been the ground force for executing services as complex as conducting health awareness programmes on nutrition and sanitation, providing first-contact healthcare, maternal and child health, community mobilization and counseling.
As the NRHM was redesigned into National Health Mission after inclusion of an urban health mission, it was extended to 2017. However, the last decade has not seen any change in the status of ASHAs who continue to function as ‘activists’ being a significant part of government’s healthcare workforce.
A five-member delegation had also met the union health minister J.P Nadda in March to voice their concerns about honorariums remaining withheld for months and meager incentives. The delegation submitted a memorandum of demands to the health minister after hundreds of ASHA workers from all over the country had gathered for a protest at Jantar Mantar in Delhi. The memorandum included regularization of ASHA workers as government health workers, hike in allowances, and social security benefits, among other demands.
An added concern has been the 20% decrease in health budget that is likely to affect the incentives and pay of healthcare workers nationwide. According to the National Health Systems Resource Centre, a technical support institution with the National Health Mission, the total number of ASHAs working all across the country was estimated to be over 8 lakh in 2013.
Even as there has been no decision by the central government on the demands, the agitations are set to intensify through strikes and protests over next few months. It also needs to be mentioned that the government’s stance towards the health workers would have a direct impact on crucial schemes such as Mission Indradhanush for immunization, digital training of ASHAs and ANMs, and state-wise drives to reduce maternal and infant mortality rate.