The Accredited Social Health Activists or ASHAs as they are popularly known and Anganwadi Workers (AWW) are women who are selected from the village community to work in the health and nutrition (of mother and child) programmes of the government of India. The ASHA is the women health worker under the National Rural Health Mission. The NRHM was launched 7 years ago with the aim “to provide effective healthcare to the rural population throughout the country with special focus on 18 states” and the ASHA is one of its key components. The AWW is the key resource in implementing the Integrated Child Development Services (ICDS) programme, which was launched in 1975 and whose main aim is to improve the nutritional and health status of children and mothers and thereby reduce the incidence of maternal and child mortality.
What is common to both the ASHA and the AWW is that these are women from the local community who have broken tradition to enter into the work force and engage in the provision of public health services. The concept of the ASHA was promoted as an innovation with the claim that such a critical resource for the programme must be someone from and of the village and therefore acceptable to the community. Such health workers are given significant responsibilities in these programmes but their compensation is far from commensurate with their work and their duties. In the first place, they are not workers of the government, even though they are crucial to the programmes. Secondly, their remuneration is a pittance – they are almost expected to work voluntarily! They are supposed to be paid an incentive based on fulfillment of targets; these incentives range from Rs.75 to Rs.350 for various services, but the maximum an ASHA is estimated to make in a year is Rs.17,200.
However, these workers have not taken this exploitation quietly. They have organised in every state and are demanding their right to job security, fair wages and other benefits of government workers. They are an organized force – currently there are more than 8.5 lakh ASHAs and an equal number of AWWs. They have participated in joint trade union demonstrations and in the joint women’s day programmes. Over the last two years, the ASHAs and Anganwadi Workers (AWW), across the country, have time and again agitated for their rights (see Box 1).
The responsibilities of the ASHA are manifold. She is mandated to assist the Anganwadi Worker (AWW) in registering women and children for immunisation, ante-natal and post-partum care; this implies that the ASHA must actively mobilise the potential beneficiaries to seek these services. She has to refer cases to the sub-centre/primary health centre; she has to assist the AWW further in the nutrition program for adolescent girls, receive and distribute contraceptives, counsel women on birth preparedness and persuade them to seek institutional delivery and escort them for the same, facilitate referral of difficult cases, provide nutrition and health education, promote breast feeding and infant feeding good practices, ensure registration of all births and deaths in the village.
In effect, the ASHA is expected to promote behaviour change, covering a population of 1000 women and men in the village, which is very complex and time consuming because it requires gaining the confidence of the community, some of whom have experienced very negative responses from the health system when they have sought health services at one or another point of time. The role and responsibilities of the ASHA has been set in such a way that it is not time-bound nor is it defined specifically. It is expected that she will be present at all times, on all occasions in the village to carry out many functions.
When the ICDS scheme was launched in 1975, the AWW was paid a measly stipend of Rs.500 and was not considered a permanent worker of the government. The AWWs have been in struggle time and again and through their struggle under the aegis of the All India Anganwadi Workers Federation, they have forced the government to increase their salaries to Rs.3000/- per month! However, their demand to be made permanent with comprehensive retirement benefits like other government staff are yet to be fulfilled. Successive governments have turned a deaf ear to the continuing workers’ protests and public debates on the issue.
Condemn the exploitative conditions of the ASHAs and AWWs and support their struggles
Mazdoor Ekta Lehar strongly condemns the exploitation of the women health workers working for government health programmes/ schemes like the NRHM and the ICDS. It is a matter of shame that such an abysmal condition of public health prevails in the country after more than 65 years of independence; and it is equally condemnable that successive governments have launched public health programmes to provide the most basic health services to rural women and their families with such fanfare and noble objectives, but exploit the key human resources that are to implement these programmes/ schemes.
The exploitation of women’s labour is a characteristic of the capitalist system. The capitalist system uses this fact of underpaid women’s labour to drive down the general wages of all labour. The advantages for a woman to work in the local community, not having to stay away from home for long, etc. are used as excuses for informal conditions of women’s labour. The absence of a formal contract enables the government to get away with non-payment of fixed remuneration. However, like the Saathins of the Women’s Development Programme (see Box 2) the ASHA’s and AWW are becoming more aware of their exploitation and the necessity to organise themselves in their districts and states. Mazdoor Ekta Lehar supports the continuing struggles of the women health workers.
ASHA and AWW protests over the last year
May 05, 2012 - Members of the Karnataka State Anganwadi Workers Sangha staged a protest in Bengaluru against the moves of the state government to outsource maintenance of day care centres to Vedanta Prathishtana, a corporate social responsibility arm of global mining company Vedanta Resource
May 01, 2012 - All India Anganwadi Workers and Helpers Federation (AIAWHF) held their state level conference of All Arunachal Pradesh Anganwadi Workers and Helpers Union (AAPAWHU) urging the government of Arunachal Pradesh to implement various welfare schemes and benefits meant for Anganwadi workers
Oct 04, 2011 - Hundreds of ASHA workers from all parts of the valley participated in the demonstration organised by the Jammu and Kashmir Accredited Social Health Activists (ASHA) Workers Union, highlighting their demands including, government employee status, enhancement and timely monthly salary, six hours duty, supply of special kits, adequate protection in the field, issuance of identity cards and other incentives. Representatives of the All India Federation of Anganwadi Workers and Helpers (AIFAWH) were present in a show of solidarity with the ASHA workers
Sep 05, 2011 - Demanding fixed monthly remunerations and confirmation as permanent employees, members of Karnataka State ASHA Workers Federation (KSAWF) affiliated to Centre for Indian Trade Unions (CITU) staged a protest near Freedom Park. They were also protesting the fact that ASHA workers had not received their incentives based on their work performance and travel expenses. They also demanded social security through ESI and provident fund benefits.
Several instances of ASHA workers being denied their incentive and the consequent deprivation faced by them were highlighted at the protests. One of the workers said that she has not received any incentive till date though she had been working since three months. “I have taken care of six delivery cases in our village and have not even minded helping the women in need at midnight. It is quite disappointing that I have not yet received any kind of remuneration for the work I have done,” she said.
A former beedi worker who opted to be an ASHA worker with the intention to help the people in her village said, “Now I am finding it difficult to make both ends meet because I have lost the income I used to earn by rolling beedi. I am left in dire straits,” she reveals.
July 24, 2011 - Thousands participated in a rally in Ludhiana organised by the ASHA Workers Union of Punjab demanding minimum wages, hike in incentives, promotion as per seniority and implementation of granted notifications. They demanded that the government of Punjab fulfil the promises which they had made to the ASHA workers’ union.
Feb 24, 2011 - Thousands of anganwadi workers held a militant demonstration in Delhi. Women from all over the country took part in this demonstration. The women challenged Congress Chairperson Sonia Gandhi to run a family on this pittance. The Anganwadi workers denounced the government for the precarious condition they are forced to live in. They wanted to be treated as workers covered by labour laws, and paid wages sufficient to maintain a family. They have demanded a decent salary, medical and other benefits for themselves and their families.
ASHA workers from all over the country also gathered at the same venue under the banner of All India Health Employees and Workers Confederation. They demanded an end to privatization of health services, banning of contract labour and outsourcing of jobs, regularization of temporary, casual and contract workers, equal pay for equal work, dignity and protection for the health workers. They demanded that ASHA workers be made permanent.
The struggles of the Saathins
The key functionary of the Women’s Development Programme launched in the 1980s was the Saathin who was supposed to be a voluntary worker. The stated purpose of this programme was to organize women so that they could get their fair share of the fruits of development from government programmes. Under the programme, the Saathins started taking initiatives in a variety of matters ranging from securing minimum wages for women in relief works organized by the government to solving family disputes. They fought petty corruption and managed to get women's priorities translated into action at the village level. Their exposure to the idea of women’s empowerment and their experience of success of organisation made the Saathins acutely aware of the injustices they themselves were subjected to.
While on one hand, they were called voluntary workers and paid a pittance (Rs.400 p.m), on the other, the government expected them to fulfill their duties like any other employee. While they were called voluntary workers and leaders of village women, in reality they were treated as the lowest functionary in a chain of command. While they were expected to organize village women into groups because 'unity was power', their own attempts to form an organization was met with extreme repression. Finally, in 1990, the Saathins organized themselves into a trade union and struck work to demand an increase in their honorarium, given the increasing workload and the cost of living. By July 1993, they managed to have a state level convention and made a first charter of demands which included getting the status of a worker for Saathins, due wages, giving priority to issues raised by villagers as compared to those imposed by the government, putting an end to the arbitrariness of government functionaries, and to ensure safe working conditions forSaathins.The struggles of the Saathins in fact exposed the fraud of “stree sashaktikaran” that the Indian government boasted of through such programmes and showed that it is in organizing themselves that these workers could win some rights.