Women health workers (ASHAs) and mid-day meal workers of Haryana held a protest in Rohtak on June 22. The members of ASHA (Accredited Social Health Activists) Workers’ Union and the Mid-Day Meal Workers’ Union were demanding their right to minimum wages, appointment letters, identity cards, social security and other benefits. In a word, they are demanding that the government recognise and treat them as workers and guarantee their rights as workers. The government has persistently refused to accept this just demand of the women health workers.
Instead, to add insult to injury, on May 31, a Union Ministry of Health and Family Welfare order listed additional duties for ASHAs – they will now work as family planning counselors in addition to carrying out their existing duties. Already, the scope of ASHA’s duties is very large; it covers ensuring immunization for pregnant mothers and children, ante-natal and post-partum care, referral of cases to the sub-centre/primary health centre, assisting the AWW further in the nutrition program for adolescent girls, receiving and distribution of contraceptives, counseling women on birth preparedness and persuading them to seek institutional delivery and escorting them for the same, facilitating referral of difficult cases, providing nutrition and health education, promoting breast feeding and infant feeding good practices and ensuring registration of all births and deaths in the village.
The government order further made it clear that they will only be paid a performance incentive for carrying out this task, no question of regular wages; further, this incentive will be based not for the number of couples they counsel but for the number of couples who agree to adopt family planning methods!
The latest government order further proves that the government is trying to extract maximum work from ASHAs with minimum compensation. On the one hand the ASHAs are vested with the responsibility for crucial tasks, while on the other, they are not compensated for their work with a regular and living wage. They are paid a pittance for the increasing workload that is foisted on them with each government order and even that is not paid regularly. The government announces one health scheme after another to hide the fact that inadequate health infrastructure is all that the poor get even today. The very fact that the government is loading all kind of onerous responsibilities on the ASHA workers, while at the same time, dealing with them as part time volunteers, shows its utter disregard for providing health care to the people.
The eleventh report of the Parliamentary Committee on Empowerment of Women on the working conditions of ASHAs, tabled in the Rajya Sabha and presented to the Lok Sabha on September 7, 2011, made several recommendations. The Health Ministry turned down most of them, though it accepted that ASHAs were crucial for the NRHM. The recommendations ranged from raising the required educational qualification for ASHAs to improving their working conditions and remuneration.
The Report pointed out that ASHAs were overworked: it said that it was “humanly not possible for the ASHA to perform the assigned duties in eight to twelve hours a week”. It also made a strong case for better compensation, saying that just performance-based incentives were not enough. It also found during its interaction with the workers and mentors that payments were irregular.
The government has argued against a fixed remuneration (also recommended earlier by the Mission Steering Group of the NRHM) on the grounds that it ran contrary to the approach of the performance-linked remuneration adopted by the department and approved by the Cabinet. The payment, it was further argued, did not justify the concept of an ASHA working as an activist and a volunteer! The government has repeatedly stuck to this false argument that the ASHAs and Anganwadi workers are voluntary, and do not work more than 3-4 hours a day. But as experience has shown and confirmed by the investigations of the Committee, their tasks demand much more intensive effort and time.
The Parliamentary Committee recommended fixed remunerations for the almost nine lakh women health activists in the country. Following the release of the Report of the Committee, in November 2011, the ASHAs and their urban counterparts, USHAs organized huge protests, led by the All India Coordination Committee of ASHA Workers. A delegation met the Health Minister with their demands, but it was categorically told that all existing and future responsibilities would be incentive-based.
We can clearly draw two conclusions from this policy of the government. The first is that it is very deliberately labeling the ASHAs “activists” and “volunteers” in an attempt to escape from its responsibility of paying them for their work and making them eligible for all benefits that workers have a right to. Secondly, this state is so anti-people that it does not care if the very crucial health needs of women and children in our country, a majority of whom are already dying from poverty, malnutrition and unsanitary living conditions, are provided for or not. If it did, it would not leave this crucial task to volunteers but ensure that the human resources required to implement the tasks of the health care programs are adequately trained to carry out their tasks and justly compensated for them.